Comparison the Sedation Effect and Satisfaction of Two Combinations, Dexmedetomidine and Fentanyl with Midazolam and Fentanyl, in Patients Undergoing Bronchoscopy

  • Alireza Kamali Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.
  • Sepideh Sarkhosh Medical Sciences Research Committee, Arak University of Medical Sciences, Arak, Iran.
  • Hosein Kazemizadeh Department of Internal Medicine, Arak University of Medical Sciences, Arak, Iran.

Abstract

Objectives: The aim of this study was to compare sedative effects of dexmedetomidine and fentanyl with midazolam and fentanyl in patients undergoing bronchoscopy.
Methods: This study was a double-blind randomized clinical trial that was performed on 92 patients who referred to Amir al Momenin Hospital in Arak for bronchoscopy and underwent ASA 1 or 2 underlying grading procedure. Patients were randomly divided into two groups of dexmedetomidine and fentanyl (D) midazolam and fentanyl (M). Primary vital signs including hypertension and arterial oxygen saturation were monitored and recorded. Then all patients were injected with 2 μg / kg fentanyl as a painkiller and after 3 minutes 30 μg dexmedetomidine in syringe with code A and midazolam 3 mg in syringe with code B were injected to patients by an anesthesiologist. Then the two groups were compared in terms of pain at injection, conscious relaxation, satisfaction of operation, recovery time, hypotension and arterial oxygen saturation and drug side effects and data were analyzed by using statistical tests.
Results: There was no significant difference between the two groups in terms of mean age and sex distribution. According to the results of this study, there was no significant difference between the two groups in mean blood pressure (P-value = 0.6) and mean heart rate (P-value = 0.4) at the time of bronchoscopy, but at 5 and 10 minutes after bronchoscopy there was a significant difference, mean blood pressure and heart rate were significantly lower in dexmedetomidine group.
Conclusion: Both dexmedetomidine and midazolam drug groups contributed to the development of stable and sedative hemodynamics and satisfaction in patients undergoing bronchoscopy, however, the dexmedetomidine and fentanyl group showed a significant decrease in blood pressure and heart rate compared to midazolam and fentanyl and a weaker decrease in arterial oxygen saturation, and patients with bronchoscopy were more satisfied in the dexmedetomidine group.
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References

1- Kubba H, Cooke J, Heartly B. Can we develop a protocol for the safe decannulation of tracheostomies in children less than 18 months old? Int J Pediatr Otorhinolaryngol. 2004; 6(8): 935–937.
2- Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, Brown CA, Brandt C, Deakins K, Hartnick C, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013; 14(8): 6-9.
3- Cristea I, Baker CD. Ventilator weaning and tracheostomy decannulation in children: more than one way. Pediatric Pulmonol. 2016; 5(1): 773–774.
4- Cabrini L, Gioia L, Gemma M, Melloni G, Carretta A, Ciriaco P, et al. Acupuncture for diagnostic fiber optic bronchoscopy: a prospective, randomized, placebo-controlled study. Am J Chin Med. 2006; 34(3): 409-15.
5- Simma B, Spehler D, Burger R, Uehlinger J, Ghelfi D, Dangel P, Hof E, Fanconi S. Tracheostomy in children. Eur J Pediatr.1996; 15(3): 291–296.
6- Savola JM, Ruskoaho H, Puurunen J, Salonen JS, Karki NT. Evidence for medetomidine as a selective and potent agonist at alpha 2-adrenoreceptors. J Auton Pharmacol. 1986; 6(3): 275–84.
7- Gurbet A, Basagan-Mogol E, Turker G, Ugun F, Kaya FN, Ozcan B. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth. 2006; 53(5): 646–52.
8- Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012; 116(4): 1312–22.
9- Bekker A, Haile M, Kline R, Didehvar S, Babu R, Martiniuk F, Urban M. The effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery. J Neurosurg Anesthesiol. 2013; 25(1): 16-24.
10- Anand KJ, Barton BA, McIntosh N. Analgesia and sedation in preterm neonates who require ventilatory support: results from the NOPAIN trial. Neonatal Outcome and Prolonged Analgesia in Neonates. Arch Pediatr Adolesc Med. 1999; 153(4): 331–338.
11- Anand KJ, Hall RW, Desai N. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet. 2004; 363(9422): 1673–1682.
12- Qu W, Rippe RA, Ma J, Scarborough P, Biagini C, Fiedorek FT, et al. Nutritional status modulates rat liver cytochrome P450 arachidonic acid metabolism. Mol Pharmacol. 1998; 54(3): 504–513.
13- Du Rand I, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. Thorax. 2013; 6(8): 1-4.
14- Kremer B, Botos-Kremer AI, Eckel HE, Schlondorff G. Indications, complications and surgical techniques for pediatric tracheostomies an update. J Pediatr Surg. 2002; 3(7): 1556-1562.
15- Dere K, Sucullu I, Budak ET, Yeyen S, Filiz AI, Ozkan S, Dagli G. A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation. Eur J Anaesthesiol. 2010; 27(7): 648-52.
16- Demiraran Y, Korkut E, Tamer A, Yorulmaz I, Kocaman B, Sezen G, Akcan Y. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Can J Gastroenterol. 2007; 21(1): 25-9.
17- Cheung CW, Ying CLA, Chiu WK, Wong GTC. A comparison of dexmedetomidine and midazolam for sedation in third molar surgery. 2007; 6(2): 1132–1138.
Published
2021-01-03
How to Cite
KAMALI, Alireza; SARKHOSH, Sepideh; KAZEMIZADEH, Hosein. Comparison the Sedation Effect and Satisfaction of Two Combinations, Dexmedetomidine and Fentanyl with Midazolam and Fentanyl, in Patients Undergoing Bronchoscopy. Journal of Contemporary Medical Sciences, [S.l.], v. 6, n. 6, jan. 2021. ISSN 2413-0516. Available at: <http://www.jocms.org/index.php/jcms/article/view/856>. Date accessed: 20 jan. 2021. doi: https://doi.org/10.22317/jcms.v6i6.856.