Intranasal dexmedetomidine in combination with patient‐controlled sedation during upper gastrointestinal endoscopy: a randomised trial

Background Sedation using intranasal dexmedetomidine is a convenient and well‐tolerated technique. This study evaluated the sedative efficacy of intranasal dexmedetomidine in combination with patient‐controlled sedation ( PCS ) for upper gastrointestinal endoscopy. Methods In this double‐blind, randomised, controlled trial, 50 patients received either intranasal dexmedetomidine 1.5 μg/kg (dexmedetomidine group) or intranasal saline (placebo group) 1 h before the procedure. PCS with propofol and alfentanil was provided for rescue sedation. Additional sedative consumption, perioperative sedation scores using O bserver's A ssessment of A lertness/ S edation ( OAA / S ) scale, recovery, vital signs, adverse events and patient satisfaction were assessed. Results Total consumption of PCS propofol and alfentanil was significantly less in the dexmedetomidine than placebo group with a mean difference of −13.8 mg propofol (95% confidence interval −27.3 to −0.3) and −34.5 μg alfentanil (95% confidence interval −68.2 to −0.7) at the completion of the procedure ( P = 0.044). Weighted areas under the curve ( AUC w ) of OAA / S scores were significantly lower in the dexmedetomidine group before, during and after procedures ( P < 0.001, P = 0.024 and P = 0.041 respectively). AUC w of heart rate and systolic blood pressure were also significantly lower during the procedure ( P = 0.007 and P = 0.022 respectively) with dexmedetomidine. There was no difference in recovery, side effects or satisfaction. Conclusion Intranasal dexmedetomidine with PCS propofol and alfentanil confers deeper perioperative clinical sedation with significantly less use of additional sedatives during upper gastrointestinal endoscopy.