Pregabalin and dexmedetomidine conscious sedation for flexible bronchoscopy: a randomized double-blind controlled study

Ibrahim, Ezzeldin S; Sultan, W; Helal, Saffa; Abo-Elwafa, Hatem; Abdelaziz, Ahmed

doi:10.23736/s0375-9393.18.12685-x

Cited by 14 publications

(7 citation statements)

References 20 publications

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“…standardized sedation protocol has been available until now, although an increasing number of studies have focused on searching for appropriate anaesthesia methods for flexible bronchoscopy (12)(13)(14)(15)(16). In its early years, flexible bronchoscopy was performed under general anaesthesia with muscle relaxation and ventilation through a tracheal tube or laryngeal mask.…”

Section: Discussionmentioning

confidence: 99%

Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial

et al. 2019

J. Thorac. Dis.

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Background: Dexmedetomidine plus opioid infusion after topical anaesthesia with nebulized lidocaine for cough suppression is a commonly used method for flexible bronchoscopy. Recently, the use of dexmedetomidine as an additive to local anaesthetics has been reported to have several advantages over conventional intravenous administration. However, there are no data regarding the use of nebulized dexmedetomidine-lidocaine for topical anaesthesia as a premedication for flexible bronchoscopy. Therefore, this study compared the tolerability and safety of nebulized dexmedetomidine with that of conventional intravenous administration in patients undergoing bronchoscopy with moderate sedation. Methods: Sixty patients requiring flexible bronchoscopy were randomly assigned to three groups: (I) nebulized dexmedetomidine + lidocaine, n=20; (II) intravenous dexmedetomidine + nebulized lidocaine, n=20; and (III) nebulized lidocaine alone (no dexmedetomidine), n=20. The patients' coughing scores were assessed and graded. Our primary hypothesis was that nebulized dexmedetomidine-lidocaine could reduce the incidence of moderate to severe coughing. The secondary endpoints were the rates of glottis closure, complete jaw relaxation and limb movement during the procedure; the elapsed time until recovery; and the dosages of vasoconstrictors and atropine. Results: The incidence of moderate to severe coughing was 15% in the nebulized dexmedetomidine group, 50% in the intravenous dexmedetomidine group and 55% in the no dexmedetomidine group. The nebulized dexmedetomidine group had the lowest incidence of moderate to severe coughing (P=0.019).Nebulized dexmedetomidine showed a protective effect for reducing coughing compared with intravenous dexmedetomidine [P=0.008, odds ratio (OR): 0.273, 95% confidence interval (CI): 0.089-0.833]. No differences in the rates of complete jaw relaxation and limb movement during the procedure were observed among the three groups (all P>0.05). The rates of glottis closure were similar (20%, 25%, and 35%; P>0.05).The elapsed time until recovery in the nebulized dexmedetomidine group was significantly shorter than that in the intravenous dexmedetomidine group (10.60±1.39 vs. 15.10±1.45, P<0.001). The vasoconstrictor dosages were significantly lower in the nebulized dexmedetomidine group than in the intravenous dexmedetomidine group (P<0.001). Conclusions: Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy was well tolerated during bronchoscopies performed under moderate sedation and was associated with a reduced incidence of moderate to severe coughing, a shorter recovery time and reduced vasoconstrictor consumption.

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Section: Discussionmentioning

confidence: 99%

Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial

et al. 2019

J. Thorac. Dis.

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“…As a result, PetCO 2 , a noninvasive and continuous method to monitor ventilation, is expected to be a useful monitoring device for non-intubated patients during FB and was used for all outpatients in this study according to the recommendation of the Association of Anaesthetists of Great Britain and Ireland. However, end tidal CO 2 measurements were considered unreliable in a prior study where most patients showed false low-end tidal CO 2 levels due to an unsealed dual nasal cannula and room-air dilution of expired gases ( Ibrahim et al, 2019 ). Despite the fact that recent evidence supports the use of capnography in deep sedation, its use in moderate sedation has not been shown to improve patient safety ( Vakil et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

Chen

Xin

et al. 2022

Front. Pharmacol.

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Purpose: This study aimed to compare the efficacy and safety of remimazolam tosilate-remifentanil (RT-RF) vs dexmedetomidine-remifentanil (Dex-RF) for outpatients undergoing fiberoptic bronchoscopy (FB).Patients and methods: We conducted a double-blind, randomized, prospective study involving a total of 146 outpatients undergoing FB divided into two groups. The RT-RF (RR) group (n = 73) received an initial dose of 12 mg/kg/h of RT for 10 min followed by a maintenance dose of 1–2 mg/kg/h, while the Dex-RF (DR) group (n = 73) received an initial dose of 0.5 μg/kg of Dex for 10 min followed by a maintenance dose of 0.2–0.7 μg/kg/h. All outpatients also received 0.05–0.2 μg/kg/min RF to maintain the Modified Observer’s Assessment of Alertness and Sedation (MOAA/S) scale <3. The primary outcome was rate of successful FB completed. Secondary outcomes were time metrics, hemodynamics, intubating conditions, oxygen saturation, coughing severity, number of remedies, total dose of fentanyl, RF, RT, and Dex, incidence of dreaming, patient and bronchoscopist satisfaction, willingness to repeat bronchoscopy, and adverse events.Results: The FB successful completion rate was 94.52% (95% CI: 89.20–99.90) in the RR group and 91.78% (95% CI: 85.30–98.20) in the DR group. Compared with patients in the DR group, the onset time, time to fully alert, and hospital discharge were all significantly shorter in the RR group (p < 0.01), and hemodynamics were more stable in the RR group. Intubating conditions, clinically acceptable intubating conditions, lowest oxygen saturation, coughing severity, consumption of fentanyl and RF, number of remedies, and patient and bronchoscopist satisfaction were similar between the groups (p > 0.05), as were demographic characteristics, incidence of dreaming, willingness to repeat bronchoscopy, and adverse events (p > 0.05).Conclusion: RT-RF has non-inferior efficacy, better time metrics and hemodynamic stability for outpatients undergoing FB than Dex-RF.Systematic Review Registration: [http://www.chictr.org.cn/showproj.aspx?proj=66673], identifier [ChiCTR2000041524].

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“…For instance, dexmedetomidine can mimic IPOC’s renal protective effect by activating the PI3K-Akt survival cascade to induce cytoprotectant ( Gu et al, 2011 ). Dexmedetomidine has been widely used in recent years as an anesthetic adjuvant during surgery due to its favorable perioperative hemodynamic stability and its intraoperative anesthesia-sparing effect ( Ibrahim et al, 2019 ). Lempiainen, et al (2014) suggested that dexmedetomidine preconditioning (DPRC), but not DPOC, restrain renal IRI.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine postconditioning provides renal protection in patients undergoing laparoscopic partial nephrectomy: A randomized controlled trial

Jiang

Zhang

et al. 2022

Front. Pharmacol.

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Background: For localized disease, partial nephrectomy of small tumors continues to be the gold-standard treatment. However, temporary clamping is routinely performed during this process to control renal blood flow, which can cause renal ischemic/reperfusion injury. We evaluated whether dexmedetomidine postconditioning (DPOC) can reduce renal ischemic/reperfusion injury for patients receiving laparoscopic partial nephrectomy (LPN).Methods: This randomized double-blind controlled trial included 77 patients who were scheduled for LPN at our hospital. Patients were randomly allocated to the DPOC or control group. DPOC was performed via intravenous administration of dexmedetomidine at 0.6 μg kg−1 for 10 min immediately after unclamping the renal artery. In the control group, saline was administered in place of dexmedetomidine under the same protocol. All participants underwent a 6-month follow-up. The primary outcome were the values of 99mTc-DTPA-GFR in the affected kidney at one and 6 months post-LPN.Result: The GFR values in the DPOC group (35.65 ± 4.89 ml min−1.1.73 m−2) were significantly higher than those the control group (33.10 ± 5.41 ml min−1.1.73 m−2; p = 0.022) at 1 month after LPN. There was no statistically significant difference in GFR value between the two groups at 6 months after LPN.Conclusion: DPOC provides therapeutic benefits to LPN patients, at least on a short-term basis, by alleviating renal ischemic/reperfusion injury.Clinical Trial Registration: Chinese Clinical Trial Registry, identifier [ChiCTR-TRC-14004766].

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Pregabalin and dexmedetomidine conscious sedation for flexible bronchoscopy: a randomized double-blind controlled study

Cited by 14 publications

References 20 publications

Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial

Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

Dexmedetomidine postconditioning provides renal protection in patients undergoing laparoscopic partial nephrectomy: A randomized controlled trial

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