Lidocaine and dexmedetomidine combined infusion as an alternative to propofol for sedation in colonoscopy

Abstract

Background Colonoscopy is one of the commonly performed procedures for the diagnosis of colonic disorders. Several sedation regimens are administered during colonoscopy. To date, the propofol-based sedation regimen is commonly used, although it may have some risks. I studied the efficacy of dexmedetomidine–lidocaine combination as a substitution for propofol for sedation in colonoscopy procedures. It is a prospective randomized controlled study; 62 patients were recruited and divided into two equal groups: group P is the propofol group which included patients who received sedation with IV propofol using a loading dose of 50–100 mg of propofol and were continued on propofol IV infusion 25–75 μg/kg/min and group D-L is the dexmedetomidine–lidocaine group where patients received a loading dose of dexmedetomidine 1 μg/kg infused over 10 min followed by infusion of dexmedetomidine 0.2–0.7 μg/kg/h and lidocaine 1 mg/kg IV followed by an infusion of 1.5 mg/kg/h. The primary outcome was the median patients’ satisfaction scores after recovery assessed by the Likert 5-item scoring system. Other outcomes included postprocedure pain score, mean arterial blood pressure, saturation, heart rate during the procedure, amount of fentanyl and midazolam used during the procedure, and the number of apneic attacks. Results Patients in both groups were satisfied by the procedure, and the median and 1st–3rd IQ satisfaction scores were 5 (4.0–5.0) in group P and 4 (4.0–5.0) in group D-L; however, this difference was statistically significant (P value = 0.014), reflecting more satisfaction in patients who received propofol. Patients in group D-L required significantly more doses of midazolam and fentanyl to achieve an adequate sedation score, had a more significant drop in heart rate, and had significantly more postoperative pain scores than those in group P. Patients in group P had significantly more apneic attacks and lower intraprocedural oxygen saturation levels than those in group D-L. Conclusion Dexmedetomidine–lidocaine combined IV infusion was found to be effective and safe for sedation in colonoscopy with less side effects in terms of apneic attacks and desaturation, although patient satisfaction was significantly higher in the propofol group, yet as per the sedation scores this was considered to be clinically non-significant. Trial registration The study was registered by the Australian New Zealand Clinical Trials Registry (trial ID: 12620000249954).