From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine (JK, SMC, YSP, C-HL, S-ML, CGY,YWK, JL), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea (JK).
Eur J Anaesthesiol. 2021 May 1;38(5):534-540. doi: 10.1097/EJA.0000000000001370.
Desaturation is a common complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Dexmedetomidine (DEX), a commonly used sedative in intensive care, is associated with less respiratory depression compared with other sedatives.
We compared DEX with midazolam (MDZ) when used as a sedative during EBUS-TBNA.
A randomised, parallel, double-blinded trial.
A university-affiliated teaching hospital between June 2014 and July 2015.
A total of 102 patients who underwent EBUS-TBNA were randomly allocated to two groups (48 DEX group, 54 MDZ group).
DEX group received 0.25 to 0.75 μg kg-1 h-1 (start with 0.5 μg kg-1 h-1, modulated in three steps from 0.25 to 0.75 μg kg-1 h-1) of DEX after a loading dose of 0.25 μg kg-1 h-1 for 10 min to maintain a Ramsay Sedation Scale (RSS) of 3 to 5. If the patient was agitated, 1 mg of MDZ bolus was used as a rescue drug. Patients in the MDZ group initially received 0.05 mg kg-1 of MDZ as a bolus. For maintenance and rescue, 1 mg of MDZ bolus was used.
The primary outcome was the presence of oxygen desaturation. Secondary outcomes were level of sedation (Ramsay Sedation Scale score), cough score, sedation and procedure satisfaction score.
The baseline characteristics of the patients, duration of EBUS-TBNA procedures and the use of rescue MDZ were not different between the groups. There was no significant difference in desaturation events between the DEX and MDZ groups (56.3 and 68.5%, respectively; P = 0.20). The level of sedation and the sedation satisfaction scores were similar between the two groups. However, cough score was significantly lower in the DEX group (41.9 vs. 53.4; P = 0.02).
The use of DEX during EBUS-TBNA was not superior to MDZ in terms of oxygen desaturation.
Clinicaltrials.gov identifier: NCT02157818.
经支气管超声内镜引导下经支气管针吸活检（EBUS-TBNA）中常发生低氧血症。右美托咪定（DEX）是一种在重症监护中常用的镇静剂，与其他镇静剂相比，其呼吸抑制作用较小。
比较 DEX 和咪达唑仑（MDZ）在 EBUS-TBNA 中作为镇静剂的使用效果。
随机、平行、双盲试验。
2014 年 6 月至 2015 年 7 月间的一所大学附属医院。
共 102 例行 EBUS-TBNA 的患者被随机分配到两组（48 例 DEX 组，54 例 MDZ 组）。
DEX 组在负荷剂量 0.25μg/kg/h 持续 10min 后，给予 0.250.75μg/kg/h 的 DEX 以维持 Ramsay 镇静评分（RSS）35 级（起始剂量 0.5μg/kg/h，分 3 步上调至 0.75μg/kg/h）。如患者躁动，给予 1mg MDZ 作为解救药物。MDZ 组患者初始给予 0.05mg/kg 的 MDZ 作为负荷剂量。维持和解救时，给予 1mg MDZ 。
主要结局是氧饱和度下降。次要结局为镇静水平（Ramsay 镇静评分）、咳嗽评分、镇静和程序满意度评分。
两组患者的基线特征、EBUS-TBNA 操作时间和 MDZ 解救的使用情况无差异。DEX 组和 MDZ 组的低氧血症发生率无显著差异（分别为 56.3%和 68.5%；P=0.20）。两组患者的镇静水平和镇静满意度评分相似，但 DEX 组的咳嗽评分明显较低（41.9 比 53.4；P=0.02）。
在 EBUS-TBNA 中使用 DEX 并不优于 MDZ ，在氧饱和度下降方面无优势。
Clinicaltrials.gov 标识符：NCT02157818。
