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Dexmedetomidine Versus Remifentanil for Monitored Anesthesia Care During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Controlled Trial

St-Pierre, Patrick MD, FRCPC*; Tanoubi, Issam MD, MA(ed), DESAR; Verdonck, Olivier MD, MSc, DESAR; Fortier, Louis-Philippe MD, MSc, FRCPC; Richebé, Philippe MD, PhD, DESAR; Côté, Isabelle MD, FRCPC; Loubert, Christian MD, FRCPC; Drolet, Pierre MD, FRCPC

doi: 10.1213/ANE.0000000000003633
Patient Safety: Original Clinical Research Report
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BACKGROUND: We hypothesized that, compared to remifentanil, dexmedetomidine used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) performed under monitored anesthesia care (MAC) in nonintubated patients would result in fewer episodes of major respiratory adverse events (number of episodes of bradypnea, apnea or desaturation) but no difference in satisfaction with perioperative conditions.

METHODS: Sixty (American Society of Anesthesiologists physical status I–III) patients scheduled to undergo EBUS-TBNA under MAC were randomized to receive either remifentanil (0.5 µg/kg IV bolus) in 10 minutes, followed by 0.05–0.25 µg/kg/min, or dexmedetomidine (0.4 µg/kg IV bolus) in 10 minutes, followed by 0.5–1.0 µg/kg/h. The primary outcome was the number of major respiratory adverse events (bradypnea, apnea, or hypoxia). The secondary outcomes included hemodynamic variables, discharge time from the postanesthesia care unit, endotracheal lidocaine use, patient’s sedation using the Observer Assessment of Alertness/Sedation Scale, operative conditions, operator and patient satisfaction, pain, coughing, vocal cord mobility, recall, and nausea/vomiting.

RESULTS: Dexmedetomidine produced significantly fewer episodes of major respiratory events (bradypnea, apnea, or desaturation), with 0 [0–0.5] episodes versus 2 [0–5] (median [interquartile range]) (P = .001), than did remifentanil. Fewer episodes of bradypnea or apnea (dexmedetomidine: 0 [0–0] versus remifentanil: 0 [0–0.5]; P = .031), and fewer episodes of desaturation (dexmedetomidine: 0 [0–0.5] versus remifentanil: 1 [0–4]; P = .039) were recorded in the dexmedetomidine group. The time needed for patients to meet postanesthesia care unit discharge criteria (Aldrete score: 9) after EBUS-TBNA was longer in the dexmedetomidine group (10 [3–37.5] minutes) versus the remifentanil group (3 [3–5] minutes) (P < .001). No differences were observed in the 2 groups for sedation depth (Observer Assessment of Alertness/Sedation Scale), endotracheal lidocaine use, operative conditions, operator and patient satisfaction, pain, coughing, vocal cord mobility, recall, and nausea/vomiting episodes.

CONCLUSIONS: Dexmedetomidine resulted in fewer respiratory adverse events during EBUS-TBNA under MAC, when compared to remifentanil, with no difference in overall operative conditions. However, dexmedetomidine use was associated with delayed postoperative discharge.

From the *Department of Anesthesiology, Hôpital Pierre-Boucher, Longueuil, Quebec, Canada; and Departments of

Anesthesiology and

Pneumology, Centre Intégré Universitaire De Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS), Montréal, Quebec, Canada.

Accepted for publication May 21, 2018.

Published ahead of print 21 May 2018.

Funding: None.

The authors declare no conflicts of interest.

Registered clinical trial: The institutional research ethics board of the Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS) approved the study protocol (IRB#11021) for this single-center prospective randomized clinical trial on June 10, 2011. Written informed consent was obtained from all trial participants. Before patient enrollment, the study was registered at ClinicalTrials.gov (identifier: NCT01381627: principal investigator: O.V. date of registration: June 27, 2011).

Reprints will not be available from the authors.

Address correspondence to Issam Tanoubi, MD, MA(ed), DESAR, Department of Anesthesiology, Centre Intégré Universitaire De Santé et de Services Sociaux de l’Est-de-l’Îlede-Montréal (CIUSSS), 5415 Blvd de l’Assomption, Montréal, QC H1T 2M4, Canada. Address e-mail to i.tanoubi@umontreal.ca.

Copyright © 2018 International Anesthesia Research Society
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