Efficacy and safety of remimazolam versus dexmedetomidine for patients undergoing flexible fiberoptic bronchoscopy: A randomized, clinical trial

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2024-11-07 DOI:10.1016/j.jclinane.2024.111677

Laiying Zhou , Jingcheng Zou , Xue Li , Xiaozhuo Zuo , Mengting Gu , Kai Sun , Wen Fan , Yuanyuan Yao , Min Yan

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Abstract

Study objective

Remimazolam's benefits for patients undergoing painless flexible fiberoptic bronchoscopy remain uncertain. We aimed to compare the efficacy and safety of remimazolam and dexmedetomidine in flexible fiberoptic bronchoscopy (FFB).

Design

Randomized controlled trial.

Setting

University hospital.

Patients

Between April 2021 and September 2022, patients undergoing painless flexible fiberoptic bronchoscopy were recruited.

Interventions

The patients were randomly assigned with a 1:1 ratio to remimazolam-remifentanil group (RR group) or dexmedetomidine-remifentanil group (DR group).

Measurements

The primary outcome was the procedure interruption rate during bronchoscopy. Secondary outcomes were hemodynamic changes, resuscitation time, rescue medication usage rate and dose, satisfaction scores of patients and bronchoscopists, operation-related complications, and adverse events.

Main results

A total of 363 patients were included for final analysis. The interruption rates of bronchoscopy were 8.2 % in the RR group and 39.2 % in the DR group (P < 0.05). The rescue medication usage rate (4.4 % vs. 38.7 %, P < 0.05) and dose (1.51 ± 8.15 mg vs. 13.17 ± 18.86 mg, P < 0.05) were lower in the RR group compared with the DR group. The incidence of oxygen desaturation was significantly lower in the RR group than in the DR group (14.3 % vs. 44.2 %, P < 0.05). Hemodynamic changes in patients in the DR group were significant, with longer recovery time and lower satisfaction scores for both inpatients and bronchoscopists (P < 0.05), compared with the RR group. However, there were no significant differences between groups in terms of operation-related complications (P > 0.05) except for postoperative dizziness, which was more common in the DR group (P < 0.05).

Conclusions

Remimazolam is effective and safe in painless flexible fiberoptic bronchoscopy. It allows a lower procedure interruption rate and incidence of oxygen desaturation, providing better hemodynamic stability compared to dexmedetomidine.

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对接受柔性纤维支气管镜检查的患者使用雷马唑仑与右美托咪定的有效性和安全性：随机临床试验。

研究目的雷马唑仑对接受无痛柔性纤维支气管镜检查患者的益处仍不确定。我们旨在比较雷马唑仑和右美托咪定在柔性纤维支气管镜检查（FFB）中的疗效和安全性：设计：随机对照试验：患者2021年4月至2022年9月期间，招募接受无痛柔性纤维支气管镜检查的患者：患者按1:1的比例随机分配到雷马唑仑-瑞芬太尼组（RR组）或右美托咪定-瑞芬太尼组（DR组）：主要结果是支气管镜检查过程中的手术中断率。次要结果为血流动力学变化、复苏时间、抢救药物使用率和剂量、患者和支气管镜医师的满意度评分、手术相关并发症和不良事件：最终分析共纳入了363名患者。RR组和DR组的支气管镜检查中断率分别为8.2%和39.2%（P 0.05），但术后头晕在DR组更为常见（P 结论：雷米唑仑是一种有效的支气管镜治疗药物：雷马唑仑在无痛柔性纤维支气管镜检查中既有效又安全。与右美托咪定相比，它能降低手术中断率和氧饱和度降低率，提供更好的血流动力学稳定性。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.