Gu Wei, Xu Meiying, Lu Huijie, Huang Qi, Wu Jingxiang
Department of Anaesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
J Thorac Dis. 2019 Nov;11(11):4663-4670. doi: 10.21037/jtd.2019.10.59.
Dexmedetomidine plus opioid infusion after topical anaesthesia with nebulized lidocaine for cough suppression is a commonly used method 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. However, there are no data regarding the use of nebulized dexmedetomidine-lidocaine for topical anaesthesia as a premedication for flexible bronchoscopy. Therefore, this study compared the tolerability and safety of nebulized dexmedetomidine with that of conventional intravenous administration in patients undergoing bronchoscopy with moderate sedation.
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. The patients' coughing scores were assessed and graded. Our primary hypothesis was that nebulized dexmedetomidine-lidocaine could reduce the incidence of moderate to severe coughing. 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.
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 nebulized dexmedetomidine group had the lowest incidence of moderate to severe coughing (P=0.019). Nebulized dexmedetomidine showed a protective effect for reducing coughing compared with intravenous dexmedetomidine [P=0.008, odds ratio (OR): 0.273, 95% confidence interval (CI): 0.089-0.833]. 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). The rates of glottis closure were similar (20%, 25%, and 35%; P>0.05). The elapsed time until recovery in the nebulized dexmedetomidine group was significantly shorter than that in the intravenous dexmedetomidine group (10.60±1.39 15.10±1.45, P<0.001). The vasoconstrictor dosages were significantly lower in the nebulized dexmedetomidine group than in the intravenous dexmedetomidine group (P<0.001).
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.
雾化利多卡因局部麻醉后静脉输注右美托咪定加阿片类药物用于抑制咳嗽是柔性支气管镜检查常用的方法。最近，有报道称右美托咪定作为局部麻醉剂的添加剂使用比传统静脉给药有几个优点。然而，关于雾化右美托咪定 - 利多卡因用于局部麻醉作为柔性支气管镜检查术前用药的数据尚无。因此，本研究比较了中度镇静下行支气管镜检查患者雾化右美托咪定与传统静脉给药的耐受性和安全性。
60例需要进行柔性支气管镜检查的患者被随机分为三组：（I）雾化右美托咪定 + 利多卡因，n = 20；（II）静脉注射右美托咪定 + 雾化利多卡因，n = 20；（III）单纯雾化利多卡因（无右美托咪定），n = 20。评估并分级患者的咳嗽评分。我们的主要假设是雾化右美托咪定 - 利多卡因可降低中度至重度咳嗽的发生率。次要终点是术中声门关闭、完全下颌松弛和肢体运动的发生率；恢复所需的时间；以及血管收缩剂和阿托品的用量。
雾化右美托咪定组中度至重度咳嗽的发生率为15%，静脉注射右美托咪定组为50%，无右美托咪定组为55%。雾化右美托咪定组中度至重度咳嗽的发生率最低（P = 0.019）。与静脉注射右美托咪定相比，雾化右美托咪定在减少咳嗽方面显示出保护作用[P = 0.008，优势比（OR）：0.273，95%置信区间（CI）：0.089 - 0.833]。三组术中完全下颌松弛和肢体运动的发生率无差异（均P>0.05）。声门关闭的发生率相似（20%、25%和35%；P>0.05）。雾化右美托咪定组恢复所需的时间明显短于静脉注射右美托咪定组（10.60±1.39对15.10±1.45，P<0.001）。雾化右美托咪定组血管收缩剂的用量明显低于静脉注射右美托咪定组（P<0.001）。
在中度镇静下进行支气管镜检查时，雾化右美托咪定 - 利多卡因吸入作为柔性支气管镜检查的术前用药耐受性良好，且与中度至重度咳嗽的发生率降低、恢复时间缩短和血管收缩剂用量减少有关。
