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Dexmedetomidine versus propofol at different sedation depths during drug‐induced sleep endoscopy: A randomized trial
Author(s) -
Padiyara Tonsy V.,
Bansal Sandeep,
Jain Divya,
Arora Suman,
Gandhi Komal
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27903
Subject(s) - propofol , dexmedetomidine , anesthesia , medicine , sedation , airway obstruction , polysomnography , airway , bolus (digestion) , randomized controlled trial , epiglottis , sleep apnea , apnea , surgery , larynx
Objectives/Hypothesis The aim of this study was to compare the effect of dexmedetomidine and propofol on airway dynamics, cardiorespiratory system, and emergence following drug‐induced sleep endoscopy (DISE). Study Design Prospective, randomized, single‐blinded study. Methods Sixty patients age 18 to 65 years in American Society of Anesthesiologists physical status groups 1 and 2 scheduled to undergo DISE were randomly allocated to either Group P (N = 30; receiving propofol infusion at 50–150 μg/kg/min) or Group D (N = 30; receiving dexmedetomidine bolus of 1 μg/kg followed by infusion at 0.5–1.0 μg/kg/hr). DISE was done at light sleep and deep sleep. Airway obstruction at tongue base was recorded as primary outcome. Airway obstruction at velum, oropharyngeal lateral wall, and epiglottis level during light and deep sedation, hemodynamic and respiratory parameters, time to attain sufficient sedation, time for emergence from sedation, and any adverse events during DISE with the two study drugs were recorded as secondary outcomes. Results There was a greater degree of obstruction at the tongue base level ( P = 0.001) and Oropharynx level ( P = 0.017) in Group P compared with Group D during deep sedation. Increase in airway obstruction from light to deep sleep was seen with propofol at the oropharynx ( P = 0.0185) and tongue base ( P = 0.0108) levels. Two patients (6.6%) in Group D and 10 patients (33.3%) in Group P showed oxygen saturation below the minimum oxygen saturation recorded during polysomnography. Time to open eyes to call after stopping sedation was significantly less in Group P ( P = 0.005). Conclusions Dexmedetomidine shows a lesser degree of airway collapse and higher oxygen saturation levels at greater sedation depth during DISE. Propofol has a faster onset and emergence from sedation. Level of Evidence 1b Laryngoscope , 130:257–262, 2020