A randomized double‐blind controlled trial comparing three sedation regimens during flexible bronchoscopy: Dexmedetomidine, alfentanil and lidocaine

Riachy, Moussa; Khayat, G.; Ibrahim, Ihab; Aoun, Zeina; Dabar, Georges; Bazarbachi, T.; Khalil, Nadine; Habr, Bassem

doi:10.1111/crj.12669

Cited by 23 publications

(30 citation statements)

References 32 publications

(38 reference statements)

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“… 29 In the study by Altermatt et al, the findings also demonstrate that IV lidocaine can reduce propofol requirements during surgical stimulation and further confirm that the propofol-sparing effects of IV lidocaine are not related to pharmacokinetic interactions between propofol and lidocaine. 30 Another possible explanation for this finding is that lidocaine does not cause respiratory inhibition and dilates bronchial smooth muscle, 31 – 33 thereby preventing airway reactivity on emergence in obese patients. Additionally, IV lidocaine could induce a stimulation of the ventilatory response to carbon dioxide.…”

Section: Discussionmentioning

confidence: 99%

<p>Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study</p>

Li¹,

Lv²,

Jiang³

et al. 2020

DDDT

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Propofol for procedural sedation and analgesia (PSA) for colonoscopy can result in a high prevalence of severe respiratory depression. Studies have shown that intravenous (IV) infusion of lidocaine can reduce propofol requirements significantly and increase the ventilatory response to carbon dioxide in humans. We tested the hypothesis that IV lidocaine could improve propofol-induced respiratory depression in obese patients during colonoscopy. Methods: Ninety obese patients scheduled for painless colonoscopy were randomized to receive lidocaine (1.5 mg/kg, then 2 mg/kg/h, IV) or the same volume of 0.9% saline. Intraoperative sedation was provided by propofol. The primary outcome was the number of oxygen-desaturation episodes. Secondary outcomes were: the number of apnea episodes; total propofol consumption; time to the first hypoxia episode; time to consciousness loss; intraoperative hemodynamic parameters; awakening time; adverse events; duration of postanesthesia care unit (PACU) stay; satisfaction of endoscopists and patients. Results: Demographic characteristics between the two groups were comparable. The number of oxygen-desaturation episodes in group L (1.49±1.12) decreased by 0.622 (P=0.018) compared with that in group N (2.11±1.32), and the number of apnea episodes in group L decreased by 0.533 (P<0.001). Kaplan-Meier curves showed that the median time to the first hypoxia episode was longer in group L (86.78 s) than that in group N (63.83 s) (Log rank P=0.0008). The total propofol consumption, awakening time, and duration of PACU stay were reduced in group L. There was no significant difference in the prevalence of adverse events (P>0.05 for all). Satisfaction scores for endoscopists and patients in group L were higher than that in group N (P<0.001). Conclusion: Intravenous infusion of lidocaine could significantly reduce the number of oxygen-desaturation and apnea episodes in obese patients during painless colonoscopy. This method is worthy of clinical promotion. Clinical Trials Registration: ChiCTR2000028937.

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Section: Discussionmentioning

confidence: 99%

<p>Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study</p>

Li¹,

Lv²,

Jiang³

et al. 2020

DDDT

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“…Older studies comparing alfentanil and midazolam sedation have shown that alfentanil sedation results in less cough, but not necessarily less discomfort or improved ease of the procedure 21 22. The trial comparing alfentanil to placebo did not find a statistically significant difference in cough, and did not address subject discomfort 20. Sedation was not randomised in our study, but offered to all.…”

Section: Discussionmentioning

confidence: 68%

“…Bronchoscopy sedation with alfentanil has only recently been compared with placebo or dexmedetomidine in a relatively small randomised controlled trial. The authors reported more events of hypoxaemia and heart rate changes in the alfentanil group, but present few clinically significant differences between the groups 20. Older studies comparing alfentanil and midazolam sedation have shown that alfentanil sedation results in less cough, but not necessarily less discomfort or improved ease of the procedure 21 22.…”

Section: Discussionmentioning

confidence: 96%

Complications and discomfort after research bronchoscopy in the MicroCOPD study

et al. 2020

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background Data on discomfort and complications from research bronchoscopy in chronic obstructive pulmonary disease (COPD) and asthma is limited. We present complications and discomfort occurring within a week after bronchoscopy, and investigate personal and procedural risk factors. Methods 239 subjects with COPD, asthma or without lung disease underwent research bronchoscopies as part of a microbiome study of the lower airways (the MicroCOPD study). Bronchoscopy was done in the supine position with oral scope insertion with the option of light conscious alfentanil sedation. Sampling consisted of protected specimen brushes, bronchoalveolar lavage, small volume lavage and for some, endobronchial biopsies. Bleeding, desaturation, cough, haemodynamic changes, dyspnoea and other events that required an unplanned intervention or early termination of bronchoscopy were prospectively recorded. Follow-up consisted of a telephone interview where subjects rated discomfort and answered questions about fever sensation and respiratory symptoms in the week following bronchoscopy. results An unplanned intervention or early termination of bronchoscopy was required in 25.9% of bronchoscopies. Three subjects (1.3%) experienced potentially severe complications, of which all recovered without sequelae. COPD subjects experienced more dyspnoea than controls. Sedation and lower age was associated with less unplanned intervention or premature termination. About half of the subjects (47.7%) reported fever. Discomfort was associated with postprocedural fever, dread of bronchoscopy, higher score on the COPD Assessment Test and never-smoking. In subjects undergoing more than one bronchoscopy, the first bronchoscopy was often predictive for complications and postprocedural fever in the repeated bronchoscopy. conclusion Research bronchoscopies were not associated with more complications or discomfort in COPD subjects. 47.7% experienced postbronchoscopy fever sensation, which was associated with discomfort.

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“…These findings may be attributable to the ability of dexmedetomidine to selectively inhibit the activation of the central nervous system and peripheral a2 adrenergic receptors, which reduce sympathetic nerve activity and abnormally increase blood pressure and heart rate under stress to maintain hemodynamic stability. 15 Riachy et al 15 previously reported a comparison of dexmedetomidine with other sedation regimens and proposed a protocol as a first step towards standardizing sedation practices in flexible bronchoscopy, which may be adopted in further studies to optimize treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Observation of the clinical efficacy of dexmedetomidine in flexible bronchoscopy under general anesthesia: clinical case experience exchange

Zhang

et al. 2019

J Int Med Res

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Object To investigate the clinical efficacy and safety of dexmedetomidine in flexible bronchoscopy under general anesthesia. Methods A total of 114 patients were randomly divided into intervention group A and control group B. Group A received dexmedetomidine, fentanyl, and propofol as anesthesia, while Group B received fentanyl and propofol only. Changes in heart rate, mean arterial pressure, pulse oxygen saturation, stress indices (blood cortisol, adrenaline, and norepinephrine levels), incidence of adverse events, anesthesia dose, duration of procedure, and recovery time were compared between the groups at specific time points T0, T1, and T2 during bronchoscopy. Results There was no statistical difference between the groups at T0. At T1 and T2, pulse oxygen saturation, mean arterial pressure, heart rate, and stress indices in group A were significantly more favorable than those in group B. The incidence of adverse events (5.26%) in group A was significantly lower than that in group B (17.54%), and patients in group A required less propofol and had a faster recovery time than patients in group B. Conclusion Dexmedetomidine use in flexible bronchoscopy under general anesthesia is safe and effective and decreases the stress response in synergy with propofol to provide hemodynamic stability.

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A randomized double‐blind controlled trial comparing three sedation regimens during flexible bronchoscopy: Dexmedetomidine, alfentanil and lidocaine

Abstract: Introduction: No standardized sedation protocol is available for flexible bronchoscopy (FB).

Cited by 23 publications

References 32 publications

<p>Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study</p>

<p>Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study</p>

Complications and discomfort after research bronchoscopy in the MicroCOPD study

Observation of the clinical efficacy of dexmedetomidine in flexible bronchoscopy under general anesthesia: clinical case experience exchange

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