Dexmedetomidine combined with midazolam infusion guided by bispectral index during bronchoscopy

Abstract

Background Conscious sedation guided by bispectral index (BIS) during bronchoscopy has been proved to be a feasible approach. This study aimed to investigate the safety and efficacy of dexmedetomidine combined with midazolam for undergoing conscious sedation during bronchoscopy. Methods The trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry. Patients were randomized into DEX group (dexmedetomidine combined with midazolam) and FEN group (fentanyl combined with midazolam). Bronchoscopy was performed under awake sedation titrated to a BIS level of 60–80. The primary endpoint was the incidence of hypoxia, the secondary endpoint was the incidence of bradycardia and hypotension, effect of sedation including satisfaction degree (VAS) of the operators and patients and patients’ willingness to undergo bronchoscopy again. Results A total of 222 cases in DEX group and 211 cases in FEN group completed the study. The incidence of hypoxia and tachycardia in DEX group was lower than that in FEN group (8.1% vs 14.7%, 10.4% vs 19.0%, p < 0.05), and the incidence of hypotension and bradycardia in DEX group was higher than that in FEN group (6.8% vs 0, 15.3% vs 8.1%, p < 0.05). Midazolam dosage was significantly lower in the DEX group than in the FEN group, and the duration of surgery was significantly longer in the DEX group. The differences in intraoperative discomfort of VAS score, satisfaction VAS score, and willingness rate to undergo bronchoscopy again were not statistically significant between the two groups. In addition, the proportion of “procedural interference by patient movement” in DEX group was higher than that in FEN group. Conclusions The conscious sedation regimen of dexmedetomidine combined with midazolam monitored by BIS is considered to be safe and effective during bronchoscopy. The occurrence of hypoxia and tachycardia was less, and the fluctuation of blood pressure and heart rate was mild, but the proportion of bradycardia in dexmedetomidine group was higher than that in fentanyl combined with midazolam group.

Dexmedetomidine Versus Propofol Sedation in Flexible Bronchoscopy: A Randomized Controlled Trial and a Systematic Review and Meta-Analysis

“…Finally, the level of physician satisfaction was signi cantly lower in the DEX group. The results of this study join a large number of small RCTs that were conducted in recent years, with diverse results regarding respiratory and hemodynamic outcomes [16][17][18][19][20][21][22][23][24][25][26][27]. For a more accurate and concise view of recent published results and to mitigate the current study's limitations (i.e., small sample size and lack of blinding), we conducted a systematic review and meta-analysis of all RCTs that evaluated the e cacy of DEX during bronchoscopy and included the results of the current trial.…”

“…During the period from 2012 to 2021 eleven more RCTs were conducted to evaluate DEX during bronchoscopy in comparison to propofol, midazolam and fentanyl in various combinations. While some of these trials reported a lower rate of desaturation events and an adequate sedation level, others reported no difference in desaturation events, a higher rate of hemodynamic adverse events and an inferior level of patient sedation and bronchoscopist satisfaction [17][18][19][20][21][22][23][24][25][26][27]. Therefore, DEX sedation for bronchoscopy is considered an emerging method for sedation during bronchoscopy.…”

“…Three trials had an adequate allocation concealment, randomization, and blinding although, with a small sample size that may cause a bias in reported results [16,23,26]. Four trials were randomized with adequate allocation concealment randomization and sample size but were not blinded [17,18,24,27]. And three randomized trials, including the current trial, were not blinded and with a small sample size [19,20].…”

Dexmedetomidine versus propofol sedation in flexible bronchoscopy: a randomized controlled trial

“…A review of the literature shows 12 published RCT’s that evaluated DEX sedation for bronchoscopy [ 16 – 27 ]. Four trials evaluated DEX for conscious sedation and administered the drug only once at the beginning of the procedure [ 17 , 23 , 25 , 26 ]. The largest of these trials by Zhang et al reported a lower rate of desaturation events in the DEX group however, with a higher rate of adverse events, correspondingly to the current trial.…”

“…During the period from 2012 to 2021 eleven more RCTs were conducted to evaluate DEX during bronchoscopy, in comparison to propofol, midazolam and fentanyl, in various combinations. While some of these trials reported a lower rate of desaturation events and an adequate sedation level, others reported no difference in desaturation events, a higher rate of hemodynamic adverse events and an inferior level of patient sedation and bronchoscopist satisfaction [ 17 – 27 ]. Therefore, DEX sedation for bronchoscopy is considered an emerging method for sedation during bronchoscopy.…”