It is time for patients to undergo bronchoscopy without discomfort

Gasparini, Stefano

doi:10.1183/09031936.00047311

Cited by 18 publications

(17 citation statements)

References 28 publications

(26 reference statements)

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“…However, certain studies have shown that following the use of sedatives, recovery times are longer and more desaturations occur (27,28). Although dexmedetomidine produces sedative, analgesic and hypnotic affects, unlike other sedatives it provides respiratory stability and does not cause any clinically relevant respiratory depression (29).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

Yuan

Yang

et al. 2016

Experimental and Therapeutic Medicine

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“…Esta sedação ligeira está associada a estabilidade hemodinâmica e ausência de complicações graves, o que deve encorajar o seu uso, como prática de rotina diária, em doentes sem contraindicações. Têm vindo a ser publicadas atualizações relativas a outros fármacos, com uso potencial na BF, para assegurar maior conforto ao doente 17 e, de facto, a literatura existente suporta a segurança e a eficácia desta abordagem, sempre que são usados os agentes apropriados, em doentes bem selecionados 18,19 .…”

Section: Discussionunclassified

Sedation with midazolam in flexible bronchoscopy – A prospective study

Rolo

Mota

Coelho

et al. 2012

Revista Portuguesa de Pneumologia (English Edition)

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ResumoIntrodução: Os agentes sedativos têm vindo a ser cada vez mais utilizados na broncofibroscopia (BF) para melhorar o conforto do doente. Devido à sua rápida ação, propriedades ansiolíticas e amnésicas, o midazolam é um dos sedativos mais frequentemente usados. Objetivos: Avaliar o efeito da sedação com midazolam na BF, incluindo a tolerância do doente, complicações e a sua potencial aplicação na prática clínica diária. Material e métodos: Estudo multicêntrico, prospetivo, randomizado, controlado com placebo, com inclusão de 100 indivíduos submetidos a BF em 2 Serviços de Pneumologia. Doentes do Grupo 1 receberam midazolam (0,05 mg/kg) e doentes do Grupo 2 receberam placebo (0,9% NaCl), 5 minutos antes do procedimento. A escala de ansiedade «The Hospital Anxiety and Depression Scale» (HADS-A) foi aplicada para determinar o nível de ansiedade basal do doente. Questionários subjetivos acerca dos principais receios e queixas relativamente à BF foram aplicados antes e depois do exame. Resultados: Média de idades de 56,0 ± 14,1 anos; 66% do sexo masculino. A maioria (65%) dos doentes apresentava baixa pontuação (< 7) na escala HADS-A, sem diferença entre grupos. Não se observaram diferenças significativas entre os 2 grupos no que diz respeito à duração da BF, procedimentos realizados, dose total de lidocaína usada e complicações observadas. A pressão arterial sistólica foi significativamente mais elevada (p < 0,003), durante e após a BF, nos indivíduos do Grupo 2. Os doentes do Grupo 1 apresentaram menos tosse (32 vs 56%; p = 0,03) e dispneia (2% vs 34%; p < 0,001) comparativamente com o Grupo 2, não se registando diferenças significativas relativamente à náusea (6 vs 18%; p > 0,05) e à dor (4 vs 12%; p > 0,05). Foi demonstrada recetibilidade em repetir o exame por todos os doentes do Grupo 1 e em 82% dos doentes do Grupo 2 (p = 0,003).

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“…Alleviation of perioperative stress, reducing coughing, providing amnesia without compromising airway patency and maintaining adequate oxygenation are primary goals [15]. Patient's anxiety, cultural differences, and pulmonologist training might influence the choice of anesthesia technique.…”

Section: Role Of General Anesthesia In Bronchoscopymentioning

confidence: 98%

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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It is time for patients to undergo bronchoscopy without discomfort

Cited by 18 publications

References 28 publications

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

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

Sedation with midazolam in flexible bronchoscopy – A prospective study

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

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