Effect of Different Doses of Dexmedetomidine As an Adjuvant to Lignocaine Nebulization: A Comparative Study During Awake Flexible Fiberoptic Bronchoscopy

Overview

Journal J Anaesthesiol Clin Pharmacol

Specialty Anesthesiology

Date 2024 Apr 26

PMID 38666161

Authors

Amarjeet Kumar

Poonam Kumari

Chandni Sinha

Ajeet Kumar

Saurabh Karmakar

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Mild to moderate sedation during bronchoscopy is essential for patient safety, comfort during and after the procedure, and to facilitate the performance of the bronchoscopist. Dexmedetomidine is a highly selective, centrally acting α-2 agonist used to provide conscious sedation during various procedures. The aim of this study was to compare the efficacy of three different doses of dexmedetomidine nebulization as an adjuvant to lignocaine during bronchoscopy.

Material And Methods: Ninety American Society of Anesthesiologists physical status I/II patients, aged from 18 to 60 years, scheduled for an elective bronchoscopy, were recruited. They were divided into three groups: 30 patients in each group. Group I: The patient was nebulized with a mixture of 4 ml of 4% lignocaine and dexmedetomidine 0.5 μg/kg. Group II: The patient was nebulized with a mixture of 4% lignocaine, 4 ml, and dexmedetomidine, 1 μg/kg. Group III: The patient was nebulized with 4% lignocaine 4 ml and dexmedetomidine 1.5 μg/kg.

Results: The mean cough score was (1.17 ± 0.37), (1.40 ± 0.49), and (1.70 ± 0.75) in group III, group II, and group I, respectively. A significant difference was found between the groups. Patients were more comfortable with a statistically significant difference in the comfort score in group III as compared to group II and group I.

Conclusion: Dexmedetomidine nebulization in a dose of 1.5 μg/kg (compared to 1 μg/kg or 0.5 μg/kg) as an adjuvant to lignocaine, provides better bronchoscopy conditions and patient satisfaction.

References

Mondal S, Ghosh S, Bhattacharya S, Choudhury B, Mallick S, Prasad A . Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study. J Anaesthesiol Clin Pharmacol. 2015; 31(2):212-6. PMC: 4411836. DOI: 10.4103/0970-9185.155151. View

Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A . Patient satisfaction with conscious sedation for bronchoscopy. Chest. 1999; 115(5):1437-40. DOI: 10.1378/chest.115.5.1437. View

Poi P, Chuah S, Srinivas P, Liam C . Common fears of patients undergoing bronchoscopy. Eur Respir J. 1998; 11(5):1147-9. DOI: 10.1183/09031936.98.11051147. View

Worsley M, Macleod A, Brodie M, Asbury A, Clark C . Inhaled fentanyl as a method of analgesia. Anaesthesia. 1990; 45(6):449-51. DOI: 10.1111/j.1365-2044.1990.tb14331.x. View

Zanaty O, El Metainy S . A comparative evaluation of nebulized dexmedetomidine, nebulized ketamine, and their combination as premedication for outpatient pediatric dental surgery. Anesth Analg. 2015; 121(1):167-171. DOI: 10.1213/ANE.0000000000000728. View

Aouad M, Sayyid S, Zalaket M, Baraka A . Intravenous lidocaine as adjuvant to sevoflurane anesthesia for endotracheal intubation in children. Anesth Analg. 2003; 96(5):1325-1327. DOI: 10.1213/01.ANE.0000061586.63978.DE. View

Xue F, He N, Liao X, Xu X, Xu Y, Yang Q . Clinical assessment of awake endotracheal intubation using the lightwand technique alone in patients with difficult airways. Chin Med J (Engl). 2009; 122(4):408-15. View

Mason K, Lerman J . Review article: Dexmedetomidine in children: current knowledge and future applications. Anesth Analg. 2011; 113(5):1129-42. DOI: 10.1213/ANE.0b013e31822b8629. View

Niyogi S, Basak S, Acharjee A, Chakraborty I . Efficacy of intravenous dexmedetomidine on patient's satisfaction, comfort and sedation during awake fibre-optic intubation in patients with cervical spondylotic myelopathy posted for elective cervical fixation. Indian J Anaesth. 2017; 61(2):137-143. PMC: 5330070. DOI: 10.4103/0019-5049.199856. View

10.

Ramsay M, Savege T, Simpson B, Goodwin R . Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974; 2(5920):656-9. PMC: 1613102. DOI: 10.1136/bmj.2.5920.656. View

11.

Anupriya J, Kurhekar P . Randomised Comparison between the Efficacy of Two Doses of Nebulised Dexmedetomidine for Premedication in Paediatric Patients. Turk J Anaesthesiol Reanim. 2020; 48(4):314-320. PMC: 7434347. DOI: 10.5152/TJAR.2019.78889. View

12.

Du Rand I, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S . British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013; 68 Suppl 1:i1-i44. DOI: 10.1136/thoraxjnl-2013-203618. View

13.

Grewal A . Dexmedetomidine: New avenues. J Anaesthesiol Clin Pharmacol. 2011; 27(3):297-302. PMC: 3161450. DOI: 10.4103/0970-9185.83670. View

14.

Misra S, Behera B, Mitra J, Sahoo A, Jena S, Srinivasan A . Effect of preoperative dexmedetomidine nebulization on the hemodynamic response to laryngoscopy and intubation: a randomized control trial. Korean J Anesthesiol. 2020; 74(2):150-157. PMC: 8024211. DOI: 10.4097/kja.20153. View

15.

Lee S, Kim B, Lim K, Stalker D, Wisemandle W, Shin S . Pharmacokinetics and pharmacodynamics of intravenous dexmedetomidine in healthy Korean subjects. J Clin Pharm Ther. 2012; 37(6):698-703. DOI: 10.1111/j.1365-2710.2012.01357.x. View

16.

Kumar N, Jonnavithula N, Padhy S, Sanapala V, Naik V . Evaluation of nebulised dexmedetomidine in blunting haemodynamic response to intubation: A prospective randomised study. Indian J Anaesth. 2021; 64(10):874-879. PMC: 7791430. DOI: 10.4103/ija.IJA_235_20. View

17.

Gu W, Xu M, Lu H, Huang Q, Wu J . Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial. J Thorac Dis. 2020; 11(11):4663-4670. PMC: 6940245. DOI: 10.21037/jtd.2019.10.59. View

18.

Scheuermeyer F, Andolfatto G, Qian H, Grafstein E . Does the sedation regimen affect adverse events during procedural sedation and analgesia in injection drug users?. CJEM. 2013; 15(5):279-88. DOI: 10.2310/8000.2013.130933. View

19.

Hall J, Uhrich T, BARNEY J, Arain S, Ebert T . Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000; 90(3):699-705. DOI: 10.1097/00000539-200003000-00035. View

20.

Kumar A, Kumari P, Sinha C, Kumar A, Kumar R, Kumar A . Dexmedetomidine nebulization as adjuvant to lignocaine during awake flexible fiberoptic intubation. Saudi J Anaesth. 2019; 13(2):152-153. PMC: 6448424. DOI: 10.4103/sja.SJA_579_18. View