Riachy M, et al. – The efficacy and safety of three regimens used for sedation during flexible bronchoscopy (FB) were evaluated in this randomized double–blind controlled trial. The authors concluded that no consistent differences were present between the three regimens, however, each was more appropriate in certain patient profiles. They consequently recommended a protocol as a first step towards standardizing sedation practice in FB in a patient–tailored manner. They suggested that a more comprehensive and detailed protocol including other sedative agents with their corresponding doses should be developed.

Methods

• This trial evaluated patients undergoing bronchoscopy and receiving lidocaine alone (C) or combined with dexmedetomidine (D) or alfentanil (A).
• Tolerance was assessed utilizing the bronchoscopy score, and level of sedation was evaluated utilizing the Nursing Instrument for the Communication of Sedation.
• Safety was assessed in terms of pulmonary function and vital signs.

Results

• An aggregate of one hundred sixty two patients were selected.
• The authors discovered that the bronchoscopy score was identical in all groups.
• They noted that group D subjects were the most sedated (P = .013), whereas group A subjects were the least agitated.
• Linear regression demonstrated a negative relationship between bronchoscopy score and age in A (β = -0.06; P = .001).
• It was found that positive predictors of bronchoscopy score were female gender (β = 1.96; P = .003) in D and obesity (β = 2.41; P = .012), longer procedures (β = 0.08; P = .009) and female gender (β = 1.15; P = .038) in C.
• Findings revealed that longer procedures (β = -0.12; P = .010) was a negative predictor of bronchoscopy score in D.
• Desaturation, hypoxia and heart rate changes were most prevalent in group A whereas hypotension was mostly seen in D.