Comparison of the efficacy and safety of sedation between dexmedetomidine-remifentanil and propofol-remifentanil during endoscopic submucosal dissection

Table 1 Modified observer’s assessment of alertness/sedation

Alertness/sedation level	Description
6	Agitated
5	Respond readily to name spoken in normal tone (alert)
4	Lethargic response to name spoken in normal tone
3	Responds only after name is called loudly, repeatedly, or both
2	Responds only after mild prodding or shaking
1	Does not respond to mild prodding or shaking
0	Does not respond to deep stimulus (asleep)

Table 2 Modified aldrete scoring system

Discharge criteria	Score
Activity: Able to move voluntarily or on command
Four extremities	2
Two extremities	1
Zero extremities	0
Respiration
Able to deep breathe and cough freely	2
Dyspnea, shallow or limited breathing	1
Apneic	0
Circulation
Blood pressure ± 20 mmHg of preanesthetic level	2
Blood pressure ± 20 - 50 mmHg preanesthetic level	1
Blood pressure ± 50 mmHg of preanesthetic level	0
Consciousness
Fully awake	2
Arousable on calling	1
Not responding	0
O2 saturation
Able to maintain O2 saturation > 92% on room air	2
Needs O2 inhalation to maintain O2 saturation > 90%	1
O2 saturation < 90% even with O2 supplementation	0

Table 3 Evaluation of gastric motility

Grade of gastric motility
No
No or very weak gating movement of the pyloric ring is observed, but the movement does not show strong contraction
→ No peristalsis
Mild
A circular peristaltic wave is formed in the antrum but disappears without reaching the pyloric ring, or circular contraction temporarily occurs immediately before the pyloric ring
→ Peristaltic wave does not reach the pyloric ring
Moderate
A pronounced peristaltic wave is formed and reaches the pyloric ring
→ Peristaltic wave reached the pyloric ring, which opens and closes, showing star-like contraction as a result of the peristaltic wave
Vigorous
Peristaltic wave is deep and pronounced and proceeds, strangulating the antrum
→ Peristaltic wave reaches the pyloric ring, and the pyloric ring is totally covered by the wave, the area exhibiting star-like contraction protrudes toward the opening of the pyloric ring, and the mucosa is pushed out from the central part of the opening

Table 4 Patient characteristics

	DR group(n = 29)	PR group(n = 30)	P value
Age (yr)	62.1 ± 10.3	62.9 ± 12.3	0.763
Male	19 (65.5)	22 (73.3)	0.514
Height (cm)	162.2 ± 7.7	164.8 ± 5.8	0.274
Weight (kg)	62.8 ± 8.5	65.1 ± 10.2	0.276
ASA classification n (%)			0.390
I	19 (65.5)	15 (50.0)
II	9 (31.0)	12 (40.0)
III	1 (3.4)	3 (10.0)
Snoring history	9 (31.0)	7 (23.3)	0.506

Values are presented as the mean ± SD or frequency (percentage). DR group: Indicates dexmedetomidine-remifentanil group; PR group: Propofol-remifentanil group; ASA: American society of anesthesiologists.

Table 5 Tumor characteristics n (%)

		DR group(n = 29)	PR group(n = 30)	P value
Number of lesion		36	32
Histology	Adenoma	19 (52.8)	17 (53.1)	0.995
	Carcinoma	16 (44.4)	14 (43.8)
	Others	1 (2.8)	1 (3.1)
Macroscopic appearance	Elevated	32 (88.9)	27 (84.4)	0.584
	Flat or depressed	4 (11.1)	5 (15.6)
Location	Upper body	3 (8.3)	3 (9.4)	0.945
	Middle body	8 (22.2)	8 (25.0)
	Lower body	25 (69.4)	21 (65.6)
Size (mm)		15.7 ± 7.0	14.0 ± 6.7	0.344

Values are presented as the mean ± SD or frequency (percentage).

Table 6 Drugs used for endoscopic submucosal dissection

	DR group(n = 29)	PR group(n = 30)	P value
Sedation duration (min)	42.8 ± 26.7	37.6 ± 18.5	0.477
Dexmedetomidine infusion rate (μg/kg per hour)	0.5 ± 0.3
Propofol infusion rate (μg/kg per minute)		23.8 ± 16.5
Remifentanil infusion rate (μg/kg per hour)	5.7 ± 1.4	6.3 ± 4.0	0.451
Additional propofol required
Patients	8 (27.6)	3 (10.0)	0.083
Dose (mg)	16.9 ± 10.3	13.3 ± 5.8	0.596
Butylscopolamine use
Patients	4 (13.8)	10 (33.3)	0.078
Dose (mg)	3.4 ± 9.3	10.0 ± 16.4	0.066

Values are presented as the mean ± SD or frequency (percentage).

Table 7 Efficacy of procedural performance

	DR group(n = 29)	PR group(n = 30)	P value
Advancing scope into throat			0.010
Very easy	7 (24.1)	17 (56.7)
Easy	14 (48.3)	12 (40.0)
Slight difficult	1 (3.4)	1 (3.3)
Difficult	7 (24.1)	0 (0.0)
Gastric motility			0.101
No	21 (72.4)	16 (53.3)
Mild	7 (24.1)	6 (20.0)
Moderate	1 (3.4)	7 (23.3)
Vigorous	0 (0.0)	1 (3.3)
Low: No + mild	28 (96.6)	22 (73.3)	0.013
High: Moderate + vigorous	1 (3.4)	8 (26.7)
Endoscopist’s satisfaction			0.216
Very good	21 (72.4)	17 (56.7)
Good	8 (27.6)	9 (30.0)
Fair	0 (0.0)	2 (6.7)
Bad	0 (0.0)	2 (6.7)
Favorable: Very good + good	29 (100.0)	26 (86.7)	0.042
Unfavorable: Fair + bad	0 (0.0)	4 (13.3)
Patients’ satisfaction of sedation			0.616
Very good	4 (13.8)	7 (23.3)
Good	21 (72.4)	20 (66.7)
Bearable	4 (13.8)	3 (10.0)
Unbearable	0 (0.0)	0 (0.0)

Values are presented as frequency (percentage). The gastric motility and endoscopists’ satisfaction were reclassified as low (no + mild) or high (moderate + vigorous) and favorable (very good + good) or unfavorable (fair + bad), respectively.