Colonoscopy anesthesia: dexmedetomidine adds nothing to propofol

  • Edokpolo LU & al.
  • Anesthesiology
  • 14 Jun 2019

  • International Clinical Digest
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Takeaway

  • For colonoscopy, adding dexmedetomidine (Precedex, Hospira) to propofol (Diprivan, Fresenius Kabi USA, LLC) results in more patients with delayed discharge readiness compared with propofol alone.

Why this matters

  • Propofol is often used as the sole anesthesia drug in colonoscopies and may lead to vital-sign disturbances in large doses.
  • Giving dexmedetomidine with propofol can decrease the physiologic stress response during surgery.
  • Few data addressed whether this combination would affect discharge readiness after outpatient colonoscopy.

Key results

  • 101 participants were included in the per-protocol analysis. 
  • Discharge readiness within 30 minutes of procedure end, propofol-dexmedetomidine vs propofol-placebo: 51% (26/51) vs 88% (44/50; P<.001>
  • Delays driven mostly by patient inability to ambulate.
  • Patients receiving propofol-dexmedetomidine had lower propofol consumption.
  • No between-group difference in bradycardia, apnea. 

Study design

  • Single-center randomized controlled double-blind noninferiority trial of adults undergoing elective ambulatory colonoscopy (n=114).
  • Participants were randomly assigned to anesthesia with propofol-dexmedetomidine vs propofol-placebo.
  • Intervention consisted of a single 0.3 μg/kg bolus of dexmedetomidine.
  • Outcome: percentage of patients ready for discharge within 30 minutes of the end of the procedure, using validated discharge-readiness . 
  • No external funding.

Limitations

  • Patient movements not assessed.
  • Only 1 dose of dexmedetomidine assessed.
  • No intention-to-treat analysis.