OBJECTIVE: This prospective randomized study evaluated the efficacy and patient tolerance of dexmedetomidine compared with midazolam for sedation in postoperative patients undergoing flexible bronchoscopy. METHODS: A total of 198 postoperative patients were randomized to receive dexmedetomidine (n = 99) or midazolam (n = 99) to produce conscious sedation for bronchoscopy. Peripheral oxygen saturation, heart rate and systolic and diastolic arterial pressures were recorded before, during and after the procedure. Patient tolerance was recorded using various visual analogue scales. RESULTS: The mean lowest peripheral oxygen saturation was significantly lower in the midazolam group than in the dexmedetomidine group. Heart rate and systolic arterial pressure were both significantly higher during bronchoscopy in the midazolam group than in the dexmedetomidine group. Bronchoscopy was well tolerated in both groups; there was no between-group difference in patient discomfort scores or in the percentage of patients who would accept repeat bronchoscopy. CONCLUSIONS: Compared with midazolam, dexmedetomidine provided better oxygen saturation and was equally well tolerated for conscious sedation in postoperative patients undergoing bronchoscopy.
British Thoracic Society Bronchoscopy Guidelines Committee, a Subcommittee of Standards of Care Committee of British Thoracic Society: British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax2001; 56 (suppl 1): i1–i21.
3.
Wood-BakerRBurdonJMcGregorA: Fibre-optic bronchoscopy in adults: A position paper of The Thoracic Society of Australia and New Zealand. Intern Med J2001; 31: 479–487.
4.
MatotIKramerMR: Sedation in outpatient bronchoscopy. Respir Med2000; 94: 1145–1153.
5.
JaggarSIHaxbyE: Sedation, anaesthesia and monitoring for bronchoscopy. Paediatr Respir Rev2002; 3: 321–327.
6.
SmythCMSteadRJ: Survey of flexible fibreoptic bronchoscopy in the United Kingdom. Eur Respir J2002; 19: 458–463.
7.
PicklesJJeffreyMDattaA: Is preparation for bronchoscopy optimal?Eur Respir J2003; 22: 203–206.
8.
StolzDChhajedPNLeuppiJD: Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: A randomised, double blind, placebo controlled trial. Thorax2004; 59: 773–776.
9.
FloydMDGervasiniGMasicaAL: Genotype—phenotype associations for common CYP3A4 and CYP3A5 variants in the basal and induced metabolism of midazolam in European- and African—American men and women. Pharmacogenetics2003; 13: 595–606.
10.
RogersJFRocciMLJrHaugheyDB: An evaluation of the suitability of intravenous midazolam as an in vivo marker for hepatic cytochrome P4503A activity. Clin Pharmacol Ther2003; 73: 153–158.
11.
OlkkolaKTAhonenJ: Midazolam and other benzodiazepines. Handb Exp Pharmacol2008; 182: 335–360.
12.
ClarkGLickerMYounossianAB: Titrated sedation with propofol or midazolam for flexible bronchoscopy: A randomised trial. Eur Respir J2009; 34: 1277–1283.
13.
GerlachATDastaJF: Dexmedetomidine: an updated review. Ann Pharmacother2007; 41: 245–252.
14.
RikerRRShehabiYBokeschPM: Dexmedetomidine vs midazolam for sedation of critically ill patients: A randomized trial. JAMA2009; 301: 489–499.
15.
PandharipandePPPunBTHerrDL: Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA2007; 298: 2644–2653.
16.
DurandFVallaD: Assessment of the prognosis of cirrhosis: Child—Pugh versus MELD. J Hepatol2005; 42 (suppl 1): S100–S107.
17.
StolzDKurerGMeyerA: Propofol versus combined sedation in flexible bronchoscopy: A randomised non-inferiority trial. Eur Respir J2009; 34: 1024–1030.
18.
RamsayMASavegeTMSimpsonBR: Controlled sedation with alphaxalone—alphadolone. Br Med J1974; 22: 656–659.
19.
CrawfordMPollockJAndersonK: Comparison of midazolam with propofol for sedation in outpatient bronchoscopy. Br J Anaesth1993; 70: 419–422.
20.
YoonHIKimJHLeeJH: Comparison of propofol and the combination of propofol and alfentanil during bronchoscopy: A randomized study. Acta Anaesthesiol Scand2011; 55: 104–109.
21.
TsaiCJChuKSChenTI: A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation. Anaesthesia2010; 65: 254–259.
22.
BartonKPMunozRMorellVO: Dexmedetomidine as the primary sedative during invasive procedures in infants and toddlers with congenital heart disease. Pediatr Crit Care Med2008; 9: 612–615.
23.
SeyboldJLRamamurthiRJHammerGB: The use of dexmedetomidine during laryngoscopy, bronchoscopy, and tracheal extubation following tracheal reconstruction. Paediatr Anaesth2007; 17: 1212–1214.
24.
ShukryMMillerJA: Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures. Ther Clin Risk Manag2010; 6: 111–121.
MatotIKurasYKramerMR: Effect of clonidine premedication on haemodynamic responses to fibreoptic bronchoscopy. Anaesthesia2000; 55: 269–274.
27.
BergeseSDCandiottiKABokeschPM: A phase IIIb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fiberoptic intubation. Am J Ther2010; 17: 586–595.
28.
GulerGAkinATosunZ: Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand2005; 49: 1088–1091.
29.
FoxBDKrylovYLeonP: Benzodiazepine and opioid sedation attenuate the sympathetic response to fiberoptic bronchoscopy. Prophylactic labetalol gave no additional benefit. Results of a randomized double-blind placebo-controlled study. Respir Med2008; 102: 978–983.
30.
PryorKOReinselRAMehtaM: Visual P2–N2 complex and arousal at the time of encoding predict the time domain characteristics of amnesia for multiple intravenous anesthetic drugs in humans. Anesthesiology2010; 113: 313–326.
