title: Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy.
abstract: Dexmedetomidine, an α2 agonist, has demonstrated its effectiveness as a sedative during awake intubation, but its utility in fiberoptic bronchoscopy (FOB) is not clear. We evaluated the effects of midazolam and dexmedetomidine on patient's response to FOB. The patients received either midazolam, 0.02 mg/kg (group M, n=27), or dexmedetomidine, 1 µg/kg (group D, n=27). A composite score of five different parameters and a numerical rating scale (NRS) for pain intensity and distress were used to assess patient response during FOB. Patients rated the quality of sedation and level of discomfort 24 h after the procedure. Ease of bronchoscopy, rescue medication requirement, and haemodynamic variables were noted. Ideal or acceptable composite score was observed in 15 and 26 patients, respectively, in group M (14.48±3.65) and group D (9.41±3.13), p<0.001. NRS showed that 11 patients in group M had severe pain and discomfort as compared to one patient with severe pain and two with severe discomfort in group D during the procedure, p<0.001. Rescue midazolam requirement was significantly higher in group M (p=0.023). We conclude that during FOB, under topical airway anaesthesia, IV dexmedetomidine (1 µg/kg) provides superior patient comfort and tolerance as compared to IV midazolam (0.02 mg/kg).
authors.affiliation: Department of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka 580008, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Goneppanavar
authors.affiliation: Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Magazine
authors.affiliation: Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India.
authors.forename: Bhavya
authors.initials: B
authors.lastname: Periyadka Janardhana
authors.affiliation: Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India.
authors.forename: Shreepathi
authors.initials: S
authors.lastname: Krishna Achar
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D020927:Dexmedetomidine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam