Moderate sedation with dexmedetomidine-remifentanil is safer than deep sedation with propofol-remifentanil for endobronchial ultrasound while providing comparable quality: a randomized double-blind trial.

IF 2.9 3区 医学 Q2 RESPIRATORY SYSTEM Expert Review of Respiratory Medicine Pub Date : 2022-11-01 DOI:10.1080/17476348.2022.2145949
Silvia Bermejo, Begoña Covas, Teresa Silva-Costa-Gomes, Albert Sánchez-Font, Víctor Curull, Àlex Pérez-Ramos, Anna Mases, Lluís Gallart
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引用次数: 2

Abstract

Objective: We compared dexmedetomidine-remifentanil vs. propofol-remifentanil in terms of safety and quality during sedation for Endobronchial ultrasonography (EBUS).

Methods: A randomized, double-blind trial. Outpatients undergoing EBUS randomly received 1 μg/kg/hour dexmedetomidine or a target concentration of 2.5 μg/mL propofol, both combined with remifentanil initially targeted at 1.5 ng/mL and subsequently titrated. Additional sedatives were restricted. The primary outcome was the need for airway rescue interventions to treat oxygen desaturation.

Results: Twenty-eight patients received dexmedetomidine-remifentanil and 27 received propofol-remifentanil. Airway rescue interventions were fewer in the dexmedetomidine group vs. the propofol one (23 vs. 76% patients, relative risk 3.21 (95% CI 1.55-6.64, P < 0.002)). Desaturation in the dexmedetomidine group was always resolved by increasing nasal oxygen flow, whereas additional interventions were needed in 60% of patients receiving propofol. Hypotension was more frequent in the propofol group, while hypertension, bradycardia and coughing were similar in both. Bronchoscopists' and patients' satisfaction were similar, although in the dexmedetomidine group two patients needed additional sedatives and two patients would not repeat the sedation technique.

Conclusion: Moderate sedation with dexmedetomidine-remifentanil for EBUS is safer than deep sedation with propofol-remifentanil but it would occasionally need additional sedatives to ensure patient satisfaction.

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右美托咪定-瑞芬太尼中度镇静比异丙酚-瑞芬太尼深度镇静对支气管超声更安全,同时提供同等质量:一项随机双盲试验。
目的:比较右美托咪定-瑞芬太尼与异丙酚-瑞芬太尼在支气管超声检查(EBUS)镇静中的安全性和质量。方法:随机、双盲试验。门诊EBUS患者随机给予右美托咪定1 μg/kg/h或异丙酚2.5 μg/mL靶浓度,均联合瑞芬太尼,初始靶浓度为1.5 ng/mL,随后滴定。额外的镇静剂受到限制。主要结局是需要气道抢救干预来治疗氧饱和度过低。结果:右美托咪定-瑞芬太尼治疗28例,异丙酚-瑞芬太尼治疗27例。与异丙酚组相比,右美托咪定组气道抢救干预较少(23例对76%,相对风险3.21 (95% CI 1.55-6.64, P)。结论:右美托咪定-瑞芬太尼中度镇静治疗EBUS比异丙酚-瑞芬太尼深度镇静更安全,但偶尔需要额外的镇静剂以确保患者满意度。
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来源期刊
CiteScore
6.80
自引率
2.60%
发文量
90
期刊介绍: Coverage will include the following key areas: - Prospects for new and emerging therapeutics - Epidemiology of disease - Preventive strategies - All aspects of COPD, from patient self-management to systemic effects of the disease and comorbidities - Improved diagnostic methods, including imaging techniques, biomarkers and physiological tests. - Advances in the treatment of respiratory infections and drug resistance issues - Occupational and environmental factors - Progress in smoking intervention and cessation methods - Disease and treatment issues for defined populations, such as children and the elderly - Respiratory intensive and critical care - Updates on the status and advances of specific disease areas, including asthma, HIV/AIDS-related disease, cystic fibrosis, COPD and sleep-disordered breathing morbidity
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