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. 2024 Sep-Oct;38(5):2425-2433.
doi: 10.21873/invivo.13711.

Propofol Versus Dexmedetomidine for Conscious Sedation During Vaginal Hysterectomy With Pre-emptive Local Anesthesia: A Prospective Cohort Study

Sofia Hadzilia  1 , Themos Grigoriadis  2 , Anastasia Prodromidou  2 , Emmanouil Stamatakis  3 , Dimitra Papadopoulou  3 , Dimitrios Zacharakis  2 , Stavros Athanasiou  2 , Dimitrios Valsamidis  3
Affiliations

Propofol Versus Dexmedetomidine for Conscious Sedation During Vaginal Hysterectomy With Pre-emptive Local Anesthesia: A Prospective Cohort Study

Sofia Hadzilia et al. In Vivo. 2024 Sep-Oct.

Abstract

Background/aim: Hysterectomy is the most frequent gynecological surgery. Vaginal hysterectomy (VH) seems to be related to favorable perioperative outcomes compared to abdominal or laparoscopic approaches. As the population ages, anesthesia that is safer for the elderly, such as local anesthesia (LA) with conscious sedation, is gaining popularity and is related to favorable outcomes in patients' recovery compared to general or regional anesthesia. We aimed to evaluate the efficacy of dexmedetomidine versus propofol for women undergoing VH for uterine prolapse under LA and conscious sedation.

Patients and methods: A prospective study on 40 women with uterine prolapse stage ≥3 who had VH under LA with conscious sedation under either dexmedetomidine (n=20) or propofol (n=20) was performed. A standardized surgical approach with continuous hemodynamic monitoring and sedation assessment using the Ramsay Sedation Scale (RSS) was conducted. The primary endpoint of the study was to determine the percentage of patients receiving intraoperative fentanyl.

Results: Analysis of outcomes demonstrated a significant reduction in the proportion of patients requiring intraoperative rescue fentanyl (35% vs. 5%, respectively, p=0.04) and in postoperative pain scores, with more patients achieving an optimal RSS score of 3 in the dexmedetomidine group.

Conclusion: Based on the findings of the present study, dexmedetomidine offered superior analgesia and patient comfort compared to propofol, suggesting a favorable anesthetic profile for VH under LA.

Keywords: Dexmedetomidine; conscious sedation; local anesthesia; propofol; vaginal hysterectomy.

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Conflict of interest statement

The Authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Ramsay Sedation Scale (RSS) scores of patients receiving propofol vs. those receiving dexmedetomidine at all operation times.
Figure 2
Figure 2. Percentage of patients with an absolute change of systolic blood pressure ≥20% from baseline.
Figure 3
Figure 3. Percentage of patients with an absolute change of diastolic blood pressure ≥20% from baseline.
Figure 4
Figure 4. Percentage of patients with an absolute change of mean blood pressure ≥20% from baseline.
Figure 5
Figure 5. Percentage of patients with an absolute change of heart rate ≥20% from baseline.
See this image and copyright information in PMC

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