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Propofol and dexmedetomidine in elective procedural sedation – justification for the combined use

The anesthesiologist and specialist on medical emergency conditions

Summary. Procedural sedation (PS) is the technique of administering sedatives with or without analgesics to induce a condition in which the patient can tolerate unpleasant procedures while maintaining cardio-respiratory function.

Planned PSs are performed with procedures of various invasiveness, painfulness and duration, but by definition, they do not reach the depth of general anesthesia and do not require the use of respiratory support or controlled mechanical ventilation, and even more – muscle relaxants. For effective PS, it is extremely important to establish verbal contact with the patient and achieve a stable emotional state of the patient and carefully explain to him the details of the PS.

When choosing the depth of PS, it’s necessary to reach a compromise betweenthe degree of anesthesia and amnesia, on the one hand, and the effectiveness of spontaneous breathing, as well as the possibility of an early recovery of consciousness, on the other. If possible, the problem of pain (when consciousness is partially preserved) or nociceptive stimuli (when the level of consciousness is reduced or absent) is solved separately through the use of local or regional anesthesia.

In addition, non-steroidal anti-inflammatory drugs (NSAIDs) and some other drugs with analgesic properties are often used, and opioid analgesics are avoided or used in small or minimal doses. Unlike anesthesia, even deep sedation cannot and should not completely prevent the patient from moving during intense pain / nociceptive stimuli. If necessary, the problem of patient movements is solved not only and not so much by further deepening sedation, but precisely by improving analgesia and/or fixing the patient for the duration of short-term painful manipulations.

To achieve these goals, PS is most often used propofol, or its dexmedetomidine or midazolam. This publication focuses on the advantages of using a multimodal approach for prolonged PS, which allows for a significant reduction in the dose of corresponding drugs and rate of complications in comparison with sedation with a single anaesthetic at significantly higher doses.

Keywords: procedural sedation, multimodal analgesia, consciousness, depth of sedation, airway patency, propofol, dexmedetomidine.

Authors:

PYLYPENKO M.M., MYKHAYLOV B.V.

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