Randomized triple-blind study of dexmedetomidine and remifentanil for endoscopic retrograde cholangiopancreatography

Background

The safety profiles, efficacy, and complication rates of remifentanil and dexmedetomidine for sedation during endoscopic retrograde cholangiopancreatography were investigated.

Methods

Eighty-two patients undergoing elective endoscopic retrograde cholangiopancreatography were randomly assigned to the dexmedetomidine group (Group Dex, n = 39) or the remifentanil group (Group Remi, n = 43). The primary outcome was the incidence of complications and agitation-sedation level during recovery. Hemodynamic variables, adverse events, nausea-vomiting status, amount of propofol consumed, patient, gastroenterologist, and anesthetic clinician satisfaction scores, sedation levels, and discharge times were also compared.

Results

The incidence of complications was significantly lower in the dexmedetomidine group compared to the remifentanil group (P = 0.0115). The incidence of oxygen desaturation was significantly lower in the dexmedetomidine group (P = 0.0409). Mean RASS scores at 5 min post-procedure in the recovery unit were significantly higher in the remifentanil group (P = 0.0054). There were no significant differences between the groups regarding mean arterial pressure, heart rate, nausea-vomiting status, or satisfaction scores of patients, gastroenterologists, and anesthesia clinicians (P > 0.05). There were no significant differences in discharge times and agitation-sedation levels at discharge.

Conclusion

Dexmedetomidine was associated with fewer complications, particularly less oxygen desaturation, during endoscopic retrograde cholangiopancreatography compared to remifentanil. Moreover, the absence of a significant difference in recovery times and satisfaction levels suggests that dexmedetomidine may be superior to remifentanil in non-operating room anesthesia settings.