Domenica Squillaci, Karen Console, Lara Colussi, Valentina Kiren, Marco Rabusin, Gabriele Stocco, Antonella Longo, Paolo Dalena, Egidio Barbi
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This study compares the use of dexmedetomidine and midazolam in terms of propofol dose reduction during procedural sedation in oncology patients.</p><p><strong>Methods: </strong>This one-year retrospective study compared the outcomes of procedural sedation, in terms of propofol-sparing, in 24 pediatric oncology patients who received midazolam (MP group, 52 procedures) or dexmedetomidine (DP group, 51 procedures) as premedication combined with propofol during bone marrow aspiration and/or lumbar puncture procedures. Data on propofol dosage, awakening time, vital parameters, and adverse events were examined.</p><p><strong>Results: </strong>Premedication with dexmedetomidine was associated with a significantly lower dose of propofol than midazolam (2.51 vs. 4.00 mg/kg, p < 0.001). Wake-up times were longer in the DP group (92 vs. 65 min; p = 0.045). Adverse events were very rare in both groups.</p><p><strong>Conclusions: </strong>Dexmedetomidine demonstrates superior propofol-sparing effects compared to midazolam, although it requires longer recovery times. These results support dexmedetomidine as a promising alternative in sedation protocols in pediatric oncology.</p><p><strong>Editorial comment: </strong>This retrospectively analysis of a single center series compared procedural sedation strategies for children involving propofol after standardized intravenous premedication with dexmedetomidine or midazolam. 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Data on propofol dosage, awakening time, vital parameters, and adverse events were examined.</p><p><strong>Results: </strong>Premedication with dexmedetomidine was associated with a significantly lower dose of propofol than midazolam (2.51 vs. 4.00 mg/kg, p < 0.001). Wake-up times were longer in the DP group (92 vs. 65 min; p = 0.045). Adverse events were very rare in both groups.</p><p><strong>Conclusions: </strong>Dexmedetomidine demonstrates superior propofol-sparing effects compared to midazolam, although it requires longer recovery times. These results support dexmedetomidine as a promising alternative in sedation protocols in pediatric oncology.</p><p><strong>Editorial comment: </strong>This retrospectively analysis of a single center series compared procedural sedation strategies for children involving propofol after standardized intravenous premedication with dexmedetomidine or midazolam. 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引用次数: 0
摘要
简介：异丙酚因其快速的镇静作用和良好的恢复特性而被广泛用于肿瘤手术镇静。然而，一些临床前和临床研究已经证明了这种药物的剂量依赖性神经毒性作用。右美托咪定和咪达唑仑是潜在的佐剂，如果用作前用药，可以减少丙泊酚的所需剂量。本研究比较了右美托咪定和咪达唑仑在肿瘤患者手术镇静过程中异丙酚剂量的减少。方法：这项为期一年的回顾性研究比较了24例小儿肿瘤患者在骨髓穿刺和/或腰椎穿刺过程中接受咪达唑仑（MP组，52例）或右美托咪定（DP组，51例）作为异丙酚的前用药联合镇静的结果。检查异丙酚剂量、苏醒时间、重要参数和不良事件的数据。结果：右美托咪定用药前异丙酚剂量明显低于咪达唑仑（2.51 mg/kg vs. 4.00 mg/kg, p）。结论：与咪达唑仑相比，右美托咪定具有更好的异丙酚节约效果，尽管需要更长的恢复时间。这些结果支持右美托咪定作为儿科肿瘤镇静方案的一个有希望的替代方案。编辑评论：本回顾性分析单中心系列比较了标准化静脉前用药右美托咪定或咪达唑仑后使用异丙酚的儿童的程序性镇静策略。研究结果表明，这些剂量的右美托咪定与异丙酚联合使用比用药前剂量的咪达唑仑更能证实镇静效力和持续时间。
Dexmedetomidine Versus Midazolam for Propofol Sparing in Procedural Sedation of Children With Leukemia: A Consecutive Case Series.
Introduction: Propofol is commonly used in procedural sedation in oncology due to its rapid sedative effect and favorable recovery profile. However, several preclinical and clinical studies have demonstrated a dose-dependent neurotoxic effect of this drug. Dexmedetomidine and midazolam are potential adjuvants that, if used as premedication, could reduce the required dose of propofol. This study compares the use of dexmedetomidine and midazolam in terms of propofol dose reduction during procedural sedation in oncology patients.
Methods: This one-year retrospective study compared the outcomes of procedural sedation, in terms of propofol-sparing, in 24 pediatric oncology patients who received midazolam (MP group, 52 procedures) or dexmedetomidine (DP group, 51 procedures) as premedication combined with propofol during bone marrow aspiration and/or lumbar puncture procedures. Data on propofol dosage, awakening time, vital parameters, and adverse events were examined.
Results: Premedication with dexmedetomidine was associated with a significantly lower dose of propofol than midazolam (2.51 vs. 4.00 mg/kg, p < 0.001). Wake-up times were longer in the DP group (92 vs. 65 min; p = 0.045). Adverse events were very rare in both groups.
Conclusions: Dexmedetomidine demonstrates superior propofol-sparing effects compared to midazolam, although it requires longer recovery times. These results support dexmedetomidine as a promising alternative in sedation protocols in pediatric oncology.
Editorial comment: This retrospectively analysis of a single center series compared procedural sedation strategies for children involving propofol after standardized intravenous premedication with dexmedetomidine or midazolam. The findings demonstrated that dexmedetomidine in those doses and in combination with propofol confirmed sedative potency and duration more than that of the chosen midazolam premedication dosing.
期刊介绍：
Acta Anaesthesiologica Scandinavica publishes papers on original work in the fields of anaesthesiology, intensive care, pain, emergency medicine, and subjects related to their basic sciences, on condition that they are contributed exclusively to this Journal. Case reports and short communications may be considered for publication if of particular interest; also letters to the Editor, especially if related to already published material. The editorial board is free to discuss the publication of reviews on current topics, the choice of which, however, is the prerogative of the board. Every effort will be made by the Editors and selected experts to expedite a critical review of manuscripts in order to ensure rapid publication of papers of a high scientific standard.
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