Comparison of the sedative effects of dexmedetomidine and propofol using spectral entropy in gastrointestinal endoscopic and colonoscopic procedures

Effective and safe sedation is of paramount importance in gastrointestinal endoscopic procedures to ensure patient comfort and procedural success. Adequate monitoring of sedation depth is critical for preventing potential adverse effects and enhancing procedural efficacy. In recent years, electroencephalography-based spectral entropy monitoring has emerged as a prominent method for objectively assessing sedation depth. This study aimed to compare the sedative efficacy of dexmedetomidine and propofol administered via different protocols, using spectral entropy the Modified Observer's Assessment of Alertness and Sedation Scale (mOAA/S), vital signs, satisfaction scores, and patient comfort scales. A total of 134 patients undergoing upper and lower gastrointestinal endoscopy were included in this prospective observational study. Sedation depth was monitored using response entropy (RE), state entropy (SE), and the mOAA/S scale. Additionally, mean arterial pressure, heart rate, oxygen saturation, end-tidal carbon dioxide levels, Modified Aldrete Score, adverse events, patient and endoscopist satisfaction via Likert scale and patient comfort assessed by the Gloucester Comfort Scale were recorded. According to the findings, the propofol infusion group demonstrated more stable cardiorespiratory parameters, a faster onset of sedation, and higher satisfaction scores. Propofol bolus administration was associated with greater variability in sedation levels and higher total doses of propofol. Dexmedetomidine infusion was linked to a higher incidence of adverse events and an increased need for rescue sedation due to insufficient sedation depth. A strong correlation was observed between entropy values and mOAA/S scores, indicating that both methods reliably reflect sedation depth. In conclusion, propofol infusion appears to be a safe and effective sedation strategy for endoscopic procedures. Sedative agent selection should be individualized based on patient profile, procedure duration, and clinical requirements.