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Year : 2014  |  Volume : 58  |  Issue : 6  |  Page : 789  

Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial


Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Date of Web Publication17-Dec-2014

Correspondence Address:
Dr. Nidhi Arun
Room No. - 05, NMDH, Indira Gandhi Institute of Medical Sciences, Patna - 800 014, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.147191

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How to cite this article:
Arun N, Kumar R. Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial. Indian J Anaesth 2014;58:789

How to cite this URL:
Arun N, Kumar R. Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial. Indian J Anaesth [serial online] 2014 [cited 2019 Dec 15];58:789. Available from: http://www.ijaweb.org/text.asp?2014/58/6/789/147191

Sir,

In the open-label randomised controlled trial on dexmedetomidine versus midazolam for conscious sedation published in Indian Journal of Anaesthesia, Sethi et al. have concluded that dexmedetomidine can be a superior alternative to midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP) based on early recovery, better patient and endoscopist satisfaction score, less complication and better Facial Pain Scale (FPS) score at 5 and 10 min of procedure. [1]

We differ on the use of FPS for assessment of pain during ERCP procedure. It is not only difficult but rather impossible to evaluate pain score in patient with a distorted face due to bite-block and endoscope passing through mouth, by his/her facial expression. We think author should have considered other scoring systems [2],[3] for evaluation of pain such as Behavioural Pain Scale, Colorado Behavioural Numerical Pain Scale and 4-point pain score (1 - no pain, 2 - mild, 3 -moderate and 4 - severe pain), expressed by patient through gestures like showing fingers, as in this study, authors' have aimed at achieving Ramsay sedation score (RSS) of 3-4 with patient able to respond on command. We also disagree with the statement "venous access was secured on non-dominant hand of every individual by 18G/20G cannula". During ERCP, mostly patients are positioned in left lateral position with left hand behind. Hence, practically, during ERCP, the preferred site for venous access is 'non-dependent hand' (i.e., usually right hand), rather than 'non-dominant hand' (i.e., usually left hand).

 
   References Top

1.
Sethi P, Mohammed S, Bhatia PK, Gupta N. Dexmedetomidine versus Midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial. Indian J Anaesth 2014;58:18-24.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Ahlers SJ, van der Veen AM, van Dijk M, Tibboel D, Knibbe CA. The use of the Behavioral Pain Scale to assess pain in conscious sedated patients. Anesth Analg 2010;110:127-33.  Back to cited text no. 2
    
3.
Salmore R. Development of a new pain scale: Colorado Behavioral Numerical Pain Scale for sedated adult patients undergoing gastrointestinal procedures. Gastroenterol Nurs 2002;25:257-62.  Back to cited text no. 3
    




 

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