Wang Longfei, Wu Qiuyue, Wang Ming, Ming Wanquan, Sheng Cheng, Zhang Yonghua, Chen Yongbin, Cao Yunfei
School of Medicine, Ningbo University, Ningbo, China.
Department of Anesthesiology, Beilun District People's Hospital of Ningbo, Ningbo, China.
Front Pharmacol. 2022 Oct 21;13:1036840. doi: 10.3389/fphar.2022.1036840. eCollection 2022.
Sedation is recommended by most guidelines to be offered to all patients undergoing diagnostic flexible bronchoscopy (DFB) without contraindications, and the most commonly reported regimen is midazolam in combination with a short-acting opioid (fentanyl or alfentanil) to provide both sedative and antitussive effects. However, the optimal dose or ideal regimen of the combination therapy with midazolam and opioids has not yet been found. So this randomized, double-blinded clinical trial was designed and registered (ChiCTR2100049052) to assess the safety and efficacy of midazolam combined with different doses of alfentanil in DFB sedation. Our study showed that relative high doses of alfentanil (10-25 μg/kg) combined with a fixed low dose of midazolam can markedly reduce hemodynamic fluctuations, cough reactions, patients' discomforts, and improve their satisfaction in a dose-dependent manner during DFB, with no significant increase in the desaturation risks.
大多数指南建议，对于所有接受诊断性可弯曲支气管镜检查（DFB）且无禁忌证的患者给予镇静，最常报告的方案是咪达唑仑联合短效阿片类药物（芬太尼或阿芬太尼），以提供镇静和镇咳作用。然而，尚未找到咪达唑仑与阿片类药物联合治疗的最佳剂量或理想方案。因此，本随机双盲临床试验进行了设计并注册（ChiCTR2100049052），以评估咪达唑仑联合不同剂量阿芬太尼用于DFB镇静的安全性和有效性。我们的研究表明，相对高剂量的阿芬太尼（10 - 25μg/kg）联合固定低剂量的咪达唑仑，可在DFB期间显著降低血流动力学波动、咳嗽反应、患者不适，并以剂量依赖方式提高其满意度，且去饱和风险无显著增加。
