Comparison of midazolam and low‑dose dexmedetomidine in flexible bronchoscopy: A prospective, randomized, double‑blinded study

Magazine, Rahul and Venkatachala, Shivaraj Kumar and Surendra, Vyshak Uddur and Guddattu, Vasudeva and Chogtu, Bharti (2020) Comparison of midazolam and low‑dose dexmedetomidine in flexible bronchoscopy: A prospective, randomized, double‑blinded study. Indian Journal of Pharmacology, 52 (1). pp. 23-30. ISSN 0253-7613

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Abstract

BACKGROUND: Dexmedetomidine is a clinically useful drug for providing sedation, but concern regarding its cardiovascular side effect profile can limit its widespread use during routine diagnostic flexible bronchoscopy (FB). MATERIALS AND METHODS: Patients between 18 and 65 years of age, who required diagnostic FB, were screened. Eligible patients were randomized to either receive 0.5 µg/kg intravenous dexmedetomidine over 10 min or intravenous midazolam 0.035 mg/kg over 1 min. If required, rescue medication (intravenous midazolam 0.5 mg bolus) was administered. The primary outcome measure was the composite score. Other parameters observed were numerical rating scale, hemodynamic variables, oxygen saturation, number of doses of rescue medication, visual analog scale score for cough, ease of bronchoscopy, Ramsay Sedation Score, and postprocedure patient response after 24 h of bronchoscopy. RESULTS: Atotal of 54patients were enrolled, 27 in each group. Total composite score(mean±standard deviation) in dexmedetomidine and midazolam group at nasopharynx was 7.04 ± 2.19 and 6.59 ± 1.55 (P = 0.387), respectively. The corresponding values at the level of trachea were 9.22 ± 3.69 and 8.63 ± 2.13 (P = 0.475). In the dexmedetomidine group, patient response after 24 h of bronchoscopy showed the quality of sedation to be excellent in three patients, good in 10, fair in 11, and poor in 3 and discomfort to be nil in 14, mild 7, moderate in 3, and severe in 3. The corresponding values in the midazolam group for the quality of sedation were 0, 9, 18, 0 and for discomfort 10, 16, 1, 0. Other parameters did not reveal any statistically significant difference. CONCLUSION: Dexmedetomidine at a dose of 0.5 μg/kg may provide clinically useful conscious sedation, comparable to midazolam.

Item Type: Article
Uncontrolled Keywords: Dexmedetomidine; flexible bronchoscopy; midazolam; sedation.
Subjects: Departments at MU > Public Health
Medicine > KMC Manipal > Pharmacology
Medicine > KMC Manipal > Pulmonary Medicine
Depositing User: KMC Library
Date Deposited: 01 Jul 2021 10:02
Last Modified: 01 Jul 2021 10:02
URI: http://eprints.manipal.edu/id/eprint/156918

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