Comparative Study of Endoscopic Esophageal Varix Ligation Anesthesia with Different Doses of Dexmedetomidine

Abstract

Objective To investigate the ideal dosage of dexmedetomidine(DEX) with 1.0 μg/kg fentanyl for monitored anesthesia care (MAC)during endoscopic variceal ligation (EVL). Methods A total of 60 patients, of ASA physical status 2-3, aged 36–59 yr, with body weight 50–75 kg, scheduled for elective EVL, were randomly divided into 3 groups (n=20): dexmedetomidine 1.0, 1.5 and 2.0 μg/kg groups (D1, D2 and D3 groups. After fentanyl 1.0 μg/kg was infused intravenously, the loading dosage of DEX 1.0, 1.5, 2.0μg/kg was separately continuous infused in 10 min. When the modified OAA / S scale > 3 points, EVL was carried out. The modified OAA/S score at the time-points of before induction (T0), before endoscope insertion (T1) and 5mins later(T2), end of surgery (T3) were recorded. The operation duration, recovery time, satisfaction of patient and doctor, incidence of nausea, body movement, bradycardia, hypotension, tachycardia, hypertension and hypoxemia was recorded. Results There were no differences in the 3 groups about the general status, operation duration and satisfaction score(P>0.05). (1) Before endoscope insertion(T1),the improved OAA/S score in Group D3 (4.4±0.2) were higher than D1(3.4±0.5) and D2 groups(3.8±0.3) (P>0.05).At the time-point of 5mins later(T2), the score in Group D3 (4.5±0.3)were higher than D1(3.5±0.6)and D2 groups(3.7±0.4) (P<0.05),there were no differences between D1 and D2(P>0.05). At the end of surgery (T3),the score were almost similar(P>0.05)(2) Compared with group D1 (3.1±0.9)and D2(3.8±0.8), group D3 (6.6±1.2) had longer recovery time(min) (P<0.05).(3) The satisfaction of endoscope doctor in Group D1(8.0±0.8) was lower than group D2(9.4±0.6)and D3(9.5±0.5)(P<0.05). The incidences of nausea (30%) and body movement (15%) in group D1 is significantly higher than group D2 (5%)and D3(0) (P<0.05), there were no differences between D2 and D3(P>0.05). The incidences of bradycardia (40%) in group D3 is significantly higher than group D1(0) and D2(10%) (P<0.05),there were no differences between D1 and D2(P>0.05).Conclusion Combined with 1.0μg/kg fentanyl, 1.5 μg/kg DEX is more efficacy and safer for EVL in the status of monitored anesthesia care.