The Effectiveness of Low-dose Dexmedetomidine Infusion in Sedative Flexible Bronchoscopy: A Retrospective Analysis

Abstract

Background and objectives: Flexible bronchoscopy has been widely used for diagnosis and intervention, while various drugs are used for sedation during bronchoscopy. We examined two regular standardized sedation options (with or without dexmedetomidine) regularly used in our regional hospital. The aim was to assess the efficacy and safety of dexmedetomidine on conscious sedation under bronchoscopy. Materials and Methods: A retrospective chart review was conducted from April 2017 to March 2018. All patients undergoing flexible bronchoscopy with moderate sedation were enrolled. Patients having received dexmedetomidine-propofol-fentanyl were defined as group D, and those having received midazolam-propofol-fentanyl were defined as group M. The primary outcome was a safety profile during the procedure, including the incidence of procedural interference by patient cough or movement, transient hypoxemia, and hypotension. The secondary outcome was measured by the recovery profile (awake and ambulation time). Results: Thirty-five patients in group D and thirty-three in group M were collected in this retrospective study. All patients underwent the procedure successfully. Group D showed higher safety with fewer procedural interference incidences by cough or body movement than Group M (3.3% versus 36.3%, p < 0.001) and minor respiratory adverse effects. Patients in group D showed faster recovery in a shorter ambulation time than group M (24.9 ± 9.7 versus 31.5 ± 11.9, p = 0.02). In group D, bronchoscopist satisfaction to sedation was higher than group M (p = 0.01). More transient bradycardia episodes were noted in patients receiving dexmedetomidine (p < 0.05), but all recovered without atropine intervention. Overall post-procedural adverse events and satisfaction were comparable in the two groups. Conclusions: The co-administration of dexmedetomidine met the safety and recovery demands of flexible bronchoscopy. Compared to the conventional midazolam-propofol-fentanyl regimen, the application of dexmedetomidine improved sedative effectiveness with less procedural interruptions, shorter time to ambulation and higher bronchoscopist satisfaction.

Developmental Trends and Research Hotspots in Bronchoscopy Anesthesia: A Bibliometric Study

“…In Figure 6B , the keywords in purple appeared earlier than those in yellow. Yellow circles indicated the newest occurring keywords, including clinical trials of a combination of remifentanil and dexmedetomidine or other methods of sedation ( 20 – 22 ). For example, it was safer and more comfortable to use deep sedation when removing airway foreign bodies in children, indicating that the application of a combination of remifentanil and dexmedetomidine in painless bronchoscopy might be the priority and hotspot issue in future research on bronchoscopy anesthesia ( 23 ).…”

“…Compared with midazolam, pre-injection of dexmedetomidine before induction significantly decreased the incidence of dreaming in patients undergoing flexible bronchoscopy during general anesthesia; as most dreams were pleasant, patients rarely kept painful memories. The application of dexmedetomidine improved sedative effectiveness with fewer procedural interruptions, shorter time to ambulation, and higher bronchoscopist satisfaction ( 20 , 22 ). Therefore, we need to pay more attention to precision anesthesia and comfort in the future.…”

Randomized Single-blind Comparative Study of the Midazolam/pethidine Combination and Midazolam Alone During Bronchoscopy

“…The combination of pethidine and midazolam has been shown to be useful in endoscopic pharyngeal observation [23]. However, there is also a report showing the bene t of remimazolam in bronchoscopic sedation [22] and a report showing the bene t of the combination of dextometetodine [24], so the best combination remains to be determined.…”

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

“…There are studies in the literature which have used doses of dexmedetomidine lower than the usual 1 μg/kg loading dose. [ 25 ] In one such randomized double-blind study, the investigators found that there was no difference between 0.5 μg/kg of dexmedetomidine and alfentanil 10 μg/kg when used during flexible bronchoscopy. [ 12 ] Thus suggesting that a reduced dose of dexmedetomidine retains its clinical efficacy.…”