Safety And Efficacy Of Dexmedetomidine Sedation In Flexible Bronchoscopy

ObjectiveDexmedetomidine,an a2-adrenoceptor agonist,is a valuable drug for use during various procedures such as fiberoptic intubation as it induces sedation and an algesia without depressing respiratory.The safety and efficacy of dexmedetomidine sedation in flexible bronchoscopy were investigated.The study was conducted to compare propofol–remifentanil and dexmedetomidine for flexible bronchoscopy in terms of oxygen desaturation,respiratory depression,level of sedation,coughing scores,Limb movement scores,haemodynamic stability,and patient and bronchoscopist satisfaction.MethodA total of 83 patients was selected for the trial,they were scheduled for elective flexible bronchoscopy.After the patients were sent to the operating room,the were provided supplemental oxygen(3 liter?min-1)via nasal cannula.we recorded patient's vital signs,including electrocardiogram(ECG),noninvasive blood pressure(NIBP),pulse oxygen saturation(Sp O2),respiration rates(RR).Then the patients were given dexamethasone 10 mg IV,tropisetron 5 mg IV,sufentanil 0.1 ug/kg IV.The patients in dexmedetomidine group(Group D)received a loading dose(2ug/kg)infused over 10 min followed by a continuous infusion of 2ug/kg/h.In propofol-remifentanil group(Group PR),propofol was administered at the Cet of 2-3ug/ml,remifentanil was administered at Cet of 0.1-0.5ng/ml in the induction.In the maintenance,propofol target concentration remained unchanged,remifentanil target concentration was adjusted to 0.3ng/ml.Tetracaine and lidocaine was used to achieve topical anesthesia by spraying the nostril,oropharynx and trachea.The levels of sedation was evaluated by the modified observer's assessment of alert ness/sedation(MOAA/S)score,when the MOAA/S was zero,the procedure was performed.The primary outcomes was the incidence of hypoxemia andhemodynamic changes.The dose of propofol,remifentanil,dexmedetomidine and vasoactive drug was recorded.The levels of sedation,bronchoscopy procedure time,wake-up time,recovery time,airway artificial interventions,satisfaction scores of bronc hoscopists and patients were also compared.ResultThe incidence of oxygen desaturation were lower at the time of T3?T4?Te in Group D than Group PR in(P<0.05).The number of airway artificial interventions were no significant differences.Systolic blood pressure and mean arterial pressure were higher at the time of T1?T2?Te in Group D than in Group PR(P<0.05),the difference was significant.Wake-up time and recovery time longer in Group D than in Group PR(P<0.05),there were significant differences between the two groups.Bronchoscopist satisfaction scores were also higher in Group D than in Group PR(P<0.05),However,Both groups received higher satisfaction sc ores in two groups.The level of drowsiness were also higher in Group D than in Group PR(P<0.05).However,HR,RR,the levels of sedation,satisfaction scores of patients,the duration of bronchoscopy,choking score,limb movements score,requirement of topical anaesthesia,vasoactive andantispasmodic drugs did not differ significantly between the two groups(P>0.05).ConclusionDexmedetomidine(a loading dose of 2ug/kg,a maintenance dose of 2ug/kg/h)can achieve the requirement for sedation during fexible bronchoscopy.There was less impact on breathing.The haemodynamic response was reduced during theprocedure.Weconsider that dexmedetomidine can be safely and effectively used for fiberoptic bronchoscopy.