ABSTRACT
Dexmedetomidine provides sedation with minimal respiratory depression which is a desirable characteristic in patients with obstructive sleep apnea [OSA]. This observational study prospectively evaluated the efficacy and safety of dexmedetomidine/ propofol anesthesia for patients with OSA characteristics without endotracheal intubation during upper gastrointestinal [GI] endoscopy. Twenty patients undergoing upper GI endoscopy who were considered high probability of having OSA based on an adjusted neck circumference greater than 48 were enrolled in the study. Dexmedetomidine 1 meg/kg bolus was given over 10 min followed by propofol boluses until adequate depth of anesthesia was achieved. Propofol infusion was used to maintain anesthesia. Blood pressure, heart rate, and O2 saturation were recorded before, during, and after the procedure. The endoscopists evaluated the anesthesia condition on a 10 points numerical scale. Post-Anesthesia Care Unit [PACU] time was recorded. The following day, patients were questioned about complications and were asked to evaluate their overall anesthesia experience on a 10 points numerical scale. Fifteen males and five females aged 51 +/- 8 years were enrolled. Their BMI was 34.7 +/- 8.4, and their adjusted neck circumference was 53.4 +/- 3.4. Propofol induction dose was 0.8 +/- 0.4 mg/kg; and PACU time was 67.5 +/- 26.7 min. Two patients developed transient hypoxemic episodes during the procedure. Transient hypotension was experienced by three patients during the procedure and three patients in PACU. The evaluation score was 9 +/- 1.7 by the endoscopists, and 8 i 2.3 by the patients. After discharge, 16 patients complained of drowsiness, two patients reported dysphoric symptoms, and one patient complained of dry mouth. Dexmedetomidine / propofol combination can provide satisfactory anesthesia for upper GI endoscopy in OSA patients. The technique provides an alternative to endotracheal intubation in these high risk patients. The prolonged induction and recovery times, however, may limit its routine use