Phenazepam® and Dexmedetomidine for Planned Percutaneous Coronary Interventions

Abstract

INTRODUCTION: Intraprocedural analgosedation in planned percutaneous coronary interventions is a priority method of anesthesia, since it provides comfort for patient in comparison with when it is absent; it leads to a fast recovery of patients and reduction of the incidence of complications in comparison with the general anesthesia. The question of the optimal sedation method is still open. AIM: To carry out a comparative analysis of sedation with Phenazepam® and Dexmedetomidine in planned percutaneous coronary interventions in patients with stable coronary heart disease. MATERIALS AND METHODS: A prospective randomized study was conducted from September 2021 to January 2022. The study included patients with stable ischemic heart disease (serum troponin T level less than 0.32 ng/ml; absence of anginous pain at the beginning of X-ray endovascular intervention), who had planned percutaneous coronary intervention. The Phenazepam® sedation group included 40 patients, including 30.0% (n = 12) women and 70.0% (n = 28) men. 40 patients were included in the Dexmedetomidine sedation group: 30.0% (n = 12) women, 70.0% (n = 28) men. RESULTS: There was a statistically significant (p < 0.001) reduction of blood pressure and heart rate in patients in the group of sedation with Dexmedetomidine at the stage of stenting of the coronary artery, compared with analogous parameters in the group of sedation with Phenazepam®. Patients in the group of sedation with Dexmedetomidine developed chest pain at the stage of coronary artery stenting reliably 3.13 times less often (p = 0.024) than patients of the group of sedation with Phenazepam® (OR: 0.32; 95% CI: 0.13–0.80). With use of Dexmedetomidine, relief of anginal pain with narcotic analgesics was required 20 times less often (p < 0.001) than with Phenazepam® (OR: 0.05; 95% CI: 0.01–0.38). One can confidently speak about the superiority and safety of analgosedation with Dexmedetomidine in planned percutaneous coronary interventions over sedation with Phenazepam®. CONCLUSIONS: Dexmedetomidine provides deeper sedation and sufficient pain relief in patients in planned percutaneous coronary interventions than Phenazepam®. At the same time, Dexmedetomidine has a more pronounced hypotensive and a negative chronotropic effect.