Edward T Chang1, Victor Certal2,3, Sungjin A Song4, Soroush Zaghi5, Marina Carrasco-Llatas6, Carlos Torre7, Robson Capasso5, Macario Camacho5,8. 1. Division of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI, 96859, USA. etchan78@gmail.com. 2. Department of Otorhinolaryngology/Sleep Medicine Centre, Hospital CUF, Porto, Portugal. 3. CINTESIS Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal. 4. Division of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI, 96859, USA. 5. Department of Otolaryngology-Head and Neck Surgery Division of Sleep Surgery and Medicine, Stanford Hospital and Clinics, Stanford, CA, USA. 6. Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Doctor Peset, 46017, Valencia, Spain. 7. Department of Otolaryngology-Head and Neck Surgery Miller School of Medicine, University of Miami, Miami, FL, USA. 8. Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Redwood City, CA, USA.
Abstract
BACKGROUND: The purpose of the present study is to review the international literature, using a systematic review, for studies comparing propofol and dexmedetomidine for drug-induced sleep endoscopy (DISE) or sedation in which there is a description of the effect of the agents on the upper airway and associated variables (e.g., vital signs, sedation scores). METHODS: This is a systematic review through October 4, 2016. PubMed/MEDLINE and four additional databases were accessed for this study. RESULTS: Two hundred twenty studies were screened, 79 were downloaded, and 10 met criteria. The majority of the studies identified dexmedetomidine as the preferred pharmacologic agent for DISE due to an overall safer and more stable profile based upon hemodynamic stability. However, propofol provided greater airway obstruction with oxygen desaturations. With either agent, the degree of obstruction in the upper airway lacks some degree of validity as to whether the obstructions accurately represent natural sleep or are simply a drug-induced effect. CONCLUSION: Dexmedetomidine and propofol have their advantages and disadvantages during DISE. Generally, dexmedetomidine was preferred and seemed to provide a more stable profile based upon cardiopulmonary status. However, propofol has a quicker onset, has a shorter half-life, and can demonstrate larger degrees of obstruction, which might more accurately reflect what happens during REM sleep. Additional research is recommended.
BACKGROUND: The purpose of the present study is to review the international literature, using a systematic review, for studies comparing propofol and dexmedetomidine for drug-induced sleep endoscopy (DISE) or sedation in which there is a description of the effect of the agents on the upper airway and associated variables (e.g., vital signs, sedation scores). METHODS: This is a systematic review through October 4, 2016. PubMed/MEDLINE and four additional databases were accessed for this study. RESULTS: Two hundred twenty studies were screened, 79 were downloaded, and 10 met criteria. The majority of the studies identified dexmedetomidine as the preferred pharmacologic agent for DISE due to an overall safer and more stable profile based upon hemodynamic stability. However, propofol provided greater airway obstruction with oxygen desaturations. With either agent, the degree of obstruction in the upper airway lacks some degree of validity as to whether the obstructions accurately represent natural sleep or are simply a drug-induced effect. CONCLUSION:Dexmedetomidine and propofol have their advantages and disadvantages during DISE. Generally, dexmedetomidine was preferred and seemed to provide a more stable profile based upon cardiopulmonary status. However, propofol has a quicker onset, has a shorter half-life, and can demonstrate larger degrees of obstruction, which might more accurately reflect what happens during REM sleep. Additional research is recommended.
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