Application of Alfentanil Combined With Dexmedetomidine for Conscious Sedation of Patients During Transesophageal Echocardiography Examination.

Abstract

Objectives: To investigate the efficacy and safety of combining alfentanil with dexmedetomidine for conscious sedation in outpatients undergoing transesophageal echocardiography (TEE).

Design: Prospective, randomized, double-blind clinical trial.

Setting: University-affiliated teaching hospital.

Participants: We recruited 80 patients scheduled to undergo transesophageal echocardiography examinations from May 2023 to July 2023.

Interventions: Eighty patients were randomly assigned into 2 groups, namely, the alfentanil + dexmedetomidine (AD) group (n = 40) and the oropharyngeal topical anesthesia with dyclonine + midazolam + dexmedetomidine (MD) group (n = 40).

Measurements and main results: Suppression of the patient's pharyngeal reflexes was assessed, and the hemodynamic parameters, along with the incidence of intraoperative adverse events, were also documented. The primary outcome was the initial sedation success rate, defined as achieving a pharyngeal reflex grade of less than 3, no excessive sedation (Ramsay sedation scores >4), and no serious adverse effects. This rate was significantly higher in the AD group (85%) compared with the MD group (35%) (p < .001). Compared with the MD group (47.5%), the incidence of hypotension in AD group (25.0%) decreased significantly (p < .05). Although the incidence of respiratory depression in AD group (42.5%) was higher than that in MD group (15.0%) (p < .01), no hypoxia and asphyxia occurred in either group. The recovery time of AD group (626.25 ± 295.80) was significantly shorter than that of MD group (768.33 ± 310.43) (p < .05). No serious complications occurred in either group.

Conclusions: Intravenous alfentanil combined with dexmedetomidine effectively inhibits pharyngeal reflexes and demonstrates a favorable safety profile, with fewer incidents of hypotension but a higher incidence of manageable respiratory depression compared with the MD protocol.