A COMPARATIVE STUDY OF PROPOFOL VERSUS PROPOFOL COMBINED WITH DEXMEDETOMIDINE IN DRUG-INDUCED SLEEP STUDIES
Main Article Content
Keywords
Propofol, Dexmedetomidine, Drug-induced sleep endoscopy, Sedation, Obstructive sleep apnea, Airway collapse
Abstract
Background: Drug-induced sleep endoscopy (DISE) is a diagnostic procedure used to evaluate upper airway obstruction in patients with suspected obstructive sleep apnea (OSA). Propofol is the most commonly used agent; however, it may exaggerate airway collapse due to its muscle-relaxant properties. Dexmedetomidine, known for preserving upper airway tone, is being investigated in combination with propofol to improve the accuracy and safety of DISE.
Aim: To compare the efficacy, airway dynamics, hemodynamic stability, and safety of propofol alone versus propofol combined with dexmedetomidine during DISE.
Methods: A prospective randomized controlled study was conducted on 60 adult patients undergoing DISE. Patients were divided into two groups. Group P received intravenous propofol titrated to achieve a BIS of 60–80. Group PD received a dexmedetomidine bolus (1 mcg/kg over 10 minutes) followed by titrated propofol. Parameters studied included level and pattern of airway collapse, hemodynamic responses, sedation scores, adverse events, and recovery characteristics. Results: Both regimens provided adequate sedation. Group PD had improved visualization of airway structures and more stable hemodynamic parameters. There was a statistically significant reduction in complete concentric collapse at the level of the soft palate in Group PD compared to Group P. Recovery times were longer in the combination group. Patient satisfaction scores were higher in Group PD.
Conclusion: The combination of dexmedetomidine and propofol offers superior airway visualization and hemodynamic stability compared to propofol alone, although recovery may be prolonged. It represents a safe and effective alternative in drug-induced sleep studies, especially in patients at risk for exaggerated airway collapse.
References
2. Kezirian E.J., “Drug-induced sleep endoscopy,” Otolaryngologic Clinics of North America, 2011, 44(3): 691–706.
3. Capasso R., Rosa T., Tsou D.Y., Guilleminault C., “Propofol effects on pharyngeal collapsibility during drug-induced sleep endoscopy,” The Laryngoscope, 2016, 126(2): 519–524.
4. Cattano D., Killoran P., Cai C., Katsiampoura A.D., Corso R.M., Hagberg C.A., “Propofol sedation: incidence of hypotension and respiratory depression,” Anesthesia & Analgesia, 2011, 112(4): 741–746.
5. Mahmoud M., Mason K.P., “Dexmedetomidine and propofol sedation for procedures outside the operating room,” Current Opinion in Anesthesiology, 2013, 26(4): 442–447.
6. Cho S.H., Kim D.W., Jeon Y.S., “Comparison of dexmedetomidine and propofol sedation during sleep endoscopy in patients with obstructive sleep apnea,” Clinical and Experimental Otorhinolaryngology, 2015, 8(1): 36–41.
7. Mahdy A.M., Elhadi A.A., Abdelwahab M.S., “Sedation with dexmedetomidine in sleep endoscopy: Effects on airway dynamics and safety,” Egyptian Journal of Anaesthesia, 2018, 34(2): 81–87.
8. Hillman D.R., Walsh J.H., Maddison K.J., Kirkness J.P., Walsh C.L., Eastwood P.R., “The upper airway during anesthesia and sleep: implications for obstructive sleep apnea,” Clinical Chest Medicine, 2009, 30(2): 525–536.
9. Yoon H.S., Lee H.C., Lee J.H., “Recovery profile of dexmedetomidine versus propofol in upper airway assessment,” Korean Journal of Anesthesiology, 2017, 70(1): 48–54.
10. Yoon B.W., Lee Y.S., Han J.J., Kim Y.H., “Sedative agents in drug-induced sleep endoscopy: balancing efficacy and safety,” Sleep and Breathing, 2016, 20(1): 373–379.
11. Hillman D.R., Walsh J.H., Maddison K.J., et al., “The effect of sedation on upper airway collapsibility in obstructive sleep apnea,” American Journal of Respiratory and Critical Care Medicine, 2009, 180(3): 241–246.
12. Mahmoud M., Schibler A., Hammer G.B., et al., “Dexmedetomidine: Review of a Sedative and Analgesic Agent for Use in Critically Ill Children,” Pediatric Critical Care Medicine, 2009, 10(2): 205–212.
13. Mahmoud M., Mason K.P., Sanborn P.A., et al., “Dexmedetomidine and propofol sedation for pediatric MRI: A retrospective review of efficacy and safety,” British Journal of Anaesthesia, 2010, 104(4): 454–458.
14. Barends C.R., Absalom A.R., van Minnen B., et al., “Dexmedetomidine versus midazolam in procedural sedation. A systematic review of efficacy and safety,” PLoS ONE, 2017, 12(1): e0169525.
15. Koroglu A., Demirbilek S., Teksan H., et al., “Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: Preliminary results,” British Journal of Anaesthesia, 2005, 94(6): 821–824.
16. Yoon S.Y., Kim J.Y., Lee S.H., et al., “Sedation and recovery characteristics of dexmedetomidine compared with propofol for conscious sedation during upper gastrointestinal endoscopy,” Journal of Clinical Anesthesia, 2011, 23(6): 479–483.
17. Capasso R., Rosa T., Tsou D.Y., et al., “Effects of sedation with propofol and dexmedetomidine on airway collapsibility in patients with obstructive sleep apnea,” The Laryngoscope, 2016, 126(4): 977–982.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Sylph Tajamul
MD, Anaesthesiology and Critical Care, Government Medical College Anantnag, Jammu and Kashmir, India
Dr. Sajad Ahmed Baba
Dnb Resident, Department of Anaesthesiology and Critical care, Government Medical College Anantnag, Jammu and Kashmir, India