Sedative Effects of Dexmedetomidine in Combination with Propofol in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion following Catheter Ablation

Sedative Effects of Dexmedetomidine in Combination with Propofol in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion following Catheter Ablation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sedative Effects of Dexmedetomidine in Combination with Propofol in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion following Catheter Ablation Chao Liu, Rongbing Peng, Xiaolong li, Manli Yu, Zhifu Guo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4614121/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To observe the safety and effectiveness of sedation in patients with atrial fibrillation (AF) undergoing electrical cardioversion following catheter ablation using a combination of propofol and dexmedetomidine (P-D group) versus propofol alone (P group). Methods A total of 120 AF patients undergoing electrical cardioversion post-catheter ablation were enrolled from October 2020 to August 2022. They were randomly assigned to either the observation group (P-D group) or the control group (P group), with 60 patients in each group. Vital signs, adverse events, analgesic effects, and awakening time were assessed at different stages (T0-T4) in both groups. Results In P-D group, HR was lower than T0 in T1-4, the MAP and SpO 2 began to decreased in T2-3.In P group, SpO 2 , HR and MAP in T2-4 were all inferior to baseline period of T0. Whereas, in P-D group, the descend range of MAP and SpO 2 of T2, and the SpO 2 of T3 were distinctly less than the P group. The adverse events including respiratory depression and bradycardia in P-D group were inferior to the P group (16.7% vs 40% P = 0.045; 13.3% vs 3.3%; P = 0.35). The satisfaction of analgesia in P-D group was apparently prominent than P group (93.3% vs 73.3%; P < 0.05). Conclusion In AF patients requiring electrical cardioversion, the combination of propofol and dexmedetomidine demonstrates good sedative and analgesic effects, significantly reducing the propofol dosage and lowering the incidence of clinical adverse events, thereby enhancing medication safety. Electrical cardioversion Dexmedetomidine Propofol Respiratory depression Introduction Atrial fibrillation (AF) is a common cardiac arrhythmia [ 1 ] , and catheter ablation is the primary treatment modality. Patients with persistent AF often require electrical cardioversion to restore a normal rhythm following catheter ablation. However, electrical cardioversion is a painful procedure and typically necessitates adequate sedation or analgesia. Propofol is a commonly used medication for electrical cardioversion, but it can significantly depress a patient's respiratory and circulatory systems, with relatively weak analgesic effects. Therefore, selecting a safe and effective sedation strategy is crucial [ 2 ] . Dexmedetomidine is a highly selective α-2 adrenergic receptor agonist known for its combined sedative and analgesic efficacy, as well as mild respiratory depression, easy reversibility, and a low incidence of adverse events [ 3 , 4 ] . However, there is a lack of experience in using dexmedetomidine in AF patients undergoing electrical cardioversion. This study aims to compare the safety and effectiveness of propofol in combination with dexmedetomidine versus propofol alone in patients undergoing electrical cardioversion post-catheter ablation to investigate a suitable procedural sedation strategy. Materials and Methods 1.1 General Information From October 2020 to August 2022, 120 patients with AF requiring electrical cardioversion were enrolled. Patients were randomly assigned to the propofol-dexmedetomidine (P-D group) or propofol-only group (P group), with 60 patients in each group. This study was approved by the hospital's ethics review board (Ethics Approval Number: CHEC 2020-116), and all patients provided informed consent. Exclusion criteria included: (1) ASA III-IV classification, (2) age 80 years, (3) allergy to any sedative or analgesic medications, (4) recent acute infection, severe hepatic or renal dysfunction, (5) difficult airway or sleep apnea syndrome, and (6) inadequate anticoagulation or the presence of left atrial thrombus. There were no statistically significant differences in baseline characteristics between the two groups (P > 0.05). 1.2 Anesthetic Techniques All patients underwent a thorough examination and were screened for contraindications to electrical cardioversion. They fasted for 6-8 hours preoperatively, had peripheral intravenous access established, and received continuous electrocardiographic monitoring and supplemental oxygen through a nasal cannula (4 L/min). Vital signs were closely monitored. 1.2.1 Observation Group (P-D Group) After catheter ablation completion and within the 20 minutes before cardioversion, a loading dose of 1 µg/kg of dexmedetomidine (trade name: Youbito, manufacturer: Jiangsu Enhua Pharmaceutical Co., Ltd., product number: 19040732) was administered using a microinfusing pump. It was followed by a maintenance dose of 0.4 µg/kg/h. Propofol (trade name: Diprivan, Corden Pharma S.P.A; X20047B) was slowly administered for induction. The rate of propofol infusion was adjusted based on patient responsiveness until clinical signs indicated successful anesthesia induction, such as loss of consciousness, disappearance of the eyelash reflex, and a Ramsay Sedation Score of 5, indicating adequate sedation. 1.2.2 Control Group (P Group) After catheter ablation completion and within the 20 minutes before cardioversion, normal saline (0.9% sodium chloride solution, 50 mL: 450 mg, manufacturer: Zhejiang Dubang Pharmaceutical Co., Ltd.) was administered using the same infusion rate as in the observation group. Propofol (trade name: Diprivan, Corden Pharma S.P.A; X20047B) was then used in the same manner for induction. Both groups proceeded to cardioversion once patients achieved adequate sedation, defined as loss of consciousness and a Ramsay Sedation Score of 5. 1.3 Observations The primary safety endpoint was the occurrence of adverse events requiring medical or pharmacological intervention. 1.3.1 Vital Signs Vital signs, including heart rate, blood pressure, and oxygen saturation, were recorded at five different time points: before drug administration (T0), 20 minutes after injection (T1), after induction completion (T2), 5 minutes after induction (T3), and 15 minutes after induction (T4). Note: Dexmedetomidine was administered before induction, and propofol was administered during induction. 1.3.2 Adverse Events This was a primary safety endpoint in the study, and it involved recording adverse events requiring medical or pharmacological intervention throughout the procedure. These events included bradycardia (HR < 60 bpm), hypotension (MAP < 60 mmHg), respiratory depression (SpO2 < 90%), shouting or body movement during cardioversion, cardiac arrest, agitation during the awakening period, delirium, and so on. Management measures included: (1) atropine 1 mg for bradycardia, (2) fluid resuscitation with 0.9% saline (250 mL) and vasopressors for hypotension, (3) for respiratory depression: (i) increasing nasal oxygen flow, (ii) switching to a face mask for improved ventilation, and (iii) elevating the jaw or inserting a nasopharyngeal airway, with endotracheal intubation if necessary, (4) additional analgesics for significant body movements during cardioversion, and (5) chest compressions, vasopressors, and temporary pacing for cardiac arrest. 1.3.3 Analgesic Effect The analgesic effect was assessed using the Numeric Rating Scale (NRS) pain assessment scale [5], which categorizes pain into five levels: pain-free (0), mild pain (1-3), moderate pain (4-6), severe pain (7-9), and extreme pain (10). The scale was completed by the operator postoperatively based on the patient's actual experience. 1.3.4 Other Data regarding anesthetic recovery time, propofol dosage, and other parameters were collected and recorded, and patients were transferred to the ward once they fully regained consciousness. 1.4 Statistical Analysis Data were analyzed using SPSS software (version 25.0). Continuous variables were expressed as means ± standard deviation (X ± S) and analyzed using t-tests or rank sum tests. Categorical variables were expressed as percentages (%) and analyzed using chi-squared tests or Fisher's exact tests. A significance level of P < 0.05 was considered statistically significant. Results 2.1 Comparison of Baseline Characteristics between the Two Groups Patients were divided into the P-D group (n=60) and the P group (n=60) using a random number table. In the P-D group, there were 42 male and 18 female patients, with an average age of (61.17±9.5) years and an average BMI of (23.98±2.86) kg/m2. Of these, 50 were classified as ASA I and 10 as ASA II. In the P group, there were 38 male and 22 female patients, with an average age of (62.47±8.79) years and an average BMI of (24.24±2.88) kg/m2. Of these, 52 were classified as ASA I and 8 as ASA II. There were no significant differences in baseline characteristics between the two groups (P > 0.05), indicating a reasonable degree of comparability, as shown in Table 1. Table 1 Baseline Characteristics of Patients P-D(n=60) P(n=60) P value age（year) 61.17±9.50 62.47±8.79 0.573 Sex, Male（%) 42(70%) 38(63.3%) 0.584 BMI（kg/m 2 ） 23.98±2.86 24.24±2.88 0.726 ALT(U/L) 24.77±11.13 31.50±34.73 0.657 AST(U/L) 19.73±5.61 19.14±14.72 0.500 Creatinine(umol/L) 72.53±16.70 80.57±17.78 0.133 eGFR(ml/min) 94.58±19.88 87.81±15.37 0.217 Potassium(mmol/L) 3.92±0.34 4.02±0.36 0.260 Hypertension (%) 22(36.7%) 26(43.3%) 0.598 Diabetes (%) 8(13.3%) 12(20%) 0.488 Coronary Heart Disease (%) 10(16.7%) 12(20%) 0.739 ASA grade 0.718 I 50(83.3%) 52(86.7%) II 10(16.7%) 8(13.3%) 2.2 Comparison of Vital Signs at Different Time Points in Both Groups The study results showed that in the P-D group, at T1, heart rate (HR) was significantly lower than at T0, while at T2 and T3, both mean arterial pressure (MAP) and HR were lower than at T0, and oxygen saturation (SpO2) was also lower at T2, T3, and T4. In the P group, at T1, there were no significant changes compared to T0. However, at T2-T4, both MAP and HR were significantly lower than at T0, as well as SpO2. These differences were statistically significant (P < 0.05). Notably, the reduction in MAP and SpO2 at T2 in the P-D group was significantly lower than that in the P group. Similarly, the reduction in SpO2 at T3 in the P-D group was also lower than in the P group. Other HR changes between the two groups at various time points did not exhibit significant differences, as displayed in Table 2. Table 2 Hemodynamics Data Groups Sample Time MAP (mmHg) HR (bpm) SpO 2 (%) P-D 60 T0 108.14±15.54 88.80±13.06 99.43±1.28 T1 106.41±16.00 85.23±9.31* 99.23±1.22 T2 103.68±16.76*# 74.07±11.09* 95.33±4.91*# T3 101.49±13.45* 72.90±10.92* 97.17±3.68*# T4 105.10±13.16 72.33±10.87* 99.33±1.27 P 60 T0 110.74±10.18 94.73±22.32 99.83±0.53 T1 112.82±13.24 94.77±25.02 99.60±0.73 T2 99.93±16.05* 78.00±12.33* 93.20±5.18* T3 99.00±21.44* 77.57±14.09* 95.23±3.84* T4 102.11±18.06* 76.43±10.13* 99.07±1.55* P-D, Propofol-Dexmedetomidine group; P, Propofol group * P <0.05, compared with the baseline value of T0 # P <0.05, compared the difference value from the baseline to current time with control group 2.3 Comparison of Baseline Vital Signs, Recovery Time, and Medication Dosages between the Two Groups Baseline vital signs, anesthesia recovery time, and propofol dosages were compared between the two groups. The results revealed that there were no significant differences in baseline vital signs and anesthesia recovery time between the P-D group and the P group. However, the propofol dosage in the P-D group was significantly lower than in the P group, with statistical significance (P < 0.001), as indicated in Table 3. Table 3 Baseline vital signs, recovery time, and drug doses P-D P P value HR（bpm) 88.80±13.06 94.73±22.32 0.377 SpO 2 （%) 99.43±1.28 99.83±0.53 0.208 MAP（mmHg) 108.14±15.54 110.74±10.18 0.447 Recovery time（min） 8.10±1.90 9.57±4.60 0.161 Total dose of Propofol（mg） 48.67±15.03 71.33±19.03 ＜0.001 Drug doses（mg/kg） 0.70±0.20 0.97±0.31 ＜0.001 2.4 Comparison of Perioperative Adverse Events between the Two Groups Statistical analysis of adverse events in both groups showed that the incidence of respiratory depression in the P-D group was 16.7%, while it was 40% in the P group (P=0.045). The incidence of bradycardia in the P-D group was 13.3%, compared to 3.3% in the P group (P=0.35). The overall rate of adverse events in the P-D group was significantly lower than that in the P group (33.3% vs. 63.3%), with statistical significance (P < 0.05), as presented in Table 4. Table 4 Comparison of adverse events between groups [n(%)] Groups respiratory depression Body movement delirium bradycardia Total P-D 10(16.7%) 4(6.7%) 0(0%) 8(13.3%) 20 * (33.3%) P 24(40%) 16(26.7%) 4(6.7%) 2(3.3%) 38(63.3%) P value 0.045 0.038 0.472 0.350 0.020 * P <0.05, compared with the control group 2.5 Comparison of Analgesic Satisfaction between the Two Groups Based on the Numeric Rating Scale (NRS) scoring, in the P-D group, 93.3% of patients reported mild pain (0-3 points), and 6.7% reported moderate pain (4-6 points). In the P group, 73.4% of patients reported mild pain (0-3 points), 23.3% reported moderate pain (4-6 points), and 3.3% reported severe pain (7-9 points). The analgesic satisfaction in the P-D group was significantly higher than in the P group, with statistical significance (P < 0.05), as shown in Table 5. Table 5 NRS analgesic score between the two groups Groups Sample 0 1-3 4-6 7-9 10 P-D 60 40 16 4 0 0 P 60 24 20 14 2 0 Compared with the control group, Z=-2.337, P =0.019 Discussion Atrial fibrillation is a common clinical arrhythmia [ 1 ] , and catheter ablation is one of its primary treatment modalities. In persistent atrial fibrillation, patients often require electrical cardioversion to restore sinus rhythm. While electrical cardioversion is advantageous due to its high success rate, rapid conversion, and low risk of proarrhythmia [ 2 , 6 , 7 ] , the procedure can be painful. The pain is induced by the electrical current stimulating the skin, the manipulation during cardioversion, and the tense atmosphere, all of which can cause significant discomfort to patients. This unpleasant experience can also lead to psychological distress. Hence, adequate sedation and analgesia are essential to alleviate pain, improve procedural success, and enhance the patient experience. Propofol is a commonly used sedative agent in clinical practice [ 8 – 10 ] . It is widely applied in various medical procedures and examinations, such as gastrointestinal endoscopy, interventional procedures, and oral surgery, due to its rapid onset, quick metabolism, and lack of accumulation. However, the use of propofol as a single agent for sedation has distinct limitations. Large-scale studies involving 1000 patients undergoing interventional procedures have shown that the incidence of hypotension (SBP < 90 mmHg) following propofol sedation was approximately 14% [ 8 ] . Even at normal dosages, propofol can significantly suppress a patient's cardiovascular and respiratory systems. Moreover, its analgesic effect is relatively weak, often necessitating increased dosages to achieve satisfactory results, which, in turn, heightens the risk of adverse events. Therefore, the exploration of a safe and highly effective sedation strategy is of paramount importance. Dexmedetomidine [ 3 , 4 , 11 – 13 ] is a highly selective alpha-2 receptor agonist that can stimulate alpha-2 receptors located in the locus coeruleus and spinal cord. It exerts both sedative and analgesic effects. Due to the continuous stimulation of alpha-2 receptors, this drug causes minimal respiratory depression at effective doses and often leads to rapid eye movement (REM) sleep, making patients easily arousable. Additionally, when combined with other sedative or analgesic agents, dexmedetomidine can reduce the required dosage of the corresponding drugs and attenuate surgical stress responses [ 12 , 13 ] . This has led to its use as an adjuvant in anesthesia and analgesia, as well as in sedation during various clinical procedures. Research [ 14 , 15 ] has suggested that the combination of dexmedetomidine and low-dose propofol can provide satisfactory sedation and analgesia, reduce intraoperative stress responses, and maintain stable vital signs. However, given the lack of experience with the use of dexmedetomidine in sedation during electrical cardioversion, our study aimed to compare the efficacy and safety of propofol in combination with dexmedetomidine and propofol alone during the electrical cardioversion process. The analysis of Table 1 shows that in the P-D group, after the administration of dexmedetomidine at T1, HR started to decrease significantly and continued to be lower than at T0 during the subsequent T1-4 intervals. In the P group, after completing induction, HR at T2-T4 was also lower than at T0, but there were no significant statistical differences in HR changes between the two groups at various time intervals. Following the administration of propofol in both groups, at T2 and T3, both MAP and SpO2 were lower than at T0. However, at T2, the reduction in MAP and SpO2 in the P-D group was significantly smaller than in the P group. At T3, the reduction in MAP was not significantly different between the two groups, but the reduction in SpO2 in the P-D group remained lower than in the P group. This suggests that the P-D group exhibited more stable blood pressure and oxygen saturation, milder respiratory depression, and steadier vital signs after induction. This may be attributed, in part, to the lower respiratory depression associated with dexmedetomidine and the smaller propofol dosage. As per the adverse events data, the P-D group had a lower incidence of respiratory depression compared to the P group (16.7% vs. 40%; P = 0.045). Additionally, the P-D group showed a lower rate of bradycardia than the P group (13.3% vs. 3.3%). The overall rate of adverse events in the P-D group was significantly lower than in the P group (33.3% vs. 63.3%), with statistical significance (P < 0.05), as presented in Table 4 . Table 5 demonstrates that the analgesic satisfaction in the P-D group was significantly higher than in the P group. In the P-D group, 93.3% of patients reported mild pain (0–3 points), while 6.7% reported moderate pain (4–6 points). In the P group, 73.4% of patients reported mild pain, 23.3% reported moderate pain, and 3.3% reported severe pain. The higher analgesic satisfaction in the P-D group is of significant importance for alleviating patient pain and improving the procedural success rate. Some studies have reported that dexmedetomidine can cause hypotension by activating postsynaptic alpha-2 receptors, leading to sympathetic nerve inhibition. It can also induce biphasic hemodynamic responses, initially characterized by a rise in blood pressure, followed by reflex bradycardia, which then gradually recovers. This response is typically transient and does not require specific interventions [ 16 , 17 ] . In our study, both groups experienced heart rate reductions, but there were no significant differences. In the P-D group, the four cases of bradycardia were transient and did not require any treatment, eventually returning to normal ranges. This aligns with the conclusions of previous research. In our study, no cases of hypotension were observed in the P-D group, and respiratory depression was significantly lower than in the P group, with no need for further intervention. Some studies have shown that the risk of bradycardia and hypotension increases only when critically ill patients are given a maintenance dose exceeding 0.7 µg/kg/h [ 18 ] . Therefore, the administration of 0.4 µg/kg/h of dexmedetomidine in our study was safe. In summary, for patients undergoing electrical cardioversion during catheter ablation of atrial fibrillation, the combination of propofol and dexmedetomidine demonstrated excellent sedation and analgesic effects. This approach significantly reduced the propofol dosage, further lowering the risks of hypotension and respiratory depression, thus enhancing medication safety. It is worthy of consideration for clinical application Ethics declarations Declarations Ethics approval and consent to participate The study involving human peripheral blood has been obtained according to consent regulation and approved by the Ethics Review Committee of Changhai Hospital; meanwhile, the informed consent has been provided by all patients conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare that they have no conflicts of interest. Funding: supported by the National Natural Science Foundation of China (No. 8200021467, 82000283, 82070419, 82170275 and 82170233) and the Shanghai “Rising Star” Program 20224Z0007. Author Contribution MLY and ZFG performed the study design. CL analyzed data and drafted the manuscript. RBP and XLL contributed to study conception and data collection, analysis and interpretation. All authors contributed to the revision of the manuscript. 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Application of dexmedetomidine combined with propofol in painless gastroenteroscopy in elderly patients [J]. Mod Dig interventional therapy. 2017;22(02):203–5. Yang A, Gao F. Effect of dexmedetomidine combined with propofol on stress response, hemodynamics, and postoperative complications in patients undergoing laparoscopic cholecystectomy[J]. Am J translational Res. 2021;13(10):11824–32. Hoy S, Keating G. Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation[J]. Drugs. 2011;71(11):1481–501. Keating G, Hoy S, Lyseng-Williamson K. Dexmedetomidine: a guide to its use for sedation in the US[J]. Clin Drug Investig. 2012;32(8):561–7. Tan J, Ho K. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult. patients. a meta-analysis[J]. Intensive Care Med. 2010;36(6):926–39. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4614121","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319644819,"identity":"23f40b5b-d33f-4369-bc6e-9aaaf67deed2","order_by":0,"name":"Chao Liu","email":"","orcid":"","institution":"Changhai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chao","middleName":"","lastName":"Liu","suffix":""},{"id":319644820,"identity":"9fe84e93-f281-4e7a-b207-a497ef26de41","order_by":1,"name":"Rongbing Peng","email":"","orcid":"","institution":"Changhai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rongbing","middleName":"","lastName":"Peng","suffix":""},{"id":319644821,"identity":"4f07fb32-0079-4106-b33b-e7eb31aa2297","order_by":2,"name":"Xiaolong li","email":"","orcid":"","institution":"Changhai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaolong","middleName":"","lastName":"li","suffix":""},{"id":319644822,"identity":"c866b531-9c10-4970-8bb0-5a08af5a07e5","order_by":3,"name":"Manli Yu","email":"","orcid":"","institution":"Changhai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Manli","middleName":"","lastName":"Yu","suffix":""},{"id":319644823,"identity":"8b43b29a-ca21-494b-83e8-187d90afdba5","order_by":4,"name":"Zhifu Guo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYJACZgYDOQZ+ZuaDD0jRYswg2c6WbECCFgZjBoPzPGYCRCmXj0g+/LmgwCBx82EGMwaGGptogloMb6QlGM8wMEjcdpgh7QHDsbTcBoJaZuQYJPMY/AFpOW7A2HCYOC2HeYC2bG5mbJMgSou8RI5hM0jLBmZmNuK0GPA8S2YGajGecZiN2SCBGL/ItwNDjOePgWx///mPDz7U2BBhywFkXgIh5WBbCBo6CkbBKBgFowAAhgA60a/dOD0AAAAASUVORK5CYII=","orcid":"","institution":"Changhai Hospital","correspondingAuthor":true,"prefix":"","firstName":"Zhifu","middleName":"","lastName":"Guo","suffix":""}],"badges":[],"createdAt":"2024-06-21 00:44:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4614121/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4614121/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97324677,"identity":"af8aeda1-af6f-43e6-82be-deb868daed03","added_by":"auto","created_at":"2025-12-03 08:26:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":889678,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4614121/v1/bd324a44-1c8b-446a-a756-7e57c9f65799.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sedative Effects of Dexmedetomidine in Combination with Propofol in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion following Catheter Ablation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAtrial fibrillation (AF) is a common cardiac arrhythmia\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, and catheter ablation is the primary treatment modality. Patients with persistent AF often require electrical cardioversion to restore a normal rhythm following catheter ablation. However, electrical cardioversion is a painful procedure and typically necessitates adequate sedation or analgesia. Propofol is a commonly used medication for electrical cardioversion, but it can significantly depress a patient's respiratory and circulatory systems, with relatively weak analgesic effects. Therefore, selecting a safe and effective sedation strategy is crucial\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Dexmedetomidine is a highly selective α-2 adrenergic receptor agonist known for its combined sedative and analgesic efficacy, as well as mild respiratory depression, easy reversibility, and a low incidence of adverse events\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. However, there is a lack of experience in using dexmedetomidine in AF patients undergoing electrical cardioversion. This study aims to compare the safety and effectiveness of propofol in combination with dexmedetomidine versus propofol alone in patients undergoing electrical cardioversion post-catheter ablation to investigate a suitable procedural sedation strategy.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 General Information\u003c/strong\u003e From October 2020 to August 2022, 120 patients with AF requiring electrical cardioversion were enrolled. Patients were randomly assigned to the propofol-dexmedetomidine (P-D group) or propofol-only group (P group), with 60 patients in each group. This study was approved by the hospital\u0026apos;s ethics review board (Ethics Approval Number: CHEC 2020-116), and all patients provided informed consent. Exclusion criteria included: (1) ASA III-IV classification, (2) age \u0026lt;20 or \u0026gt;80 years, (3) allergy to any sedative or analgesic medications, (4) recent acute infection, severe hepatic or renal dysfunction, (5) difficult airway or sleep apnea syndrome, and (6) inadequate anticoagulation or the presence of left atrial thrombus. There were no statistically significant differences in baseline characteristics between the two groups (P \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Anesthetic Techniques\u003c/strong\u003e All patients underwent a thorough examination and were screened for contraindications to electrical cardioversion. They fasted for 6-8 hours preoperatively, had peripheral intravenous access established, and received continuous electrocardiographic monitoring and supplemental oxygen through a nasal cannula (4 L/min). Vital signs were closely monitored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1 Observation Group (P-D Group)\u003c/strong\u003e After catheter ablation completion and within the 20 minutes before cardioversion, a loading dose of 1 \u0026micro;g/kg of dexmedetomidine (trade name: Youbito, manufacturer: Jiangsu Enhua Pharmaceutical Co., Ltd., product number: 19040732) was administered using a microinfusing pump. It was followed by a maintenance dose of 0.4 \u0026micro;g/kg/h. Propofol (trade name: Diprivan, Corden Pharma S.P.A; X20047B) was slowly administered for induction. The rate of propofol infusion was adjusted based on patient responsiveness until clinical signs indicated successful anesthesia induction, such as loss of consciousness, disappearance of the eyelash reflex, and a Ramsay Sedation Score of 5, indicating adequate sedation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.2 Control Group (P Group)\u0026nbsp;\u003c/strong\u003eAfter catheter ablation completion and within the 20 minutes before cardioversion, normal saline (0.9% sodium chloride solution, 50 mL: 450 mg, manufacturer: Zhejiang Dubang Pharmaceutical Co., Ltd.) was administered using the same infusion rate as in the observation group. Propofol (trade name: Diprivan, Corden Pharma S.P.A; X20047B) was then used in the same manner for induction. Both groups proceeded to cardioversion once patients achieved adequate sedation, defined as loss of consciousness and a Ramsay Sedation Score of 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Observations\u0026nbsp;\u003c/strong\u003eThe primary safety endpoint was the occurrence of adverse events requiring medical or pharmacological intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3.1 Vital Signs\u0026nbsp;\u003c/strong\u003eVital signs, including heart rate, blood pressure, and oxygen saturation, were recorded at five different time points: before drug administration (T0), 20 minutes after injection (T1), after induction completion (T2), 5 minutes after induction (T3), and 15 minutes after induction (T4).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eNote: Dexmedetomidine was administered before induction, and propofol was administered during induction.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3.2 Adverse Events\u0026nbsp;\u003c/strong\u003eThis was a primary safety endpoint in the study, and it involved recording adverse events requiring medical or pharmacological intervention throughout the procedure. These events included bradycardia (HR \u0026lt; 60 bpm), hypotension (MAP \u0026lt; 60 mmHg), respiratory depression (SpO2 \u0026lt; 90%), shouting or body movement during cardioversion, cardiac arrest, agitation during the awakening period, delirium, and so on.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eManagement measures included: (1) atropine 1 mg for bradycardia, (2) fluid resuscitation with 0.9% saline (250 mL) and vasopressors for hypotension, (3) for respiratory depression: (i) increasing nasal oxygen flow, (ii) switching to a face mask for improved ventilation, and (iii) elevating the jaw or inserting a nasopharyngeal airway, with endotracheal intubation if necessary, (4) additional analgesics for significant body movements during cardioversion, and (5) chest compressions, vasopressors, and temporary pacing for cardiac arrest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3.3 Analgesic Effect\u003c/strong\u003e The analgesic effect was assessed using the Numeric Rating Scale (NRS) pain assessment scale [5], which categorizes pain into five levels: pain-free (0), mild pain (1-3), moderate pain (4-6), severe pain (7-9), and extreme pain (10). The scale was completed by the operator postoperatively based on the patient\u0026apos;s actual experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3.4 Other Data\u003c/strong\u003e regarding anesthetic recovery time, propofol dosage, and other parameters were collected and recorded, and patients were transferred to the ward once they fully regained consciousness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Statistical Analysis\u0026nbsp;\u003c/strong\u003eData were analyzed using SPSS software (version 25.0). Continuous variables were expressed as means \u0026plusmn; standard deviation (X \u0026plusmn; S) and analyzed using t-tests or rank sum tests. Categorical variables were expressed as percentages (%) and analyzed using chi-squared tests or Fisher\u0026apos;s exact tests. A significance level of P \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e2.1 Comparison of Baseline Characteristics between the Two Groups \u0026nbsp;\u003c/strong\u003ePatients were divided into the P-D group (n=60) and the P group (n=60) using a random number table. In the P-D group, there were 42 male and 18 female patients, with an average age of (61.17\u0026plusmn;9.5) years and an average BMI of (23.98\u0026plusmn;2.86) kg/m2. Of these, 50 were classified as ASA I and 10 as ASA II. In the P group, there were 38 male and 22 female patients, with an average age of (62.47\u0026plusmn;8.79) years and an average BMI of (24.24\u0026plusmn;2.88) kg/m2. Of these, 52 were classified as ASA I and 8 as ASA II. There were no significant differences in baseline characteristics between the two groups (P \u0026gt; 0.05), indicating a reasonable degree of comparability, as shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Baseline Characteristics of Patients\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"539\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003eP-D(n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003eP(n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eage（year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e61.17\u0026plusmn;9.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e62.47\u0026plusmn;8.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eSex, Male（%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e42(70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e38(63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eBMI（kg/m\u003csup\u003e2\u003c/sup\u003e）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e23.98\u0026plusmn;2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e24.24\u0026plusmn;2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eALT(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e24.77\u0026plusmn;11.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e31.50\u0026plusmn;34.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eAST(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e19.73\u0026plusmn;5.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e19.14\u0026plusmn;14.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eCreatinine(umol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e72.53\u0026plusmn;16.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e80.57\u0026plusmn;17.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eeGFR(ml/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e94.58\u0026plusmn;19.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e87.81\u0026plusmn;15.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003ePotassium(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e3.92\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e4.02\u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e22(36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e26(43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e8(13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e12(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.488\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eCoronary Heart Disease (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e10(16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e12(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eASA\u0026nbsp;grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.718\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e50(83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e52(86.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;II\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e10(16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e8(13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Comparison of Vital Signs at Different Time Points in Both Groups\u0026nbsp;\u003c/strong\u003eThe study results showed that in the P-D group, at T1, heart rate (HR) was significantly lower than at T0, while at T2 and T3, both mean arterial pressure (MAP) and HR were lower than at T0, and oxygen saturation (SpO2) was also lower at T2, T3, and T4. In the P group, at T1, there were no significant changes compared to T0. However, at T2-T4, both MAP and HR were significantly lower than at T0, as well as SpO2. These differences were statistically significant (P \u0026lt; 0.05). Notably, the reduction in MAP and SpO2 at T2 in the P-D group was significantly lower than that in the P group. Similarly, the reduction in SpO2 at T3 in the P-D group was also lower than in the P group. Other HR changes between the two groups at various time points did not exhibit significant differences, as displayed in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Hemodynamics Data\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003eSample\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003eMAP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003eHR (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003eSpO\u003csub\u003e2\u003c/sub\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003eP-D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e108.14\u0026plusmn;15.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e88.80\u0026plusmn;13.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e99.43\u0026plusmn;1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e106.41\u0026plusmn;16.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e85.23\u0026plusmn;9.31*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e99.23\u0026plusmn;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e103.68\u0026plusmn;16.76*#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e74.07\u0026plusmn;11.09*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e95.33\u0026plusmn;4.91*#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e101.49\u0026plusmn;13.45*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e72.90\u0026plusmn;10.92*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e97.17\u0026plusmn;3.68*#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e105.10\u0026plusmn;13.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e72.33\u0026plusmn;10.87*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e99.33\u0026plusmn;1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e110.74\u0026plusmn;10.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e94.73\u0026plusmn;22.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e99.83\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e112.82\u0026plusmn;13.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e94.77\u0026plusmn;25.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e99.60\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e99.93\u0026plusmn;16.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e78.00\u0026plusmn;12.33*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e93.20\u0026plusmn;5.18*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e99.00\u0026plusmn;21.44*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e77.57\u0026plusmn;14.09*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e95.23\u0026plusmn;3.84*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.843648208469055%\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e102.11\u0026plusmn;18.06*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e76.43\u0026plusmn;10.13*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.498371335504885%\"\u003e\n \u003cp\u003e99.07\u0026plusmn;1.55*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eP-D, Propofol-Dexmedetomidine group; P, Propofol group\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, compared with the baseline value of T0\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e#\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, compared the difference value from the baseline to current time with control group\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Comparison of Baseline Vital Signs, Recovery Time, and Medication Dosages between the Two Groups\u003c/strong\u003e Baseline vital signs, anesthesia recovery time, and propofol dosages were compared between the two groups. The results revealed that there were no significant differences in baseline vital signs and anesthesia recovery time between the P-D group and the P group. However, the propofol dosage in the P-D group was significantly lower than in the P group, with statistical significance (P \u0026lt; 0.001), as indicated in Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Baseline vital signs, recovery time, and drug doses\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"539\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003eP-D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eHR（bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e88.80\u0026plusmn;13.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e94.73\u0026plusmn;22.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eSpO\u003csub\u003e2\u003c/sub\u003e（%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e99.43\u0026plusmn;1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e99.83\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eMAP（mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e108.14\u0026plusmn;15.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e110.74\u0026plusmn;10.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eRecovery time（min）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e8.10\u0026plusmn;1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e9.57\u0026plusmn;4.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eTotal dose of Propofol（mg）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e48.67\u0026plusmn;15.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e71.33\u0026plusmn;19.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.75836431226766%\" valign=\"top\"\u003e\n \u003cp\u003eDrug doses（mg/kg）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e0.70\u0026plusmn;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.20817843866171%\" valign=\"top\"\u003e\n \u003cp\u003e0.97\u0026plusmn;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.825278810408921%\" valign=\"top\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Comparison of Perioperative Adverse Events between the Two Groups\u003c/strong\u003e Statistical analysis of adverse events in both groups showed that the incidence of respiratory depression in the P-D group was 16.7%, while it was 40% in the P group (P=0.045). The incidence of bradycardia in the P-D group was 13.3%, compared to 3.3% in the P group (P=0.35). The overall rate of adverse events in the P-D group was significantly lower than that in the P group (33.3% vs. 63.3%), with statistical significance (P \u0026lt; 0.05), as presented in Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Comparison of adverse events between groups\u003c/strong\u003e\u003cstrong\u003e[n(%)]\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"561\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.428571428571429%\" valign=\"top\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.535714285714285%\" valign=\"top\"\u003e\n \u003cp\u003erespiratory depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.178571428571427%\" valign=\"top\"\u003e\n \u003cp\u003eBody movement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003edelirium\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003ebradycardia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.428571428571429%\" valign=\"top\"\u003e\n \u003cp\u003eP-D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.535714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e10(16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.178571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e4(6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e8(13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003csup\u003e*\u003c/sup\u003e(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.428571428571429%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.535714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e24(40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.178571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e16(26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e4(6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e2(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e38(63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.428571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.535714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.178571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, compared with the control group\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Comparison of Analgesic Satisfaction between the Two Groups\u0026nbsp;\u003c/strong\u003eBased on the Numeric Rating Scale (NRS) scoring, in the P-D group, 93.3% of patients reported mild pain (0-3 points), and 6.7% reported moderate pain (4-6 points). In the P group, 73.4% of patients reported mild pain (0-3 points), 23.3% reported moderate pain (4-6 points), and 3.3% reported severe pain (7-9 points). The analgesic satisfaction in the P-D group was significantly higher than in the P group, with statistical significance (P \u0026lt; 0.05), as shown in Table 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 NRS analgesic score between the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003eSample\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e4-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e7-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003eP-D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCompared with the control group, Z=-2.337, \u003cem\u003eP\u003c/em\u003e=0.019\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAtrial fibrillation is a common clinical arrhythmia\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, and catheter ablation is one of its primary treatment modalities. In persistent atrial fibrillation, patients often require electrical cardioversion to restore sinus rhythm. While electrical cardioversion is advantageous due to its high success rate, rapid conversion, and low risk of proarrhythmia\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, the procedure can be painful. The pain is induced by the electrical current stimulating the skin, the manipulation during cardioversion, and the tense atmosphere, all of which can cause significant discomfort to patients. This unpleasant experience can also lead to psychological distress. Hence, adequate sedation and analgesia are essential to alleviate pain, improve procedural success, and enhance the patient experience.\u003c/p\u003e \u003cp\u003ePropofol is a commonly used sedative agent in clinical practice\u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. It is widely applied in various medical procedures and examinations, such as gastrointestinal endoscopy, interventional procedures, and oral surgery, due to its rapid onset, quick metabolism, and lack of accumulation. However, the use of propofol as a single agent for sedation has distinct limitations. Large-scale studies involving 1000 patients undergoing interventional procedures have shown that the incidence of hypotension (SBP\u0026thinsp;\u0026lt;\u0026thinsp;90 mmHg) following propofol sedation was approximately 14%\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Even at normal dosages, propofol can significantly suppress a patient's cardiovascular and respiratory systems. Moreover, its analgesic effect is relatively weak, often necessitating increased dosages to achieve satisfactory results, which, in turn, heightens the risk of adverse events. Therefore, the exploration of a safe and highly effective sedation strategy is of paramount importance.\u003c/p\u003e \u003cp\u003eDexmedetomidine\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e is a highly selective alpha-2 receptor agonist that can stimulate alpha-2 receptors located in the locus coeruleus and spinal cord. It exerts both sedative and analgesic effects. Due to the continuous stimulation of alpha-2 receptors, this drug causes minimal respiratory depression at effective doses and often leads to rapid eye movement (REM) sleep, making patients easily arousable. Additionally, when combined with other sedative or analgesic agents, dexmedetomidine can reduce the required dosage of the corresponding drugs and attenuate surgical stress responses\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. This has led to its use as an adjuvant in anesthesia and analgesia, as well as in sedation during various clinical procedures. Research\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e has suggested that the combination of dexmedetomidine and low-dose propofol can provide satisfactory sedation and analgesia, reduce intraoperative stress responses, and maintain stable vital signs. However, given the lack of experience with the use of dexmedetomidine in sedation during electrical cardioversion, our study aimed to compare the efficacy and safety of propofol in combination with dexmedetomidine and propofol alone during the electrical cardioversion process.\u003c/p\u003e \u003cp\u003eThe analysis of Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that in the P-D group, after the administration of dexmedetomidine at T1, HR started to decrease significantly and continued to be lower than at T0 during the subsequent T1-4 intervals. In the P group, after completing induction, HR at T2-T4 was also lower than at T0, but there were no significant statistical differences in HR changes between the two groups at various time intervals. Following the administration of propofol in both groups, at T2 and T3, both MAP and SpO2 were lower than at T0. However, at T2, the reduction in MAP and SpO2 in the P-D group was significantly smaller than in the P group. At T3, the reduction in MAP was not significantly different between the two groups, but the reduction in SpO2 in the P-D group remained lower than in the P group. This suggests that the P-D group exhibited more stable blood pressure and oxygen saturation, milder respiratory depression, and steadier vital signs after induction. This may be attributed, in part, to the lower respiratory depression associated with dexmedetomidine and the smaller propofol dosage.\u003c/p\u003e \u003cp\u003eAs per the adverse events data, the P-D group had a lower incidence of respiratory depression compared to the P group (16.7% vs. 40%; P\u0026thinsp;=\u0026thinsp;0.045). Additionally, the P-D group showed a lower rate of bradycardia than the P group (13.3% vs. 3.3%). The overall rate of adverse events in the P-D group was significantly lower than in the P group (33.3% vs. 63.3%), with statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e demonstrates that the analgesic satisfaction in the P-D group was significantly higher than in the P group. In the P-D group, 93.3% of patients reported mild pain (0\u0026ndash;3 points), while 6.7% reported moderate pain (4\u0026ndash;6 points). In the P group, 73.4% of patients reported mild pain, 23.3% reported moderate pain, and 3.3% reported severe pain. The higher analgesic satisfaction in the P-D group is of significant importance for alleviating patient pain and improving the procedural success rate.\u003c/p\u003e \u003cp\u003eSome studies have reported that dexmedetomidine can cause hypotension by activating postsynaptic alpha-2 receptors, leading to sympathetic nerve inhibition. It can also induce biphasic hemodynamic responses, initially characterized by a rise in blood pressure, followed by reflex bradycardia, which then gradually recovers. This response is typically transient and does not require specific interventions\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. In our study, both groups experienced heart rate reductions, but there were no significant differences. In the P-D group, the four cases of bradycardia were transient and did not require any treatment, eventually returning to normal ranges. This aligns with the conclusions of previous research. In our study, no cases of hypotension were observed in the P-D group, and respiratory depression was significantly lower than in the P group, with no need for further intervention. Some studies have shown that the risk of bradycardia and hypotension increases only when critically ill patients are given a maintenance dose exceeding 0.7 \u0026micro;g/kg/h\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Therefore, the administration of 0.4 \u0026micro;g/kg/h of dexmedetomidine in our study was safe.\u003c/p\u003e \u003cp\u003eIn summary, for patients undergoing electrical cardioversion during catheter ablation of atrial fibrillation, the combination of propofol and dexmedetomidine demonstrated excellent sedation and analgesic effects. This approach significantly reduced the propofol dosage, further lowering the risks of hypotension and respiratory depression, thus enhancing medication safety. It is worthy of consideration for clinical application\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEthics declarations\u003c/h2\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e The study involving human peripheral blood has been obtained according to consent regulation and approved by the Ethics Review Committee of Changhai Hospital; meanwhile, the informed consent has been provided by all patients conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003ch2\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003esupported by the National Natural Science Foundation of China (No. 8200021467, 82000283, 82070419, 82170275 and 82170233) and the Shanghai \u0026ldquo;Rising Star\u0026rdquo; Program 20224Z0007.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMLY and ZFG performed the study design. CL analyzed data and drafted the manuscript. RBP and XLL contributed to study conception and data collection, analysis and interpretation. All authors contributed to the revision of the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author([email protected]), upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCrijns H, Weijs B, Fairley A, et al. Contemporary real life cardioversion of atrial fibrillation: Results from the multinational RHYTHM-AF study[J]. Int J Cardiol. 2014;172(3):588\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHern\u0026aacute;ndez-Madrid A, Svendsen J, Lip G et al. Cardioversion for atrial fibrillation in current European practice: results of the European Heart Rhythm Association survey[J]. Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2013, 15(6):915\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuerra F, Pavoni I, Romandini A, et al. Feasibility of a cardiologist-only approach to sedation for electrical cardioversion of atrial fibrillation: a randomized, open-blinded, prospective study[J]. Int J Cardiol. 2014;176(3):930\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Bao D, Chi D, et al. Dexmedetomidine vs. lidocaine for postoperative analgesia in pediatric patients undergoing craniotomy: a protocol for a prospective, randomized, double-blinded, placebo-controlled trial[J]. Trials. 2021;22(1):800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Nucci A, Scialdone A, Lando G et al. Effectiveness and safety of intravenous dexmedetomidine sedation for ophthalmic surgery under regional anesthesia[J]. Eur J Ophthalmol, 2021:11206721211059013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreira-Valente M, Pais-Ribeiro J, Jensen M. Validity of four pain intensity rating scales[J]. Pain. 2011;152(10):2399\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalkins H, Hindricks G, Cappato R et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary[J]. Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2018, 20(1):157\u0026ndash;208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalukhe T, Willems S, Drewitz I et al. Propofol sedation administered by cardiologists without assisted ventilation for long cardiac interventions: an assessment of 1000 consecutive patients undergoing atrial fibrillation ablation[J]. Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2012, 14(3):325\u0026ndash;330.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHung K, Yew M, Lin Y, et al. Impact of intravenous and topical lidocaine on clinical outcomes in patients receiving propofol for gastrointestinal endoscopic procedures: a meta-analysis of randomised controlled trials[J]. Br J Anaesth. 2021;S0007\u0026ndash;0912(21):00641\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaessen H, Knuttel F, van Breugel J, et al. Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids: a pilot study[J]. J Ther Ultrasound. 2017;5:8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSreeja R, Mathew A, Velayuden M. Effect of Added Alpha 2 Agonists with Local Anaesthetic in Infraclavicular Brachial Plexus Block: A Comparative Study between Dexmedetomidine and Clonidine[J]. Anesth essays Res. 2020;14(4):638\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGautam S, Prakash V, Mishra N, et al. Effect of Two Different Doses of Dexmedetomidine on the Hemodynamics of Hypertensive Patients Undergoing Laparoscopic Cholecystectomy[J]. Anesth essays Res. 2020;14(3):401\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChauhan R, Luthra A, Sethi S, et al. A Prospective Randomized Controlled Trial Using Propofol or Dexmedetomidine for Conscious Sedation in Pediatric Patients Undergoing Sclerotherapy[J]. J Pediatr neurosciences. 2020;15(4):379\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu S, Yuan L. Application of dexmedetomidine combined with propofol in painless gastroenteroscopy in elderly patients [J]. Mod Dig interventional therapy. 2017;22(02):203\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang A, Gao F. Effect of dexmedetomidine combined with propofol on stress response, hemodynamics, and postoperative complications in patients undergoing laparoscopic cholecystectomy[J]. Am J translational Res. 2021;13(10):11824\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoy S, Keating G. Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation[J]. Drugs. 2011;71(11):1481\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeating G, Hoy S, Lyseng-Williamson K. Dexmedetomidine: a guide to its use for sedation in the US[J]. Clin Drug Investig. 2012;32(8):561\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan J, Ho K. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult.\u003c/span\u003e \u003cspan\u003epatients. a meta-analysis[J]. Intensive Care Med. 2010;36(6):926\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Electrical cardioversion, Dexmedetomidine, Propofol, Respiratory depression","lastPublishedDoi":"10.21203/rs.3.rs-4614121/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4614121/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo observe the safety and effectiveness of sedation in patients with atrial fibrillation (AF) undergoing electrical cardioversion following catheter ablation using a combination of propofol and dexmedetomidine (P-D group) versus propofol alone (P group).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 120 AF patients undergoing electrical cardioversion post-catheter ablation were enrolled from October 2020 to August 2022. They were randomly assigned to either the observation group (P-D group) or the control group (P group), with 60 patients in each group. Vital signs, adverse events, analgesic effects, and awakening time were assessed at different stages (T0-T4) in both groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn P-D group, HR was lower than T0 in T1-4, the MAP and SpO\u003csub\u003e2\u003c/sub\u003e began to decreased in T2-3.In P group, SpO\u003csub\u003e2\u003c/sub\u003e, HR and MAP in T2-4 were all inferior to baseline period of T0. Whereas, in P-D group, the descend range of MAP and SpO\u003csub\u003e2\u003c/sub\u003e of T2, and the SpO\u003csub\u003e2\u003c/sub\u003e of T3 were distinctly less than the P group. The adverse events including respiratory depression and bradycardia in P-D group were inferior to the P group (16.7% vs 40% \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.045; 13.3% vs 3.3%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.35). The satisfaction of analgesia in P-D group was apparently prominent than P group (93.3% vs 73.3%;\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn AF patients requiring electrical cardioversion, the combination of propofol and dexmedetomidine demonstrates good sedative and analgesic effects, significantly reducing the propofol dosage and lowering the incidence of clinical adverse events, thereby enhancing medication safety.\u003c/p\u003e","manuscriptTitle":"Sedative Effects of Dexmedetomidine in Combination with Propofol in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion following Catheter Ablation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-17 03:17:38","doi":"10.21203/rs.3.rs-4614121/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f6841078-ce65-45a0-9f4a-23ce171c2fdc","owner":[],"postedDate":"July 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-03T08:25:21+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-17 03:17:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4614121","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4614121","identity":"rs-4614121","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}