Safety and efficacy of combined sedation with dexmedetomidine and midazolam for endoscopic retrograde cholangiopancreatography in patients over 80 years of age

Abstract Background: This study aimed to evaluate the safety and efficacy of using a combination of dexmedetomidine (DEX) and midazolam (MDZ) for sedation in patients over 80 years of age during endoscopic retrograde cholangiopancreatography (ERCP).Methods: Thirty-two patients over 80 years of age who were scheduled to undergo ERCP from June 2020 to February 2021 at the International University of Health and Welfare Atami Hospital were included. Seventeen patients who received DEX + MDZ for sedation during ERCP were compared with a historical control group (patients who received MDZ alone). In addition, the safety and efficacy of sedation were evaluated using between-group comparisons.Results: The MDZ dose required in the DEX + MDZ group was significantly lower than in the historical control group (8.5 mg vs. 18 mg, p<0.001). There was no significant difference in respiratory depression between the two groups (0% vs. 6.9%, p=0.585). During and after the examination, the minimum systolic blood pressure and minimum heart rate were significantly lower in the DEX + MDZ group than in the historical control group. However, serious complications were not observed.Conclusions: The results indicate that the DEX + MDZ combination is potentially safe and effective in sedating the elderly and does not cause serious complications.