Moderate sedation with dexmedetomidine–remifentanil is safer than deep sedation with propofol–remifentanil for endobronchial ultrasound while providing comparable quality: a randomized double-blind trial

Bermejo, S.; Covas, Begoña; Silva-Costa-Gomes, Teresa; Sánchez-Font, Albert; Curull, Víctor; Pérez-Ramos, Àlex; Mases, A.; Gallart, L.

doi:10.1080/17476348.2022.2145949

Cited by 2 publications

(2 citation statements)

References 41 publications

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“…Therefore, anesthesiologists have been exploring the optimal combination of anesthetic drugs to achieve appropriate deep sedation while providing analgesia. For example, Bermejo et al found that moderate sedation with dexmedetomidine-remifentanil is safer than deep sedation with propofol-remifentanil for endobronchial ultrasound [14]. However, the inhibition of these drugs to respiratory and circulatory system functions is obvious, with certain risks of use.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of remifentanil and esketamine in combination with propofol for patient sedation during fiberoptic bronchoscopy

Nie,

Chen,

Jia

et al. 2023

BMC Pulm Med

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Background Ideal sedation and analgesia strategies for fiberoptic bronchoscopy have not been found. At present, propofol based sedation strategy still has some defects, such as respiratory depression and blood pressure drop. It is difficult to meet the requirements of safety and effectiveness at the same time. The aim of this study was to compare the clinical efficacy of propofol/remifentanil with propofol/esketamine for patient sedation during fiberoptic bronchoscopy. Method Patients undergoing fiberoptic bronchoscopy were randomly assigned to propofol/ remifentanil (PR group; n = 42) or propofol/esketamine (PK group; n = 42) for sedation and analgesia. The primary outcome was the rate of transient hypoxia (oxygen saturation (SpO2) < 95%). The secondary outcomes are the intraoperative hemodynamics, including the changes in blood pressure, heart rate, the incidence of adverse reactions, the total amount of propofol usage were recorded, and the satisfaction level of patients and bronchoscopists. Results After sedation, the arterial pressure and heart rate of patients in the PK group were stable without significant decrease. Decreases in diastolic blood pressure, mean arterial pressure, and heart rate were observed in patients in the PR group (P < 0.05), although it was not of clinical relevance. The dosage of propofol in the PR group was significantly higher than that in the PK group (144 ± 38 mg vs. 125 ± 35 mg, P = 0.012). Patients in the PR group showed more transient hypoxia (SpO2 < 95%) during surgery (7 vs. 0, 0% versus 16.6%, P = 0.018), more intraoperative choking (28 vs. 7, P < 0.01), postoperative vomiting (22 vs. 13, P = 0.076) and vertigo (15 vs. 13, P = 0.003). Bronchoscopists in the PK group showed more satisfaction. Conclusion Compared with remifentanil, the combination of esketamine with propofol in fiberoptic bronchoscopy leaded to more stable intraoperative hemodynamics, lower dosage of propofol, lower transient hypoxia rate, fewer incidence of adverse events, and greater bronchoscopists satisfaction.

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Section: Introductionmentioning

confidence: 99%

“…For example, Bermejo et al. found that moderate sedation with dexmedetomidine-remifentanil is safer than deep sedation with propofol-remifentanil for endobronchial ultrasound [ 14 ]. However, the inhibition of these drugs to respiratory and circulatory system functions is obvious, with certain risks of use.…”

Section: Introductionmentioning

confidence: 99%

Comparison of remifentanil and esketamine in combination with propofol for patient sedation during fiberoptic bronchoscopy

Nie,

Chen,

Jia

et al. 2023

BMC Pulm Med

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Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study

Kim,

Nam,

Seo

et al. 2024

Korean J Anesthesiol

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Background: Minimalist transcatheter aortic valve replacement (TAVR) under monitored anesthesia care (MAC) emphasizes early recovery. Remimazolam is a novel benzodiazepine with a short recovery time. This study hypothesized that remimazolam is non-inferior to dexmedetomidine in terms of recovery after TAVR.Methods: In this retrospective observational study, remimazolam was compared to dexmedetomidine in patients who underwent TAVR under MAC at a tertiary academic hospital between July 2020 and July 2022. The primary outcome was timely recovery after TAVR, defined as discharge from the intensive care unit within the first day following the procedure. Propensity score matching was used to compare timely recovery between remimazolam and dexmedetomidine, applying a non-inferiority margin of -10%.Results: The study included 464 patients, of whom 218 received remimazolam and 246 received dexmedetomidine. After propensity score matching, 164 patients in each group were included in the analysis. Regarding timely recovery after TAVR, remimazolam was non-inferior to dexmedetomidine (152 of 164 [92.7%] in the remimazolam group versus 153 of 164 [93.3%] in the dexmedetomidine group, risk difference [95% CI]: −0.6% [−6.7%, 5.5%]). The use of remimazolam was associated with fewer postoperative vasopressors/inotropes (21 of 164 [12.8%] vs. 39 of 164 [23.8%]) and temporary pacemakers (TPMs) (76 of 164 [46.3%] vs. 108 of 164 [65.9%]) compared to dexmedetomidine.Conclusions: In patients undergoing TAVR under MAC, remimazolam was non-inferior to dexmedetomidine in terms of timely recovery. Remimazolam may be associated with better postoperative recovery profiles, including a lesser need for vasopressors/inotropes and TPMs.

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Moderate sedation with dexmedetomidine–remifentanil is safer than deep sedation with propofol–remifentanil for endobronchial ultrasound while providing comparable quality: a randomized double-blind trial

Cited by 2 publications

References 41 publications

Comparison of remifentanil and esketamine in combination with propofol for patient sedation during fiberoptic bronchoscopy

Comparison of remifentanil and esketamine in combination with propofol for patient sedation during fiberoptic bronchoscopy

Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study

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