Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy

Abstract

Dexmedetomidine, an α 2 agonist, has demonstrated its effectiveness as a sedative during awake intubation, but its utility in fiberoptic bronchoscopy (FOB) is not clear. We evaluated the effects of midazolam and dexmedetomidine on patient's response to FOB. The patients received either midazolam, 0.02 mg/kg (group M, n = 27), or dexmedetomidine, 1 µg/kg (group D, n = 27). A composite score of five different parameters and a numerical rating scale (NRS) for pain intensity and distress were used to assess patient response during FOB. Patients rated the quality of sedation and level of discomfort 24 h after the procedure. Ease of bronchoscopy, rescue medication requirement, and haemodynamic variables were noted. Ideal or acceptable composite score was observed in 15 and 26 patients, respectively, in group M (14.48 ± 3.65) and group D (9.41 ± 3.13), p < 0.001. NRS showed that 11 patients in group M had severe pain and discomfort as compared to one patient with severe pain and two with severe discomfort in group D during the procedure, p < 0.001. Rescue midazolam requirement was significantly higher in group M (p = 0.023). We conclude that during FOB, under topical airway anaesthesia, IV dexmedetomidine (1 µg/kg) provides superior patient comfort and tolerance as compared to IV midazolam (0.02 mg/kg).

The safety and efficacy of dexmedetomidine-remifentanil in children undergoing flexible bronchoscopy

“…In our trial, the incidence of total children movements of 3 groups was 46.81% 22/47 versus 34.88% 15/43 versus 17.78% 8/45, respectively, of DR1, DR2, DR3, which is higher than previous studies reported. [9] However, only a small number of children required to convert to propofol (25.53% 12/47 vs 13.95% 6/43 vs 4.65% 2/45, respectively, of DR1, DR2, DR3). The reason may be mainly due to the different combinations of drugs among these studies.…”

“…Midazolam, propofol, etomidate, opioids, inhalational agents, or a combination of these drugs have been widely used during flexible bronchoscopy; however, each of these drugs has its limitations. [9–12] Midazolam, propofol, and etomidate have no analgesic property and sedative pharmacology variability of different patients may be responsible for respiratory depression. Opioids such as fentanyl, sufentanil, and remifentanil can provide excellent analgesia without enough sedation.…”

“…[15] Previous studies have reported that DEX alone or compared with midazolam, propofol, or opioids could be safely and effectively used for flexible bronchoscopy in both adult and children. [9,16,17] However, according to the independent search of MEDLINE, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science for English language articles between 1990 and 2015 using dexmedetomidine, remifentaniland, paediatric, flexible bronchoscopy, and dose-finding, there have been no trials to report the dose-finding of DEX-RF in children undergoing flexible bronchoscopy. We conducted this retrospective trial to evaluate the dose-finding of safety and efficacy of DEX-RF in children undergoing flexible bronchoscopy.…”

Anesthesia in Flexible Bronchoscopy: What do the New Articles Recommend?

“…Bronkoskopiden 10 dakika önce uygulanan 1 mg/kg deksmedetomidinin güvenli ve etkin sedasyon sağladığı, 0.02 mg/kg dozda uygulanan midazolam kadar tolere edildiği, daha iyi hasta konforu sağladığı bulunmuştur (23) .…”

Benzodiazepine Allergy With Anesthesia Administration: A Review of Current Literature

“…Another study exploring dexmedetomidine administration versus midazolam in patients undergoing flexible bronchoscopy demonstrated superior patient comfort and tolerance in the group receiving the alpha-2 agonist. 32 Oral alpha-2 agonists, such as clonidine, as well as sedating antihistamines such as hydroxyzine could also be considered. IM ketamine is a common agent used in office-based dental anesthesia as well.…”