Laryngoscope investigative otolaryngology · 2025
Novel Combination Dexmedetomidine and Propofol Anesthetic Regimen for DISE Improves Procedural Efficiency Compared to Single-Agent Regimens.
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Patrick Ryan, Birmingham Ann, Allen Paul, Karelsky Sveta
Аннотация
OBJECTIVES: This study examines a combination anesthetic regimen of propofol and dexmedetomidine during drug induced sleep endoscopy (DISE) and its procedure time, VOTE findings, and perioperative hemodynamic profiles when compared to procedures conducted with either anesthetic agent alone.
METHODS: Retrospective chart analysis of 407 patients undergoing DISE at a single institution with anesthetic regimens of dexmedetomidine alone, propofol alone, or a combination of both. Demographic information, DISE findings via VOTE scoring, and perioperative vital signs and timing intervals were compared.
RESULTS: With respect to operative time, the combination regimen cohort demonstrated an average operative time of 22.1 min, 14% shorter than the dexmedetomidine only (25.8 min; p = 0.0001) and 42% shorter than the propofol only (38.4 min; p = 0.0001) cohorts. Recent intra-system analysis demonstrates a current average DISE time of 14 min with the combination regimen. With respect to perioperative vital sign findings, the combination regimen demonstrated a higher intra- and post-operative minimum heart rate (61.7, 60.9 bpm) compared to the dexmedetomidine regimen (56.9, 56.9 bpm; p = 0.0003, p = 0.0014) and a lower intraoperative O2 nadir (86.0%) than the dexmedetomidine regimen (90.0%, p = 0.0001). With respect to DISE findings, the propofol cohort demonstrated fewer patients with grade 2 tongue base obstruction and a greater portion with compete concentric collapse of the velum as compared to the combination cohort.
CONCLUSION: This novel combination anesthetic regimen of dexmedetomidine and propofol during DISE leads to increased procedural efficiency with preservation of vital sign stability.
LEVEL OF EVIDENCE: 3.
METHODS: Retrospective chart analysis of 407 patients undergoing DISE at a single institution with anesthetic regimens of dexmedetomidine alone, propofol alone, or a combination of both. Demographic information, DISE findings via VOTE scoring, and perioperative vital signs and timing intervals were compared.
RESULTS: With respect to operative time, the combination regimen cohort demonstrated an average operative time of 22.1 min, 14% shorter than the dexmedetomidine only (25.8 min; p = 0.0001) and 42% shorter than the propofol only (38.4 min; p = 0.0001) cohorts. Recent intra-system analysis demonstrates a current average DISE time of 14 min with the combination regimen. With respect to perioperative vital sign findings, the combination regimen demonstrated a higher intra- and post-operative minimum heart rate (61.7, 60.9 bpm) compared to the dexmedetomidine regimen (56.9, 56.9 bpm; p = 0.0003, p = 0.0014) and a lower intraoperative O2 nadir (86.0%) than the dexmedetomidine regimen (90.0%, p = 0.0001). With respect to DISE findings, the propofol cohort demonstrated fewer patients with grade 2 tongue base obstruction and a greater portion with compete concentric collapse of the velum as compared to the combination cohort.
CONCLUSION: This novel combination anesthetic regimen of dexmedetomidine and propofol during DISE leads to increased procedural efficiency with preservation of vital sign stability.
LEVEL OF EVIDENCE: 3.