Low-Dose Dexmedetomidine Reduces Median Effective Doses of Propofol Required for Successful Gastroscope Insertion: A Prospective Randomized Controlled Dose-Finding Trial.

IF 2.6 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics

Therapeutics and Clinical Risk Management Pub Date : 2026-01-12 eCollection Date: 2026-01-01 DOI:10.2147/TCRM.S571057

Qian Zhu, Pei-Pei Hao, Ling-Li Cui, Fu-Kun Liu, Fu-Shan Xue

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Abstract

Purpose: Patients undergoing painless gastrointestinal endoscopy (GIE) typically receive propofol-based sedation. However, the exact dose of propofol when combined with low-dose dexmedetomidine for this procedure remains unclear. The objective of this study was to determine and compare the median effective doses (ED₅₀, the doses required for successful gastroscope insertion in 50% of the subjects) of propofol when used with low-dose dexmedetomidine (0.3 µg/kg) premedication versus propofol alone during painless GIE.

Patients and methods: Adult outpatients aged 18 to 65 years scheduled for GIE were enrolled. Participants were randomized to receive either 0.9% saline (Group S) or 0.3 µg/kg of dexmedetomidine (Group D) intravenously over 5 min before induction with propofol. Using modified Dixon's up-and-down method (MDUDM), the initial induction dose of propofol was 1.5 mg/kg, adjusted in a step size of 0.1 mg/kg. ED₅₀ of propofol required for successful endoscope insertion was calculated by averaging the midpoints of all sequential crossovers. Using isotonic regression analysis, ED₅₀ and ED₉₅ (the effective doses required for successful gastroscope insertion in 95% of the subjects) were then extrapolated. All adverse events during painless GIE were recorded.

Results: Thirty patients were enrolled per group. Using MDUDM, the ED₅₀ of propofol for successful gastroscope insertion was significantly lower in Group D (1.48 ± 0.10 mg/kg) than in Group S (1.82 ± 0.16 mg/kg; P < 0.001). The ED₅₀ and ED₉₅ of propofol were extrapolated to 1.80 mg/kg (83% confidence interval [CI], 1.649-1.882) and 2.10 mg/kg (83% CI, 2.081-2.124) for Group S, respectively, using isotonic regression analysis. These values were significantly lower in Group D, at 1.40 mg/kg (83% CI, 1.297-1.452) and 1.70 mg/kg (83% CI, 1.667-1.753).

Conclusion: Premedication with low-dose dexmedetomidine (0.3 µg/kg) significantly reduces the median effective doses of propofol required for successful gastroscope insertion during painless GIE.

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低剂量右美托咪定降低成功插入胃镜所需异丙酚的中位有效剂量：一项前瞻性随机对照剂量发现试验。

目的：接受无痛胃肠道内镜检查（GIE）的患者通常接受基于异丙酚的镇静。然而，异丙酚与低剂量右美托咪定联合使用的确切剂量尚不清楚。本研究的目的是确定并比较在无痛性胃肠移植手术中，异丙酚与低剂量右美托咪定（0.3 μ g/kg）联合用药与单独使用异丙酚时的中位有效剂量（ED50, 50%受试者成功插入胃镜所需的剂量）。患者和方法：入选年龄在18 - 65岁、计划进行GIE治疗的成年门诊患者。参与者随机接受0.9%生理盐水（S组）或0.3µg/kg右美托咪定（D组），在异丙酚诱导前5分钟静脉注射。采用改良的Dixon上下法（MDUDM），异丙酚初始诱导剂量为1.5 mg/kg，调整步长为0.1 mg/kg。成功插入内窥镜所需的异丙酚ED50通过平均所有连续交叉的中点来计算。使用等渗回归分析，ED50和ED95（95%的受试者成功插入胃镜所需的有效剂量）被外推。记录无痛GIE期间的所有不良事件。结果：每组入组30例。使用MDUDM时，D组异丙酚成功插入胃镜的ED50（1.48±0.10 mg/kg）明显低于S组（1.82±0.16 mg/kg, P < 0.001）。采用等渗回归分析，S组异丙酚的ED50和ED95分别为1.80 mg/kg（83%置信区间[CI] 1.649 ~ 1.882）和2.10 mg/kg （83% CI, 2.081 ~ 2.124）。这些数值在D组显著降低，分别为1.40 mg/kg （83% CI, 1.297-1.452）和1.70 mg/kg （83% CI, 1.667-1.753）。结论：术前应用低剂量右美托咪定（0.3µg/kg）可显著降低无痛GIE手术中成功插入胃镜所需异丙酚的中位有效剂量。

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.