الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
In the modern medicine, upper gastrointestinal endoscopy has become a definitive tool for diagnosis and management of many diseases. It is usually preformed in separate unit as day-case procedure and for outpatient clinic. The search of a safe and effective sedation for these patients is still an open topic.
In a trial to enhance the experience of the patients and allow better sedation for this procedure, the present study was designed in patients undergoing upper GI endoscopy to compare the sedative effect and the hemodynamic effect of propofol which is usually used for such procedures and the relatively newer agent dexmedetomidine.
80 Patients undergoing upper GI endoscopy were randomly allocated into one of two groups: group 1 received propofol and group 2 received dexmedetomidine. Drugs mentioned in each group were administrated as an induction dose and a maintenance dose till the end of the procedure. Mean arterial blood pressure, heart rate, respiratory rate and peripheral oxygen saturation were measured before and after induction and every 2 minutes till the end of procedure. Time to reach proper sedation which is considered PRST score zero was recorded. Time to reach full recovery which is considered modified Alderete’s score 10 was recorded. Patients and endoscopists were interviewed to measure the satisfaction by both drugs.
The study showed that there was statistically significant difference considering the heart rate in dexmedetomidine associated with lower readings. Respiratory rate and oxygen saturation were insignificantly different in both groups. Time of induction was significantly shorter in propofol than dexmedetomidine and time to reach full recovery identified by modified Alderete’s score 10/10 was significantly shorter in dexmedetomidine than propofol. There was a significant difference between the two dugs concerning the patients and endoscopists satisfaction. The patients were more satisfied with propofol, while the endoscopists were more satisfied with dexmedetomidine.
Dexmedetomidine and propofol are equally effective and safe to provide enough sedation for upper gastrointestinal endoscopy in a day-case manner. Advantages of dexmedetomidine were providing analgesic effect, rapid recovery from sedation and stability of respiratory rate and oxygen saturation. However, there were some disadvantages such as the bradycardia and patient dissatisfaction although the bradycardia can be utilized in cardiac patients as a safety factor against myocardial ischemia. Other point noticed that using dexmedetomidine for sedation was more costly than propofol and requires the usage of a syringe pump for accurate dosing. On the contrary, propofol is cheap and available in all centers with rabid onset of induction but it causes hypotension and respiratory depression which might be risky in cardiac patients.