Animal experiments have indicated that the local application of dexmedetomidine to the airway can expand the smooth muscle of the trachea and may inhibit the cough response ( 8). Recently, the use of dexmedetomidine as an additive to local anaesthetics was reported to have several advantages over conventional intravenous administration ( 6, 7). This result can be explained by the fact that dexmedetomidine has no antitussive effects, and the passage of a flexible bronchoscope through the vocal cords can lead to coughing ( 5). However, it has been reported that intravenous dexmedetomidine is associated with a longer recovery time and worse bronchoscopist satisfaction scores ( 5).
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The combination of dexmedetomidine plus opioids or propofol infusion plus topical anaesthesia with lidocaine for cough suppression is commonly used for flexible bronchoscopy ( 4). Dexmedetomidine is a highly selective adrenergic α-2 agonist that does not cause respiratory depression and can be used as a sedative for various procedures ( 2, 3). Intravenous infusion of propofol and remifentanil combined with dexmedetomidine is a common method.
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As the procedure is usually performed on an outpatient basis, the ideal pharmacokinetic characteristics of sedatives during MAC for flexible bronchoscopy are rapid onset, short duration, and rapid recovery. To facilitate the procedure, reduce coughing, and increase patient tolerance and comfort, patients are usually under monitored anaesthesia care (MAC) during bronchoscopy ( 1). Accepted for publication Sep 27, 2019.įlexible bronchoscopy is a well-established diagnostic and therapeutic procedure for patients with a variety of respiratory diseases. Keywords: Anaesthesia flexible bronchoscopy dexmedetomidine coughing The vasoconstrictor dosages were significantly lower in the nebulized dexmedetomidine group than in the intravenous dexmedetomidine group (P<0.001).Ĭonclusions: Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy was well tolerated during bronchoscopies performed under moderate sedation and was associated with a reduced incidence of moderate to severe coughing, a shorter recovery time and reduced vasoconstrictor consumption. The elapsed time until recovery in the nebulized dexmedetomidine group was significantly shorter than that in the intravenous dexmedetomidine group (10.60☑.39 vs. The rates of glottis closure were similar (20%, 25%, and 35% P>0.05). No differences in the rates of complete jaw relaxation and limb movement during the procedure were observed among the three groups (all P>0.05). Nebulized dexmedetomidine showed a protective effect for reducing coughing compared with intravenous dexmedetomidine. The nebulized dexmedetomidine group had the lowest incidence of moderate to severe coughing (P=0.019).
Results: The incidence of moderate to severe coughing was 15% in the nebulized dexmedetomidine group, 50% in the intravenous dexmedetomidine group and 55% in the no dexmedetomidine group. The secondary endpoints were the rates of glottis closure, complete jaw relaxation and limb movement during the procedure the elapsed time until recovery and the dosages of vasoconstrictors and atropine. Our primary hypothesis was that nebulized dexmedetomidine-lidocaine could reduce the incidence of moderate to severe coughing. The patients’ coughing scores were assessed and graded. Methods: Sixty patients requiring flexible bronchoscopy were randomly assigned to three groups: (I) nebulized dexmedetomidine + lidocaine, n=20 (II) intravenous dexmedetomidine + nebulized lidocaine, n=20 and (III) nebulized lidocaine alone (no dexmedetomidine), n=20. Therefore, this study compared the tolerability and safety of nebulized dexmedetomidine with that of conventional intravenous administration in patients undergoing bronchoscopy with moderate sedation. However, there are no data regarding the use of nebulized dexmedetomidine-lidocaine for topical anaesthesia as a premedication for flexible bronchoscopy. Recently, the use of dexmedetomidine as an additive to local anaesthetics has been reported to have several advantages over conventional intravenous administration. Interviews with Outstanding Guest Editorsīackground: Dexmedetomidine plus opioid infusion after topical anaesthesia with nebulized lidocaine for cough suppression is a commonly used method for flexible bronchoscopy.Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
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