Dexmedetomidine versus Midazolam for Conscious Sedation in Postoperative Patients Undergoing Flexible Bronchoscopy: A Randomized Study

Liao, Wei; Gertz, MA; Qg, Su; Fang, Yueh‐Fu; Bc, Gu; Xm, Zou

doi:10.1177/147323001204000415

Cited by 49 publications

(80 citation statements)

References 31 publications

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“…This is in agreement with the results of a study by Liao et al (34). This trend has previously been explained as being due to the addition of an opioid to propofol resulting in oxygen desaturation in patients undergoing bronchoscopic procedures (35).…”

Section: Discussionsupporting

confidence: 93%

Dexmedetomidine-fentanyl versus propofol-fentanyl in flexible bronchoscopy: A randomized study

Yuan

Yang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to evaluate the effect of a combination of dexmedetomidine and fentanyl on peripheral oxygen saturation (SpO 2 ) and hemodynamic stability in patients undergoing flexible bronchoscopy. One hundred patients undergoing elective flexible bronchoscopy were randomized into either a propofol-fentanyl group (PF group; n=50) or a dexmedetomidine-fentanyl group (DF group; n=50). SpO 2 values, heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), patients' cough scores and discomfort scores as determined by patients and bronchoscopists, levels of sedation, number of times that additional lidocaine was required, elapsed time until recovery, and adverse events were recorded. The mean SpO 2 values in the DF group were significantly higher than those in the PF group (P<0.01), and HR, SBP and DBP were significantly lower in the DF group than in the PF group (P<0.05). There were no statistically significant differences between the two groups in terms of cough scores or discomfort scores, sedation levels, or number of times that additional lidocaine was required (P>0.05). Elapsed time until recovery in the DF group was significantly longer than in the PF group (P=0.002). The incidence of hypoxemia was significantly lower in the DF group than in the PF group (P= 0.027), but the incidence of bradycardia was significantly higher in the DF group than in the PF group (P= 0.037). Dexmedetomidine-fentanyl was superior to propofol-fentanyl in providing satisfactory SpO 2 . Furthermore, dexmedetomidine-fentanyl attenuated hemodynamic responses during bronchoscopy and maintained hemodynamic stability in the early stage of the procedure. IntroductionFlexible bronchoscopy is commonly used for the diagnosis and management of a variety of pulmonary diseases. However, it is an invasive procedure that can induce coughing, pain, dyspnea and other adverse effects (1,2). The use of sedatives not only can increase patients' safety and comfort (3) but also can make it easier for the bronchoscopist to perform the procedure and thus avoid extending its duration (4). In addition to alleviating the physiological response to airway irritation during the procedure (5), the proper sedatives should have a rapid onset and a short duration of action, in addition to allowing rapid recovery.Propofol, a non-opioid and nonbarbiturate sedative hypnotic agent, is frequently used in the induction and maintenance of anesthesia. The properties of rapid onset and offset of action and of smooth recovery (6) make propofol an appealing agent alone or in combination with an opioid for procedural sedation (7-10). However, dose-dependent respiratory depression and hypoxemia are possible, owing to interactions and synergism between sedatives and opioids (11-13).Dexmedetomidine, a highly selective α 2 -adrenoceptor agonist, has an affinity for α 2 -adrenoceptors that is 8-fold greater than that of clonidine (14). In addition to providing sedative and analgesic effects (15), dexmedetomidine can be applied generally duri...

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Section: Discussionsupporting

confidence: 93%

Dexmedetomidine-fentanyl versus propofol-fentanyl in flexible bronchoscopy: A randomized study

Yuan

Yang

et al. 2016

Experimental and Therapeutic Medicine

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“…Despite above desirable properties, dexmeditomedine is still not in popular use among bronchoscopy suites mainly because of limited available evidence. The following are possible limitations (extrapolated form non-bronchoscopybased studies) of using dexmeditomedine during bronchoscopy: [39][40][41].…”

Section: Dexmedetomidinementioning

confidence: 99%

Anesthesia for Advanced Bronchoscopic Procedures: State-of-the-Art Review

Goudra

Singh

Borle

et al. 2015

Lung

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The bronchoscopic procedures have seen a remarkable increase in both numbers and complexity. Although many anesthesia providers have kept pace with the challenge, the practice is varied and frequently suboptimal. Shared airway during bronchoscopy poses unique challenges. The available reviews have tried to address this lacuna; however, these have frequently dealt with the technical aspects of bronchoscopy than anesthetic challenges. The present review provides evidence-based management insights into anesthesia for bronchoscopy-both flexible and rigid. A systematic approach toward pre-procedural evaluation and risk stratification is presented. The possible anatomical and physiological factors that can influence the outcomes are discussed. Pharmacological principles guiding sedation levels and appropriate selection of sedatives form the crux of safe anesthetic management. The newer and safer drugs that can have potential role in anesthesia for bronchoscopy in the near future are discussed. Ventilatory strategies during bronchoscopy for prevention of hypoxia and hypercarbia are emphasized.

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“…Deksmedetomidin, selektif α2-adrenoreseptör agonisti olup, sedatif ve analjezik özelliklere sahiptir (30). Lokus seruleustaki reseptörler üzerinden etki eder ve solunum depresyonu yapmaksızın spinal korddaki reseptörler aracılığıyla sedasyon ve analjeziyi indükler (30).…”

Section: Deksmedetomidinunclassified

“…Lokus seruleustaki reseptörler üzerinden etki eder ve solunum depresyonu yapmaksızın spinal korddaki reseptörler aracılığıyla sedasyon ve analjeziyi indükler (30). Ancak hipotansiyon ve bradikardi gibi olumsuz etkileri vardır.…”

Section: Deksmedetomidinunclassified

“…Ancak hipotansiyon ve bradikardi gibi olumsuz etkileri vardır. Benzodiazepinlerle yapı-lan karşılaştırmalı çalışmada bronkoskopi sırasında daha iyi oksijen satürasyon değerlerine sahip olduğu bulunmuştur, ancak güvenlik profili karşılaştırması ile ilgili henüz bir çalışma yapılmamıştır (30). Deksmedetomidin-propofol ile remifentanil-propofol karşılaştırmalı çalışmasında, deksmedetomidin grubunda daha az oral kaviteye aspirasyon gereksinimi (tükürük ve hava yolu sekresyonlarında azalma ile) ve daha az oksijen desatürasyonu gözlenmiştir (31).…”

Section: Deksmedetomidinunclassified

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