Background: The purpose of this study was to compare the safety and efficacy of dexmedetomidine-remifentanil and propofol-remifentanil during monitored anaesthesia care (MAC) for hysteroscopy.
Methods: Seventy female patients undergoing hysteroscopy were randomly assigned to either the dexmedetomidine (Group D) or the propofol (Group P) group. In both groups, remifentanil was infused using a target-controlled-infusion system with a target concentration of 2 ng/ml. The study drug (0.6 ml/kg; dexmedetomidine 2 mg/ml or propofol 4 mg/ml) was loaded for 10 min followed by 0.1-0.5 ml/kg/h to maintain a bispectral index of 60-80 during the procedure. Respiratory depression was defined as SpO2 < 90% or respiratory rate < 8 breaths/min. Intra- and postoperative pain were also evaluated using a numeric rating scale (0-100).
Results: The intraoperative mean arterial pressure (MBP) was significantly higher in Group D only until the start of the operation. The intra- and postoperative heart rate and postoperative MBP were generally lower in Group D. The incidence of respiratory depression was significantly lower in group D (14 [41.2%] vs. 5 [13.9%], P = 0.01, Groups P and D, respectively). Intraoperative pain
(16 ± 27 vs. 7 ± 14, P > 0.05, Groups P and D respectively), postoperative pain
(20 ± 25 vs. 12 ± 21, P > 0.05, Groups P and D, respectively) did not differ between the groups.
Conclusion: We conclude that the combination of dexmedetomidine-remifentanil can reduce the incidence of respiratory depression and provide safer anaesthesia compared with propofol-remifentanil for MAC during hysteroscopy.

Randomised controlled comparison of monitored anaesthesia care using dexmedetomidine-remifentanil vs. propofol-remifentanil during hysteroscopy