Safety and efficacy of dexmedetomidine sedation for elective fiberoptic bronchoscopy: A comparative study with propofol

Abstract

Background: Dexmedetomidine has sedative and sympatholytic effects. The use of dexmedetomidine in flexible fiberoptic bronchoscopy will attenuate hemodynamic response without respiratory depression. The aim of this study was to evaluate the clinical efficiency and safety of dexmedetomidine, and to compare it with the combination of propofol-fentanyl as sedation during flexible fiberoptic bronchoscopy. Patients and methods: Seventy-two patients scheduled for elective fiberoptic bronchoscopy were included and divided into two equal groups. In propofol-fentanyl group (group PF) patients received 0.5-1 mg/kg propofol and 1 lg/kg of fentanyl. Boluses of 20 mg of propofol were given to give a sedation level of 3-4 according to Ramsay sedation score. In dexmedetomidine group (group D), dexmedetomidine 1 lg/kg over 10 min was given as a loading dose, followed by a maintenance infusion of 0.2-0.7 lg/kg/h to keep the same level of sedation. Heart rate, blood pressure and oxygen saturation were recorded. Results: Heart rate and mean arterial blood pressure values were significantly lower in group D compared to group PF all over the procedure. Group D had higher oxygen saturation values than group PF. Incidence of desaturation was more frequent in PF group (16.66%) compared to 5.55% in group D. There was no significant difference in patient satisfaction between the two groups. Conclusion: Dexmedetomidine and propofol-fentanyl are effective sedatives for patients undergoing flexible fiberoptic bronchoscopy. The sympatholytic and respiratory stability effects of dexmedetomidine make it an attractive and safe alternative for sedation during FOB.

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

“…Comparisons between dexmedetomidine and propofol–opioid (fentanyl) combinations have shown better hemodynamic stability with dexmedetomidine and higher incidence of desaturation in propofol–fentanyl group, without any difference in patient satisfaction levels. [119] Dexmedetomidine–fentanyl combinations showed higher mean SpO 2 and better hemodynamic stability as compared to dexmedetomidine–propofol; however, there was no difference in cough, discomfort score, sedation level, or requirement of topical anesthesia. [120]…”

Safety and Efficacy of Dexmedetomidine for Bronchoscopy: A Systematic Review and Meta-Analysis

“…All studies were randomized controlled studies of flexible bronchoscopy. Dexmedetomidine loading dose was 1 µg/kg in five studies [ 22 , 23 , 27 , 28 , 29 ], 0.5 µg/kg in three studies [ 24 , 30 , 31 ], and 2 µg/kg in one study [ 32 ]. The included studies of dexmedetomidine were administered intravenously, with the exception of one study [ 32 ], which was administered by aerosol.…”

“…Nine studies have explored the relationship between the use of anesthetic drugs and hypoxemia during flexible bronchoscopy, including a total of 765 patients [ 22 , 23 , 24 , 27 , 28 , 29 , 30 , 31 , 32 ]. Hypoxemia is defined as displaying SpO2 < 90% for more than 30 s, and it can be controlled by increasing the oxygen flow rate to 6 L/min or by performing mandibular support if necessary.…”

“…Six studies discussed bradycardia, including a total of 553 patients [ 22 , 23 , 24 , 27 , 29 , 32 ]. The definition of bradycardia is the presence of HR < 50–60 beats/min or 20% lower than the baseline heart rate, which is treated with 0.3–0.5 mg or 0.01 mg/kg atropine [ 24 , 28 , 29 ]. Compared with Group C, Group D was more likely to have bradycardia during bronchoscopy (OR = 3.71, 95% CI (1.84, 7.47), p = 0.0002, I 2 = 0%), which was statistically significant, and the heterogeneity between included studies was low ( Figure 8 ).…”

Clinical usefulness of intermediate-dose dexmedetomidine (0.75 μg/kg) in flexible bronchoscopy – A prospective, randomized, double-blinded study

“…Bradycardia (<50 bpm) was to be treated with atropine (0.01 mg/kg) intravenously. [ 15 ] The level of sedation of the patient was continuously assessed and kept 2–3 as per RSS.…”