Sedoanalgesia With Dexmedetomidine in Daily Anesthesia Practices: a Prospective Randomized Controlled Trial

Sedoanalgesia With Dexmedetomidine in Daily Anesthesia Practices: a Prospective Randomized Controlled Trial | 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 Sedoanalgesia With Dexmedetomidine in Daily Anesthesia Practices: a Prospective Randomized Controlled Trial Ali Kendal OĞUZ, Celaleddin SOYALP, Yunus Emre TUNÇDEMİR, Arzu Esen TEKELİ, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5199093/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Jan, 2025 Read the published version in BMC Anesthesiology → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Patient safety is important in daily anesthesia practices, and providing deep anesthesia is difficult. There are ongoing debates about the anesthetic agents used today. Objective: To evaluate the results of deep sedoanalgesia with dexmedetomidine in daily anesthesia practices. Design: Prospective randomized clinical study Settings: This study was carried out at Dursun Odabaş Medical Center Patients: 80 patients aged 18--65 years, ASA I--II, scheduled for elective hysteroscopic intervention under sedoanalgesia Main outcome measures: The primary aim was to evaluate patients' Ramsey sedation scores, VAS scores, and saturation values under deep sedation. The secondary outcomes were patient, surgeon and anesthesiologist satisfaction and evaluation of hemodynamic parameters. Interventions: Patients who agreed to participate in the study were randomized into two groups of 40 patients: Group DP (dexmedetomidine‒propofol) and Group RP (remifentanil‒propofol). A bolus of 1 mg/kg IV propofolwas administered to the patients in theDP group during the procedure. An IV bolus of 1 mcg/kg of 4 mcg/ml isotonic-dexmedetomidine solution was administered for 10 minutes. Then, infusion was started at a dose of 0.4 0.7 mcg/kg/hour. A bolus of 1 mg/kg IV propofol was administered to patients in theRP group at the time of the procedure. A 0.25 mcg/kg I bolus of 20 mcg/ml isotonic-remifentanil solution was administered. Afterward, the infusion was performed at a dose of 0.025–0.1 mcg/kg/minute. Results: The VAS score and desaturation rate were significantly (p < 0.05) lower in the DP group than in the RP group. The surgeon satisfaction score, patient satisfaction score, anesthesiologist satisfaction scoreand baseline, 1st minute, 5th minute, 10th minute, last measurement, and postop integratedpulmonary index (IPI) values were significantly (p < 0.05) greater in the DP group than in the RP group. Conclusion: We believe that dexmedetomidine in combination with propofol can provide adequate anesthesia and analgesia for procedures commonly performed in day-case patients, such as hysteroscopy outside the operating room. Moreover, remifentanil provides more stable hemodynamics than does the combination of propofol and reduces the incidence of hypoxemia by affecting patients’ respiratory function less. Trial Regıstratıon: Clinical Trials ID is NCT05674201 Daily Anesthesia Deep Sedation Dexmedetomidine Hysteroscopy Remifentanil Propofol Integrated Pulmonary Index Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 KEY POINTS Dexmedetomidine combined with propofol provides adequate depth of anesthesia and analgesia for hysteroscopic procedures. The combination of dexmedetomidine and propofol affects respiratory function less, and hypoxemia is less common in patients. When nonoperating rooms administer dexmedetomidine, one should be prepared for cardiovascular complications, especially bradycardia. INTRODUCTION Hysteroscopy is recognized as the gold standard procedure in the diagnosis and treatment of intrauterine pathologies (1,2). Owing to advances in hysteroscopic technology, including instrument downsizing and improved surgical techniques, a significant number of surgical procedures are now performed in nonoperating clinics rather than in the anesthetized operating room (3,4,5). Hysteroscopy is an effective procedure with recognized value in providing adequate visualization of the uterine cavity, high patient acceptability, and negligible complication rates; however, pain and anxiety are the most common reasons for failure to complete the procedure in the office setting (6). Therefore, a well-developed and effective anesthetic protocol is essential for smooth examination during hysteroscopy. Thus, the patient can maintain a comfortable state during the hysteroscopy procedure, the success rate of the operation increases, and a good doctor‒patient relationship is maintained (7). Propofol is a short-acting intravenous anesthetic with a strong sedative effect. Because of its short half-life, patients can rapidly awaken from anesthetic sedation after surgery. Therefore, propofol is considered an ideal anesthetic drug for hysteroscopy (8,9,10). When propofol alone is used for sedation, patients can move because of pain, as propofol has no analgesic effect. It is often necessary to increase the dosage of propofol to achieve deeper anesthesia; however, this increases the risk of circulatory and respiratory depression and delays postoperative awakening(11,12). Studies have shown that the use of opioids combined with propofol for anesthesia reduces the dosage of propofol and the likelihood of side effects. However, opioids combined with propofol have a relatively large effect on breathing and circulation, which can cause hypotension and hypoxemia and can lead to serious consequences if left untreated. Therefore, anesthesiologists are working to identify an intravenous anesthetic agent that, when combined with propofol, provides a more comprehensive and safer anesthetic effect, reducing the incidence of side effects while maintaining the sedative benefits of propofol. Dexmedetomidine is a potent and highly selective α-2 adrenoceptor agonist with sympatholytic, sedative, amnesic and analgesic properties (13,14). It provides unique “conscious sedation” and analgesia without respiratory depression(15). Dexmedetomidine is approved for short-term sedation (< 24 hours) of intubated adult patients in the intensive care unit (ICU) and for sedation of nonintubated patients during surgery and other procedures. Dexmedetomidine is widely used in the ICU and operating room for the above indications, and its clinical applications have greatly increased in recent years because of its many favorable physiologic effects(16). This study aimed to observe the perioperative effects of dexmedetomidine-propofol and remifentanil-propofol combinations in safer anesthesia for day-case patients under nonoperating room conditions for hysteroscopic procedures requiring deep anesthesia. METHOD The research adhered to the CONSORT guidelines. This study was conducted with the approval of the Van Yüzüncü Yıl University Clinical Research Ethics Committee, dated 22.06.2021 and numbered 07. The Clinical Trials ID is NCT05674201, and verbal and written consent was obtained from the subjects included in the study. Preoperative evaluation of the patients included in the study was performed at least 24 hours before in the Anesthesiology and Reanimation Clinic. ASA I-II, 80 patients aged between 18 and 65 years were included in the study. Patients younger than 18 years of age or older than 65 years of age; those whose consent could not be obtained; those with severe cardiac, renal, hepatic or respiratory diseases; those with known allergic reactions to the agents used; those with psychomotor dysfunction; and those who were intubated after the procedure were excluded. The 80 patients included in the study were randomized to either Group DP or Group RP through a computerized random number generator, and the assignments were secured within sealed and numbered envelopes. The demographic data of the patients were recorded. All patients were intravenously accessed from the right antecubital region with a 20 G branula just before the procedure, and 1000 ml of isotonic (0.9% NaCl) IV infusion was started. Patients were placed in a supine position on the gynecological table and premedicated with 0.025 mg/kg IV midazolam (Demizolam®, Dem, Turkey) after being monitored with ASA standards. A Medtronic Capnostream 35 Capnography Device was connected to all patients during the procedure, and 2 lt/min oxygen was administered via a nasal cannula. Electrocardiography (ECG) monitoring and measurements of peripheral oxygen saturation (SpO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), end-tidal CO2 (ETCO2), respiratory rate and integrated pulmonary index (IPI) were recorded. A 1 mg/kg bolus of propofol (Propofol® Lipuro 1% (10 mg/ml), Braun, Indonesia) was administered to the patients in the DP group during the procedure. Then, the isotonic dexmedetomidine solution was prepared at a concentration of 4 mcg/ml using dexmedetomidine (Sedadomid® 200 µg/2 ml, KOÇAK FARMA Turkey). This solution was administered as a 1 mcg/kg IV bolus over 10 minutes. After that, IV infusion was started at a dose of 0.4–0.7 mcg/kg/hour. Propofol (Propofol® Lipuro 1% (10 mg/ml), B. Braun Indonesia) 1 mg/kg bolus IV was administered to patients in the RP group during the procedure. Then, 20 mcg/ml isotonic-remifentanil prepared with remifentanil (Ultiva®, GlaxoSmithKline, Belgium) was administered as a 0.25 mcg/kg bolus IV. The infusion was then started at a dose of 0.025–0.1 mcg/kg/minute. Four patients in the DP group were excluded from the study. Two of these patients were excluded because of hypertension on the morning of the operation, and two patients were excluded because of a prolonged surgical procedure and the start of general anesthesia. Three patients in the RP group were excluded from the study. Two of these patients were intubated because of apnea, and one patient refused to participate in the study. The depth of sedation was measured by the Ramsey Sedation Score (RSS), and the recovery score was measured by the modified Aldrete score (MAS). The Facial Pain Scale (FPS) was used to assess pain. The depth of anesthesia was ensured so that the Ramsey Sedation Scale score of the patients was greater than four. Patients with an RSS<4 with additional propofol administration were excluded from the study. SpO2 less than 90% for more than 10 seconds was considered desaturation, and the oxygen flow rate was increased to 6 ml/min with a nasal cannula. Balloon mask ventilation was used when the nasal cannula was inadequate. A decrease in HR by 20% from baseline was considered bradycardia, an increase in HR by 20% from baseline was considered tachycardia, a decrease in OAB by 20% from baseline was considered hypotension, and an increase in OAB by 20% from baseline was considered hypertension. The duration of hysteroscopy, duration of the procedure, sedoanalgesia end time, recovery time and several possible complications (nausea and vomiting, desaturation and jaw thrust maneuver, bradycardia) were also recorded. For postprocedural recovery assessment, the time to a modified Aldrete score (MAS) above 8 was recorded. All records were made by an anesthesiologist who was not familiar with the sedation protocol administered during the procedure. In both groups, physician satisfaction was evaluated at the end of the operation, and patient satisfaction was evaluated when the MAS score was above 8. Anesthesiologist, surgeon and patient satisfaction were evaluated on a 10-point scale (0: totally dissatisfied; 10: excellent). Statistical analysis G-Power software (version 3.1.9.4; University of Kiel, Kiel, Germany) was used to calculate the required sample size. With a 5% margin of error and 80% power, the standard effect size was determined to be 0.67, and it was calculated that at least 35 cases should be included in each group (Table 1) (17-18). Considering the possibility of error in the measurements, 5 cases each were also taken as reserves. Patient recruitment started with 40+40 patients. Four patients in the DP group were excluded from the study. The study was completed with a predicted sample size of 36 patients in the DP group and 37 patients in the RP group (Figure 1). The mean, standard deviation, median minimum, maximum, frequency, and ratio values were used for descriptive statistics of the data obtained. The distribution of variables was measured with the Kolmogorov‒Smirnov test. Independent sample t tests and Mann‒Whitney U tests were used to analyze quantitative independent data. The chi-square test was used for the analysis of qualitative independent data, and the Fischer test was used when the chi-square test conditions were not met. The SPSS 28.0 program was used in the analysis. RESULTS Age, height, weight, BMI, and ASA distribution did not differ significantly (p > 0.05) between the RP and DP groups (Table 2). Hysteroscopy duration, mask ventilation, and Ramsey Sedation score did not differ significantly (p > 0.05) between the RP and DP groups (Table 3). The VAS score, rate of desaturation, and rate of Jaw Thrust maneuver performance were significantly (p 4, time to MAS > 9 and rate of bradycardia were significantly (p < 0.05) greater in the DP group than in the RP group (Table 3). The anesthesiologist satisfaction score, patient satisfaction score and surgeon satisfaction score were significantly (p 0.05) between the RP and DP groups. The 1st minute, 5th minute, 10th minute, last measurement, and postop HRV values were significantly (p < 0.05) lower in the DP group than in the RP group (Figure 2). The 1 st minute, 5 th minute, 10 th minute, and last measurement and postop respiratory rate were significantly (p 0.05) between the RP and DP groups. Compared with the RP group, the DP group had significantly (p 0.05) difference in the postop SPO2 value between the RP and DP groups. The baseline, 1st minute, 5th minute, 10th minute, and last measurement SPO2 values were significantly (p 0.05) between the RP and DP groups. The 1st minute ETCO2 value was significantly (p < 0.05) greater in the DP group than in the RP group (Figure 5). The baseline, 1st minute, 5th minute, 10th minute, last measurement, and postoperative IPI values were significantly (p < 0.05) greater in the DP group than in the RP group (Figure 6). DISCUSSION Numerous studies investigating the role of dexmedetomidine as an anesthetic adjuvant have suggested several advantages of dexmedetomidine over propofol or remifentanil, including better hemodynamic stability, less respiratory depression, and prolonged postoperative analgesic effects (19,20,21). Tekeli et al. reported that the dexmedetomidine‒propofol combination is an effective and reliable option for sedation in endoscopic procedures (22). Riachy et al. reported in a randomized, double-blind study that DEX generally causes bradycardia and hypotension but may cause hypertension in some cases (23). In a prospective randomized study titled Dexmedetomidine-Propofol Versus Remifemtanyl-Propofol Usage in Endoscopic Retrograde Cholangio Pancreatography Procedures at Monitored Anesthesia Care conducted by Ömür et al. in 2016, it was reported that hemodynamic parameters were more stable in the group receiving remifentanil than in the group receiving dexmedetomidine (24). Our study differed from the study of Ömür et al. in terms of hemodynamics and was similar to the study of M Riachy et al. The results of our study revealed that the combination of dexmedetomidine with propofol provided more stable hemodynamics than did the combination of remifentanil with propofol. We used the Ramsey Sedation Scale to determine the adequate depth of anesthesia in the patients. In a study by Consales et al. in intensive care patients, the depth of anesthesia was measured by the bispectral index (BIS) and RSS in 40 sedated patients, and a good correlation was observed between the Ramsay score and the BIS. In the same study, different BIS values indicating deep anesthesia levels were reported to correspond to the Ramsay score of 6 (25). Both combinations were effective in providing the desired depth of anesthesia because the Ramsey Sedation scores of the patients in both groups were similar. However, the dexmedetomidine-propofol combination provided an adequate depth of sedation throughout hysteroscopy and resulted in better saturation values than did the remifentanil-propofol combination. In our study, the rate of desaturation was significantly lower in patients treated with the combination of dexmedetomidine and propofol than in patients treated with the combination of remifentanil and propofol. In our study, we used the integrated pulmonary index algorithm to determine patients’ pulmonary function and hypoxia throughout the procedure. The integrated pulmonary index (IPI) is an algorithm-based monitoring parameter that combines oxygenation measured by pulse oximetry and ventilation measured by capnography. The effectiveness of the integrated pulmonary index has been demonstrated in studies. The integrated pulmonary index combines oxygenation (saturation, heart rate) and ventilation (respiratory rate, apnea > 10 seconds, partial pressure of end-tidal carbon) parameters, allowing quick and comfortable conclusions about the respiratory status of patients (26,27). The results of our study revealed that the combination of dexmedetomidine and propofol affected the physiologic respiratory functions of patients less and caused less hypoxemia than did the combination of remifentanil and propofol alone. The IPIs of patients treated with the dexmedetomidine-propofol combination were significantly greater than those of patients treated with the remifentanil-propofol combination. The findings of our study revealed that the combination of dexmedetomidine and propofol provides better surgeon, patient and anesthesiologist satisfaction than the combination of remifentanil and propofol does. The combination of dexmedetomidine and propofol was correlated with the satisfaction score and VAS score. The VAS scores of patients treated with the combination of dexmedetomidine and propofol were significantly lower than those of patients treated with the combination of remifentanil and propofol. Cardiovascular effects must be considered in patients receiving dexmedetomidine. The risk of bradycardia and hypotension can be easily managed with atropine and vasoactive agents (28,29). In our study, significantly more bradycardia was observed in patients receiving the combination of dexmedetomidine and propofol than in patients receiving the combination of remifentanil and propofol. Another important finding of our study was the determination of the awakening times of the patients whose recovery times were measured. In a study conducted by Hu et al. in 2012, dexmedetomidine resulted in faster recovery than did remifentanil (30). Our study showed different results from the study by R Hu et al. In our study, patients treated with the combination of dexmedetomidine and propofol recovered significantly later than patients treated with the combination of remifentanil and propofol did. In conclusion, when dexmedetomidine is combined with propofol, it provides adequate anesthesia and analgesia for the performance of common-day procedures such as hysteroscopy under office conditions. Moreover, remifentanil provides more stable hemodynamics than does the combination of propofol and reduces the incidence of hypoxemia by affecting patients’ respiratory function less. As a result of these data and the findings of similar studies, we believe that dexmedetomidine provides more comfortable and reliable sedo-analgesia for daily patients under office conditions and that its use will increase rapidly. Abbreviations ASA American Society of Anesthesiologists IPI Integrated Pulmonary Index DP dexmedetomidine-propofol RP Remifentanil-Propofol ICU Intensive Care Unit RSS Ramsey Sedation Score MAS Modified Aldrex score Declarations Acknowledgments We thank Nurçin GÜLHAŞ, Inonu University, for proofreading this manuscript. Authors’ contributions All the authors contributed to the study’s conception and design. The first draft of the manuscript was written by AKO and CS, and all the authors commented on previous versions of the manuscript. Material preparation: AKO and NY. Data collection: AKO and YT. Analysis was performed by AKO and AET. Review and editing: AKO, CS, and AET. All the authors read and approved the final manuscript. Funding This research received no external funding. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study was initiated after approval was obtained from the Ethics Committee of Van Yüzüncü Yıl University Clinical Research Ethics Committee, dated 22.06.2021 and numbered 07. Written and verbal informed consent for participation was obtained from all participants in the study. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. References Van Hanegem, Nehalennia, et al. "The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis." European Journal of Obstetrics & Gynecology and Reproductive Biology 197 (2016): 147-155. Bosteels, Jan, et al. "Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities." Cochrane Database of Systematic Reviews 2 (2015). Vitale, Salvatore Giovanni, et al. "Comparison of three biopsy forceps for hysteroscopic endometrial biopsy in postmenopausal patients (HYGREB‐1): a multicenter, single‐blind randomized clinical trial." International Journal of Gynecology & Obstetrics 155.3 (2021): 425-432. Vitale, Salvatore Giovanni. "The biopsy snake grasper sec. VITALE: a new tool for office hysteroscopy." Journal of Minimally Invasive Gynecology 27.6 (2020): 1414-1416. Vitale, Salvatore Giovanni, et al. "Hysteroscopic morcellation of submucous myomas: a systematic review." BioMed Research International 2017.1 (2017): 6848250. Buzzaccarini, Giovanni, et al. "Pain management during office hysteroscopy: an evidence-based approach." Medicina 58.8 (2022): 1132. Wang, Jianying, Yu Liu, and Qiong Xu. "Effects of Esketamine Combined with Propofol for Hysteroscopy Anesthesia on Patient Hemodynamics and Adverse Reactions." Alternative therapies in health and medicine 30.1 (2024): 18-23. Zhang, Xiaoqiang, Shuang Li, and Jing Liu. "Efficacy and safety of remimazolam besylate versus propofol during hysteroscopy: single-center randomized controlled trial." BMC anesthesiology 21.1 (2021): 156. Park, Seongjoo, et al. "Dexmedetomidine-remifentanil vs propofol-remifentanil for monitored anesthesia care during hysteroscopy: randomized, single-blind, controlled trial." Medicine 99.43 (2020): e22712. Zhang, Shuoya, et al. "Efficacy and safety of remimazolam tosylate in hysteroscopy: a randomized, single‐blind, parallel controlled trial." Journal of clinical pharmacy and therapeutics 47.1 (2022): 55-60. Liang, Hansheng, et al. "Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial." BMC anesthesiology 19 (2019): 1-10. Guo, Yan‐Xia, et al. "Minimal alveolar concentration of sevoflurane in combination with dexmedetomidine in patients with hysteroscopy: An up‐down sequential allocation study." Basic & Clinical Pharmacology & Toxicology 131.5 (2022): 364-371. Carollo, Dominic S., Bobby D. Nossaman, and Usha Ramadhyani. "Dexmedetomidine: a review of clinical applications." Current Opinion in Anesthesiology 21.4 (2008): 457-461. Venn, R. M., et al. "Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit." Anesthesia 54.12 (1999): 1136-1142. Panzer, Oliver, Vivek Moitra, and Robert N. Sladen. "Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists." Critical care clinics 25.3 (2009): 451-469. Bae, Hong-Beom. "Dexmedetomidine: an attractive adjunct to anesthesia." Korean Journal of Anesthesiology 70.4 (2017): 375-376. HASPOLAT, Ali, et al. "Kolonoskopi Hastalarında Bilinçli Sedasyon ve Analjeziye Nonopioid Bir Yaklaşım; Propofol–Ketamin (Ketofol)." Journal of Medical Sciences 1.4 (2020): 27-44. Cesana, Bruno M., and Franco Cavaliere. "Could the use of a table make power analysis description more reader-friendly?." Minerva anestesiologica 86.10 (2020): 1003-1005. Kim, Doyeon, et al. "Postoperative pain control after the use of dexmedetomidine and propofol to sedate patients undergoing ankle surgery under spinal anesthesia: a randomized controlled trial." Journal of Pain Research (2019): 1479-1487. Chan, Albert Kam Ming, Chi Wai Cheung, and Yeow Kuan Chong. "Alpha-2 agonists in acute pain management." Expert opinion on pharmacotherapy 11.17 (2010): 2849-2868. Gurbet, Alp, et al. "Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements." Canadian Journal of Anesthesia-Journal Canadien D. Anesthesie 53.7 (2006): 646-652. Tekeli, Arzu Esen, et al. "Comparison of dexmedetomidine-propofol and ketamine-propofol administration during sedation-guided upper gastrointestinal system endoscopy." Medicine 99.49 (2020): e23317. Riachy, Moussa, et al. "A randomized double‐blind controlled trial comparing three sedation regimens during flexible bronchoscopy: Dexmedetomidine, alfentanil and lidocaine." The clinical respiratory journal 12.4 (2018): 1407-1415.. Ömür, Yahya, et al. "Endoskopik Retrograd Kolanjio Pankreato Grafi İşleminde Monitorize Anestezi Bakımında Deksmedetomidin-Propofol ve Remifentanil-Propofol Protokollerinin Karşılaştırılması." (2016): 32-37. Consales, G., et al. "Bispectral Index compared to Ramsay score for sedation monitoring in intensive care units." Minerva anestesiologica 72.5 (2006): 329-336. Peveling‐Oberhag, Jan, et al. "Capnography monitoring of non‐anesthesiologist provided sedation during percutaneous endoscopic gastrostomy placement: A prospective, controlled, randomized trial." Journal of Gastroenterology and Hepatology 35.3 (2020): 401-407. Michael, Florian Alexander, et al. "Evaluation of the Integrated Pulmonary Index® during nonanesthesiologist sedation for percutaneous endoscopic gastrostomy." Journal of clinical monitoring and computing 35 (2021): 1085-1092. Kamibayashi, Takahiko, et al. "Clinical uses of α2-adrenergic agonists." The Journal of the American Society of Anesthesiologists 93.5 (2000): 1345-1349. Penttilä, Jani, et al. "Cardiovascular and parasympathetic effects of dexmedetomidine in healthy subjects." Canadian journal of physiology and pharmacology 82.5 (2004): 359-362.. Hu, Rong, J. X. Liu, and Hong Jiang. "Dexmedetomidine versus remifentanil sedation during awake fiberoptic nasotracheal intubation: a double-blinded randomized controlled trial." Journal of anesthesia 27 (2013): 211-217. Tables Tables 1 to 5 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Published Journal Publication published 29 Jan, 2025 Read the published version in BMC Anesthesiology → Version 1 posted Editorial decision: Revision requested 07 Oct, 2024 Editor assigned by journal 07 Oct, 2024 Submission checks completed at journal 04 Oct, 2024 First submitted to journal 03 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-5199093","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":363094521,"identity":"01b36ea4-00d1-4e66-b44e-2454b1a65098","order_by":0,"name":"Ali Kendal OĞUZ","email":"","orcid":"","institution":"Health Science University, Gazi Yaşargil Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Kendal","lastName":"OĞUZ","suffix":""},{"id":363094524,"identity":"a96e2455-6831-44ce-8eef-b5116e445adc","order_by":1,"name":"Celaleddin 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14:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5199093/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5199093/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12871-025-02918-1","type":"published","date":"2025-01-29T15:57:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71682749,"identity":"3222a80d-d764-494d-b8c8-abe52d0096d8","added_by":"auto","created_at":"2024-12-17 16:50:13","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":141889,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5199093/v1/cfc3934fb872d7d95164f44f.jpg"},{"id":71682750,"identity":"db67f50e-e9aa-4b2c-b539-681b0c68c7e1","added_by":"auto","created_at":"2024-12-17 16:50:13","extension":"jpg","order_by":2,"title":"Figure 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6","display":"","copyAsset":false,"role":"figure","size":75010,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5199093/v1/f2736e1f1aba13e75ee1ee64.jpg"},{"id":75352039,"identity":"8035e4c2-ba03-428f-8674-3deab6cdb341","added_by":"auto","created_at":"2025-02-03 16:12:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1031613,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5199093/v1/00cda691-a052-49f3-a013-9ff35259bb1d.pdf"},{"id":71682748,"identity":"43eebef0-f6ba-427e-8e4b-ce8396924063","added_by":"auto","created_at":"2024-12-17 16:50:13","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35721,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5199093/v1/0ab3a34829bcdf70c671473b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSedoanalgesia With Dexmedetomidine in Daily Anesthesia Practices: a Prospective Randomized Controlled Trial\u003c/p\u003e","fulltext":[{"header":"KEY POINTS","content":"\u003col\u003e\n \u003cli\u003eDexmedetomidine combined with propofol provides adequate depth of anesthesia and analgesia for hysteroscopic procedures.\u003c/li\u003e\n \u003cli\u003eThe combination of dexmedetomidine and propofol affects respiratory function less, and hypoxemia is less common in patients.\u003c/li\u003e\n \u003cli\u003eWhen nonoperating rooms administer dexmedetomidine, one should be prepared for cardiovascular complications, especially bradycardia.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eHysteroscopy is recognized as the gold standard procedure in the diagnosis and treatment of intrauterine pathologies (1,2). Owing to advances in hysteroscopic technology, including instrument downsizing and improved surgical techniques, a significant number of surgical procedures are now performed in nonoperating clinics rather than in the anesthetized operating room (3,4,5). Hysteroscopy is an effective procedure with recognized value in providing adequate visualization of the uterine cavity, high patient acceptability, and negligible complication rates; however, pain and anxiety are the most common reasons for failure to complete the procedure in the office setting (6). Therefore, a well-developed and effective anesthetic protocol is essential for smooth examination during hysteroscopy. Thus, the patient can maintain a comfortable state during the hysteroscopy procedure, the success rate of the operation increases, and a good doctor‒patient relationship is maintained (7).\u003c/p\u003e \u003cp\u003ePropofol is a short-acting intravenous anesthetic with a strong sedative effect. Because of its short half-life, patients can rapidly awaken from anesthetic sedation after surgery. Therefore, propofol is considered an ideal anesthetic drug for hysteroscopy (8,9,10). When propofol alone is used for sedation, patients can move because of pain, as propofol has no analgesic effect.\u003c/p\u003e \u003cp\u003eIt is often necessary to increase the dosage of propofol to achieve deeper anesthesia; however, this increases the risk of circulatory and respiratory depression and delays postoperative awakening(11,12). Studies have shown that the use of opioids combined with propofol for anesthesia reduces the dosage of propofol and the likelihood of side effects. However, opioids combined with propofol have a relatively large effect on breathing and circulation, which can cause hypotension and hypoxemia and can lead to serious consequences if left untreated. Therefore, anesthesiologists are working to identify an intravenous anesthetic agent that, when combined with propofol, provides a more comprehensive and safer anesthetic effect, reducing the incidence of side effects while maintaining the sedative benefits of propofol.\u003c/p\u003e \u003cp\u003eDexmedetomidine is a potent and highly selective α-2 adrenoceptor agonist with sympatholytic, sedative, amnesic and analgesic properties (13,14). It provides unique \u0026ldquo;conscious sedation\u0026rdquo; and analgesia without respiratory depression(15). Dexmedetomidine is approved for short-term sedation (\u0026lt;\u0026thinsp;24 hours) of intubated adult patients in the intensive care unit (ICU) and for sedation of nonintubated patients during surgery and other procedures. Dexmedetomidine is widely used in the ICU and operating room for the above indications, and its clinical applications have greatly increased in recent years because of its many favorable physiologic effects(16).\u003c/p\u003e \u003cp\u003eThis study aimed to observe the perioperative effects of dexmedetomidine-propofol and remifentanil-propofol combinations in safer anesthesia for day-case patients under nonoperating room conditions for hysteroscopic procedures requiring deep anesthesia.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003eThe research adhered to the CONSORT guidelines. This study was conducted with the approval of the Van Yüzüncü Yıl University Clinical Research Ethics Committee, dated 22.06.2021 and numbered 07. The Clinical Trials ID is NCT05674201, and verbal and written consent was obtained from the subjects included in the study.\u003c/p\u003e\n\u003cp\u003ePreoperative evaluation of the patients included in the study was performed at least 24 hours before in the Anesthesiology and Reanimation Clinic. ASA I-II, 80 patients aged between 18 and 65 years were included in the study. Patients younger than 18 years of age or older than 65 years of age; those whose consent could not be obtained; those with severe cardiac, renal, hepatic or respiratory diseases; those with known allergic reactions to the agents used; those with psychomotor dysfunction; and those who were intubated after the procedure were excluded. The 80 patients included in the study were randomized to either Group DP or Group RP through a computerized random number generator, and the assignments were secured within sealed and numbered envelopes. The demographic data of the patients were recorded. All patients were intravenously accessed from the right antecubital region with a 20 G branula just before the procedure,\u0026nbsp;and 1000 ml\u0026nbsp;of\u0026nbsp;isotonic (0.9% NaCl) IV infusion was started. Patients were placed in a supine position on the gynecological table and premedicated with 0.025 mg/kg IV\u0026nbsp;midazolam\u0026nbsp;(Demizolam®, Dem, Turkey) after being monitored\u0026nbsp;with\u0026nbsp;ASA standards. A Medtronic Capnostream 35 Capnography Device was connected to all patients during the procedure,\u0026nbsp;and 2 lt/min oxygen was administered via\u0026nbsp;a\u0026nbsp;nasal cannula. Electrocardiography (ECG) monitoring and measurements of peripheral oxygen saturation (SpO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), end-tidal CO2 (ETCO2), respiratory rate and\u0026nbsp;integrated pulmonary index\u0026nbsp;(IPI) were recorded.\u003c/p\u003e\n\u003cp\u003eA 1 mg/kg bolus of propofol (Propofol® Lipuro 1% (10 mg/ml), Braun, Indonesia) was administered to the patients in the DP group during the procedure. Then,\u0026nbsp;the\u0026nbsp;isotonic dexmedetomidine solution was prepared\u0026nbsp;at a concentration of 4 mcg/ml using dexmedetomidine (Sedadomid® 200 µg/2 ml, KOÇAK FARMA Turkey). This solution was administered as\u0026nbsp;a 1 mcg/kg IV bolus over 10 minutes. After that,\u0026nbsp;IV infusion was started at a dose of 0.4–0.7 mcg/kg/hour.\u003c/p\u003e\n\u003cp\u003ePropofol (Propofol® Lipuro 1% (10 mg/ml), B. Braun Indonesia) 1 mg/kg bolus IV was administered to patients in the RP group during the procedure. Then, 20 mcg/ml isotonic-remifentanil prepared with remifentanil (Ultiva®, GlaxoSmithKline, Belgium) was administered as a 0.25 mcg/kg bolus IV. The infusion was then started at a dose of 0.025–0.1 mcg/kg/minute.\u003c/p\u003e\n\u003cp\u003eFour patients in the DP group were excluded from the study. Two of these patients were excluded because of hypertension on the morning of the operation, and two patients were excluded because of a prolonged surgical procedure and the start of general anesthesia. Three patients in\u0026nbsp;the\u0026nbsp;RP\u0026nbsp;group\u0026nbsp;were excluded from the study. Two of these patients were intubated because of apnea,\u0026nbsp;and one patient refused to participate in the study. The depth of sedation was measured by the Ramsey Sedation Score (RSS),\u0026nbsp;and the recovery score was measured by the\u0026nbsp;modified\u0026nbsp;Aldrete\u0026nbsp;score\u0026nbsp;(MAS). The Facial Pain Scale (FPS) was used to assess pain. The depth of anesthesia was ensured so that the Ramsey Sedation Scale\u0026nbsp;score\u0026nbsp;of the patients was greater than four. Patients with\u0026nbsp;an\u0026nbsp;RSS\u0026lt;4\u0026nbsp;with additional propofol administration\u0026nbsp;were excluded from the study. SpO2\u0026nbsp;less than\u0026nbsp;90% for more than 10 seconds was considered desaturation,\u0026nbsp;and\u0026nbsp;the\u0026nbsp;oxygen flow rate was increased to\u0026nbsp;6 ml/min with a nasal cannula. Balloon mask ventilation was used when the nasal cannula was inadequate. A decrease in HR by 20% from baseline was considered bradycardia, an increase in HR by 20% from baseline was considered tachycardia, a decrease in OAB by 20% from baseline was considered hypotension, and an increase in OAB by 20% from baseline was considered hypertension. The duration\u0026nbsp;of hysteroscopy, duration of the procedure, sedoanalgesia end time, recovery time and\u0026nbsp;several\u0026nbsp;possible complications (nausea and vomiting, desaturation and jaw thrust maneuver, bradycardia) were also recorded. For\u0026nbsp;postprocedural\u0026nbsp;recovery assessment, the time to\u0026nbsp;a modified\u0026nbsp;Aldrete\u0026nbsp;score\u0026nbsp;(MAS) above 8 was recorded. All records were made by an anesthesiologist who was not familiar with the sedation protocol administered during the procedure. In both groups, physician satisfaction was evaluated at the end of the operation, and patient satisfaction was evaluated when the MAS\u0026nbsp;score\u0026nbsp;was above 8. Anesthesiologist, surgeon and patient satisfaction were evaluated on a 10-point scale (0:\u0026nbsp;totally\u0026nbsp;dissatisfied;\u0026nbsp;10:\u0026nbsp;excellent).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eanalysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eG-Power software (version 3.1.9.4; University of Kiel, Kiel, Germany) was used to calculate the required sample size. With a 5% margin of error and 80% power, the standard effect size was determined to be 0.67, and it was calculated that at least 35 cases should be included in each group (Table 1) (17-18). Considering the possibility of error in the measurements, 5 cases each were also taken as reserves. Patient recruitment started with 40+40\u0026nbsp;patients. Four\u0026nbsp;patients in\u0026nbsp;the\u0026nbsp;DP\u0026nbsp;group\u0026nbsp;were excluded from the study. The study was completed with\u0026nbsp;a\u0026nbsp;predicted sample size of 36 patients in\u0026nbsp;the\u0026nbsp;DP\u0026nbsp;group\u0026nbsp;and 37 patients in\u0026nbsp;the\u0026nbsp;RP\u0026nbsp;group\u0026nbsp;(Figure 1).\u003c/p\u003e\n\u003cp\u003eThe mean, standard deviation, median minimum, maximum, frequency, and ratio values were used for descriptive statistics of the data obtained. The distribution of variables was measured with the Kolmogorov‒Smirnov test. Independent sample t tests and Mann‒Whitney U tests were used to analyze quantitative independent data. The chi-square test was used for the analysis of qualitative independent data, and the Fischer test was used when the chi-square test conditions were not met. The SPSS 28.0 program was used in the analysis.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAge, height, weight, BMI, and ASA distribution did not differ significantly (p \u0026gt; 0.05) between the RP and DP groups (Table 2).\u003c/p\u003e\n\u003cp\u003eHysteroscopy duration, mask ventilation, and Ramsey Sedation score did not differ significantly (p \u0026gt; 0.05) between the RP and DP groups (Table 3).\u003c/p\u003e\n\u003cp\u003eThe VAS score, rate of desaturation, and rate of Jaw Thrust maneuver performance were significantly (p \u0026lt; 0.05) lower in the DP group than in the RP group (Table 3).\u003c/p\u003e\n\u003cp\u003eThe time to RSS \u0026gt; 4, time to MAS \u0026gt; 9 and rate of bradycardia were significantly (p \u0026lt; 0.05) greater in the DP group than in the RP group (Table 3).\u003c/p\u003e\n\u003cp\u003eThe anesthesiologist satisfaction score, patient satisfaction score and surgeon satisfaction score were significantly (p \u0026lt; 0.05) higher in the DP group than in the RP group (Table 4).\u003c/p\u003e\n\u003cp\u003eThe baseline HR and baseline respiratory rate did not differ significantly (p \u0026gt; 0.05) between the RP and DP groups. The 1st minute, 5th minute, 10th minute, last measurement, and postop HRV values were significantly (p \u0026lt; 0.05) lower in the DP group than in the RP group (Figure 2).\u003c/p\u003e\n\u003cp\u003eThe 1\u003csup\u003est\u003c/sup\u003e minute, 5\u003csup\u003eth\u003c/sup\u003e minute, 10\u003csup\u003eth\u003c/sup\u003e minute, and last measurement and postop respiratory rate were significantly (p \u0026lt; 0.05) higher in the DP group than in the RP group (Figure 3).\u003c/p\u003e\n\u003cp\u003eThe baseline, postoperative systolic, diastolic, and mean blood pressure values did not differ significantly (p \u0026gt; 0.05) between the RP and DP groups. Compared with the RP group, the DP group had significantly (p \u0026lt; 0.05) greater 1st minute, 5th minute, and 10th minute values and significantly greater systolic, diastolic, and mean blood pressure values (Table 5).\u003c/p\u003e\n\u003cp\u003eThere was no significant (p \u0026gt; 0.05) difference in the postop SPO2 value between the RP and DP groups. The baseline, 1st minute, 5th minute, 10th minute, and last measurement SPO2 values were significantly (p \u0026lt; 0.05) greater in the DP group than in the RP group (Figure 4).\u003c/p\u003e\n\u003cp\u003eThe baseline, 5th minute, 10th minute, last measurement and postoperative ETCO2 values did not differ significantly (p \u0026gt; 0.05) between the RP and DP groups. The 1st minute ETCO2 value was significantly (p \u0026lt; 0.05) greater in the DP group than in the RP group (Figure 5).\u003c/p\u003e\n\u003cp\u003eThe baseline, 1st minute, 5th minute, 10th minute, last measurement, and postoperative IPI values were significantly (p \u0026lt; 0.05) greater in the DP group than in the RP group (Figure 6).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eNumerous studies investigating the role of dexmedetomidine as an anesthetic adjuvant have suggested several advantages of dexmedetomidine over propofol or remifentanil, including better hemodynamic stability, less respiratory depression, and prolonged postoperative analgesic effects (19,20,21).\u0026nbsp;Tekeli et al.\u0026nbsp;reported that the dexmedetomidine‒propofol\u0026nbsp;combination is an effective and reliable option for sedation in endoscopic procedures (22). Riachy et al. reported in a randomized,\u0026nbsp;double-blind study that\u0026nbsp;DEX\u0026nbsp;generally causes bradycardia and hypotension but may cause hypertension in some cases (23). In a prospective randomized study titled Dexmedetomidine-Propofol Versus Remifemtanyl-Propofol Usage in Endoscopic Retrograde Cholangio Pancreatography Procedures at Monitored\u0026nbsp;Anesthesia\u0026nbsp;Care conducted by Ömür et al. in 2016, it was reported that\u0026nbsp;hemodynamic\u0026nbsp;parameters were more stable in the group receiving remifentanil than in the group receiving dexmedetomidine (24). Our study\u0026nbsp;differed\u0026nbsp;from the study of Ömür et al. in terms of hemodynamics and\u0026nbsp;was\u0026nbsp;similar to the study of M Riachy et al. The results of our study revealed that the combination of dexmedetomidine with propofol provided more stable hemodynamics than\u0026nbsp;did\u0026nbsp;the combination of remifentanil\u0026nbsp;with\u0026nbsp;propofol. We used the Ramsey Sedation Scale to determine the adequate depth of anesthesia in the patients. In a study by Consales et al. in intensive care patients, the depth of anesthesia was measured by\u0026nbsp;the\u0026nbsp;bispectral index (BIS) and RSS in 40 sedated patients,\u0026nbsp;and a good correlation was observed between\u0026nbsp;the\u0026nbsp;Ramsay\u0026nbsp;score\u0026nbsp;and\u0026nbsp;the BIS.\u003c/p\u003e\n\u003cp\u003eIn the same study, different BIS values indicating deep anesthesia levels were reported to correspond to the Ramsay score of 6 (25). Both combinations were effective in providing the desired depth of anesthesia because the Ramsey Sedation scores of the patients in both groups were similar. However, the dexmedetomidine-propofol combination provided\u0026nbsp;an\u0026nbsp;adequate depth of sedation throughout hysteroscopy and\u0026nbsp;resulted in\u0026nbsp;better saturation values than\u0026nbsp;did\u0026nbsp;the\u0026nbsp;remifentanil-propofol combination. In our study, the rate of desaturation was significantly lower in patients treated with\u0026nbsp;the combination of\u0026nbsp;dexmedetomidine\u0026nbsp;and\u0026nbsp;propofol than in patients treated with\u0026nbsp;the combination of\u0026nbsp;remifentanil\u0026nbsp;and propofol.\u003c/p\u003e\n\u003cp\u003eIn our study, we used the integrated pulmonary index algorithm to determine patients’ pulmonary function and hypoxia throughout the procedure. The integrated pulmonary index (IPI) is an algorithm-based monitoring parameter that combines oxygenation measured by pulse oximetry and ventilation measured by capnography. The effectiveness of the integrated pulmonary index has been demonstrated in studies. The integrated pulmonary index combines oxygenation (saturation, heart rate) and ventilation (respiratory rate, apnea \u0026gt; 10 seconds, partial pressure of end-tidal carbon) parameters, allowing quick and comfortable conclusions about the respiratory status of patients (26,27). The results of our study revealed that the combination of dexmedetomidine and propofol affected the physiologic respiratory functions of patients less and caused less hypoxemia than did the combination of remifentanil and propofol alone. The IPIs of patients treated with the dexmedetomidine-propofol combination were significantly greater than those of patients treated with the remifentanil-propofol combination.\u003c/p\u003e\n\u003cp\u003eThe findings of our study revealed that the combination of dexmedetomidine and propofol provides better surgeon, patient and anesthesiologist satisfaction than the combination of remifentanil and propofol does. The combination of dexmedetomidine and propofol was correlated with the satisfaction score and VAS score. The VAS scores of patients treated with the combination of dexmedetomidine and propofol were significantly lower than those of patients treated with the combination of remifentanil and propofol. Cardiovascular effects must be considered in patients receiving dexmedetomidine. The risk of bradycardia and hypotension can be easily managed with atropine and vasoactive agents (28,29). In our study, significantly more bradycardia was observed in patients receiving the combination of dexmedetomidine and propofol than in patients receiving the combination of remifentanil and propofol.\u003c/p\u003e\n\u003cp\u003eAnother important finding of our study was the determination of the awakening times of the patients whose recovery times were measured. In a study conducted by Hu et al. in 2012, dexmedetomidine resulted in faster recovery than did remifentanil (30). Our study showed different results from the study by R Hu et al. In our study, patients treated with the combination of dexmedetomidine and propofol recovered significantly later than patients treated with the combination of remifentanil and propofol did.\u003c/p\u003e\n\u003cp\u003eIn conclusion, when dexmedetomidine is combined with propofol, it provides adequate anesthesia and analgesia for the performance of common-day procedures such as hysteroscopy under office conditions. Moreover, remifentanil provides more stable hemodynamics than does the combination of propofol and reduces the incidence of hypoxemia by affecting patients’ respiratory function less.\u003c/p\u003e\n\u003cp\u003eAs a result of these data and the findings of similar studies, we believe that dexmedetomidine provides more comfortable and reliable sedo-analgesia for daily patients under office conditions and that its use will increase rapidly.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Society of Anesthesiologists\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIPI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntegrated Pulmonary Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003edexmedetomidine-propofol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRemifentanil-Propofol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRamsey Sedation Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eModified Aldrex score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Nurçin GÜLHAŞ, Inonu University, for proofreading this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors contributed to the study’s conception and design. The first draft of the manuscript was written by AKO and CS, and all the authors commented on previous versions of the manuscript. Material preparation: AKO and NY. Data collection: AKO and YT. Analysis was performed by AKO and AET. Review and editing: AKO, CS, and AET. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study was initiated after approval was obtained from the Ethics Committee of Van Yüzüncü Yıl University Clinical Research Ethics Committee, dated 22.06.2021 and numbered 07. Written and verbal informed consent for participation was obtained from all participants in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVan Hanegem, Nehalennia, et al. \u0026quot;The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis.\u0026quot; European Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology 197 (2016): 147-155.\u003c/li\u003e\n\u003cli\u003eBosteels, Jan, et al. \u0026quot;Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities.\u0026quot; Cochrane Database of Systematic Reviews 2 (2015).\u003c/li\u003e\n\u003cli\u003eVitale, Salvatore Giovanni, et al. \u0026quot;Comparison of three biopsy forceps for hysteroscopic endometrial biopsy in postmenopausal patients (HYGREB‐1): a multicenter, single‐blind randomized clinical trial.\u0026quot; International Journal of Gynecology \u0026amp; Obstetrics 155.3 (2021): 425-432.\u003c/li\u003e\n\u003cli\u003eVitale, Salvatore Giovanni. \u0026quot;The biopsy snake grasper sec. VITALE: a new tool for office hysteroscopy.\u0026quot; Journal of Minimally Invasive Gynecology 27.6 (2020): 1414-1416.\u003c/li\u003e\n\u003cli\u003eVitale, Salvatore Giovanni, et al. \u0026quot;Hysteroscopic morcellation of submucous myomas: a systematic review.\u0026quot; BioMed Research International 2017.1 (2017): 6848250.\u003c/li\u003e\n\u003cli\u003eBuzzaccarini, Giovanni, et al. \u0026quot;Pain management during office hysteroscopy: an evidence-based approach.\u0026quot; Medicina 58.8 (2022): 1132.\u003c/li\u003e\n\u003cli\u003eWang, Jianying, Yu Liu, and Qiong Xu. \u0026quot;Effects of Esketamine Combined with Propofol for Hysteroscopy Anesthesia on Patient Hemodynamics and Adverse Reactions.\u0026quot; Alternative therapies in health and medicine 30.1 (2024): 18-23.\u003c/li\u003e\n\u003cli\u003eZhang, Xiaoqiang, Shuang Li, and Jing Liu. \u0026quot;Efficacy and safety of remimazolam besylate versus propofol during hysteroscopy: single-center randomized controlled trial.\u0026quot; BMC anesthesiology 21.1 (2021): 156.\u003c/li\u003e\n\u003cli\u003ePark, Seongjoo, et al. \u0026quot;Dexmedetomidine-remifentanil vs propofol-remifentanil for monitored anesthesia care during hysteroscopy: randomized, single-blind, controlled trial.\u0026quot; Medicine 99.43 (2020): e22712.\u003c/li\u003e\n\u003cli\u003eZhang, Shuoya, et al. \u0026quot;Efficacy and safety of remimazolam tosylate in hysteroscopy: a randomized, single‐blind, parallel controlled trial.\u0026quot; Journal of clinical pharmacy and therapeutics 47.1 (2022): 55-60.\u003c/li\u003e\n\u003cli\u003eLiang, Hansheng, et al. \u0026quot;Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial.\u0026quot; BMC anesthesiology 19 (2019): 1-10.\u003c/li\u003e\n\u003cli\u003eGuo, Yan‐Xia, et al. \u0026quot;Minimal alveolar concentration of sevoflurane in combination with dexmedetomidine in patients with hysteroscopy: An up‐down sequential allocation study.\u0026quot; Basic \u0026amp; Clinical Pharmacology \u0026amp; Toxicology 131.5 (2022): 364-371.\u003c/li\u003e\n\u003cli\u003eCarollo, Dominic S., Bobby D. Nossaman, and Usha Ramadhyani. \u0026quot;Dexmedetomidine: a review of clinical applications.\u0026quot; Current Opinion in Anesthesiology 21.4 (2008): 457-461.\u003c/li\u003e\n\u003cli\u003eVenn, R. M., et al. \u0026quot;Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit.\u0026quot; Anesthesia 54.12 (1999): 1136-1142.\u003c/li\u003e\n\u003cli\u003ePanzer, Oliver, Vivek Moitra, and Robert N. Sladen. \u0026quot;Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists.\u0026quot; Critical care clinics 25.3 (2009): 451-469.\u003c/li\u003e\n\u003cli\u003eBae, Hong-Beom. \u0026quot;Dexmedetomidine: an attractive adjunct to anesthesia.\u0026quot; Korean Journal of Anesthesiology 70.4 (2017): 375-376.\u003c/li\u003e\n\u003cli\u003eHASPOLAT, Ali, et al. \u0026quot;Kolonoskopi Hastalarında Bilin\u0026ccedil;li Sedasyon ve Analjeziye Nonopioid Bir Yaklaşım; Propofol\u0026ndash;Ketamin (Ketofol).\u0026quot; Journal of Medical Sciences 1.4 (2020): 27-44.\u003c/li\u003e\n\u003cli\u003eCesana, Bruno M., and Franco Cavaliere. \u0026quot;Could the use of a table make power analysis description more reader-friendly?.\u0026quot; Minerva anestesiologica 86.10 (2020): 1003-1005.\u003c/li\u003e\n\u003cli\u003eKim, Doyeon, et al. \u0026quot;Postoperative pain control after the use of dexmedetomidine and propofol to sedate patients undergoing ankle surgery under spinal anesthesia: a randomized controlled trial.\u0026quot; Journal of Pain Research (2019): 1479-1487.\u003c/li\u003e\n\u003cli\u003eChan, Albert Kam Ming, Chi Wai Cheung, and Yeow Kuan Chong. \u0026quot;Alpha-2 agonists in acute pain management.\u0026quot; Expert opinion on pharmacotherapy 11.17 (2010): 2849-2868.\u003c/li\u003e\n\u003cli\u003eGurbet, Alp, et al. \u0026quot;Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements.\u0026quot; Canadian Journal of Anesthesia-Journal Canadien D. Anesthesie 53.7 (2006): 646-652.\u003c/li\u003e\n\u003cli\u003eTekeli, Arzu Esen, et al. \u0026quot;Comparison of dexmedetomidine-propofol and ketamine-propofol administration during sedation-guided upper gastrointestinal system endoscopy.\u0026quot; Medicine 99.49 (2020): e23317.\u003c/li\u003e\n\u003cli\u003eRiachy, Moussa, et al. \u0026quot;A randomized double‐blind controlled trial comparing three sedation regimens during flexible bronchoscopy: Dexmedetomidine, alfentanil and lidocaine.\u0026quot; The clinical respiratory journal 12.4 (2018): 1407-1415..\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;m\u0026uuml;r, Yahya, et al. \u0026quot;Endoskopik Retrograd Kolanjio Pankreato Grafi İşleminde Monitorize Anestezi Bakımında Deksmedetomidin-Propofol ve Remifentanil-Propofol Protokollerinin Karşılaştırılması.\u0026quot; (2016): 32-37.\u003c/li\u003e\n\u003cli\u003eConsales, G., et al. \u0026quot;Bispectral Index compared to Ramsay score for sedation monitoring in intensive care units.\u0026quot; Minerva anestesiologica 72.5 (2006): 329-336.\u003c/li\u003e\n\u003cli\u003ePeveling‐Oberhag, Jan, et al. \u0026quot;Capnography monitoring of non‐anesthesiologist provided sedation during percutaneous endoscopic gastrostomy placement: A prospective, controlled, randomized trial.\u0026quot; Journal of Gastroenterology and Hepatology 35.3 (2020): 401-407.\u003c/li\u003e\n\u003cli\u003eMichael, Florian Alexander, et al. \u0026quot;Evaluation of the Integrated Pulmonary Index\u0026reg; during nonanesthesiologist sedation for percutaneous endoscopic gastrostomy.\u0026quot; Journal of clinical monitoring and computing 35 (2021): 1085-1092.\u003c/li\u003e\n\u003cli\u003eKamibayashi, Takahiko, et al. \u0026quot;Clinical uses of \u0026alpha;2-adrenergic agonists.\u0026quot; The Journal of the American Society of Anesthesiologists 93.5 (2000): 1345-1349.\u003c/li\u003e\n\u003cli\u003ePenttil\u0026auml;, Jani, et al. \u0026quot;Cardiovascular and parasympathetic effects of dexmedetomidine in healthy subjects.\u0026quot; Canadian journal of physiology and pharmacology 82.5 (2004): 359-362..\u003c/li\u003e\n\u003cli\u003eHu, Rong, J. X. Liu, and Hong Jiang. \u0026quot;Dexmedetomidine versus remifentanil sedation during awake fiberoptic nasotracheal intubation: a double-blinded randomized controlled trial.\u0026quot; Journal of anesthesia 27 (2013): 211-217.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Daily Anesthesia, Deep Sedation, Dexmedetomidine, Hysteroscopy, Remifentanil, Propofol, Integrated Pulmonary Index","lastPublishedDoi":"10.21203/rs.3.rs-5199093/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5199093/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePatient safety is important in daily anesthesia practices, and providing deep anesthesia is difficult. There are ongoing debates about the anesthetic agents used today.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To evaluate the results of deep sedoanalgesia with dexmedetomidine in daily anesthesia practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign: \u003c/strong\u003eProspective randomized clinical study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSettings: \u003c/strong\u003eThis study was carried out at Dursun Odabaş Medical Center\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients:\u003c/strong\u003e 80 patients aged 18--65 years, ASA I--II, scheduled for elective hysteroscopic intervention under sedoanalgesia\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain outcome measures:\u003c/strong\u003e The primary aim was to evaluate patients' Ramsey sedation scores, VAS scores, and saturation values under deep sedation. The secondary outcomes were patient, surgeon and anesthesiologist satisfaction and evaluation of hemodynamic parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterventions: \u003c/strong\u003ePatients who agreed to participate in the study were randomized into two groups of 40 patients: Group DP (dexmedetomidine‒propofol) and Group RP (remifentanil‒propofol).\u003c/p\u003e\n\u003cp\u003eA bolus of 1 mg/kg IV propofolwas administered to the patients in theDP group during the procedure. An IV bolus of 1 mcg/kg of 4 mcg/ml isotonic-dexmedetomidine solution was administered for 10 minutes. Then, infusion was started at a dose of 0.4 0.7 mcg/kg/hour.\u003c/p\u003e\n\u003cp\u003eA bolus of 1 mg/kg IV propofol was administered to patients in theRP group at the time of the procedure. A 0.25 mcg/kg I bolus of 20 mcg/ml isotonic-remifentanil solution was administered. Afterward, the infusion was performed at a dose of 0.025–0.1 mcg/kg/minute.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The VAS score and desaturation rate were significantly (p \u0026lt; 0.05) lower in the DP group than in the RP group. The surgeon satisfaction score, patient satisfaction score, anesthesiologist satisfaction scoreand baseline, 1st minute, 5th minute, 10th minute, last measurement, and postop integratedpulmonary index (IPI) values were significantly (p \u0026lt; 0.05) greater in the DP group than in the RP group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eWe believe that dexmedetomidine in combination with propofol can provide adequate anesthesia and analgesia for procedures commonly performed in day-case patients, such as hysteroscopy outside the operating room. Moreover, remifentanil provides more stable hemodynamics than does the combination of propofol and reduces the incidence of hypoxemia by affecting patients’ respiratory function less.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Regıstratıon: \u003c/strong\u003eClinical Trials ID is NCT05674201\u003c/p\u003e","manuscriptTitle":"Sedoanalgesia With Dexmedetomidine in Daily Anesthesia Practices: a Prospective Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 16:50:08","doi":"10.21203/rs.3.rs-5199093/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-07T11:00:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-07T10:52:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-04T04:39:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2024-10-03T14:47:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5492b730-dc38-4d63-922b-44ff38a28267","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-03T16:09:12+00:00","versionOfRecord":{"articleIdentity":"rs-5199093","link":"https://doi.org/10.1186/s12871-025-02918-1","journal":{"identity":"bmc-anesthesiology","isVorOnly":false,"title":"BMC Anesthesiology"},"publishedOn":"2025-01-29 15:57:54","publishedOnDateReadable":"January 29th, 2025"},"versionCreatedAt":"2024-12-17 16:50:08","video":"","vorDoi":"10.1186/s12871-025-02918-1","vorDoiUrl":"https://doi.org/10.1186/s12871-025-02918-1","workflowStages":[]},"version":"v1","identity":"rs-5199093","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5199093","identity":"rs-5199093","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}