The utility of low dose Dexmedetomidine in esophageal endoscopic submucosal dissection

Abstract

Dexmedetomidine (DEX) , which has been available since 2013, is a new option for sedation during endoscopic submucosal dissection (ESD) . However, its utility in esophageal ESD has not been fully studied in Japan.
To examine the usefulness and safety of DEX, we compared the specimen size, treatment time, total dose of midazolam (MDZ) and pentazocine, body movement, blood pressure, heart rate, oxygen administration, and additional medications during esophageal ESD treatment between patients who received MDZ (Group M, 34 lesions in 32 patients) and those who received DEX (Group D, 21 lesions in 21 patients) for sedation. Group D received small amounts of MDZ for the induction and maintenance of sedation. No significant difference in specimen size or treatment time was seen. However, the total dose of MDZ and pentazocine was significantly less in Group D than in Group M. Group M more frequently required additional sedatives due to body movement. Group D showed a smaller decrease in SpO2. On the other hand, Group D more frequently showed bradycardia and a decrease in blood pressure. Low-dose DEX is a useful sedative, but the circulatory dynamics of patients who receive DEX have to be carefully monitored and managed.