The Journal of Practical Medicine ›› 2022, Vol. 38 ›› Issue (14): 1819-1824.doi: 10.3969/j.issn.1006⁃5725.2022.14.020

• Drugs and Clinic Practice • Previous Articles     Next Articles

A comparison of the feasibility of two conscious sedation scheme as midazolam combined with dexmedeto⁃ midine and fentany guided by bispectral index during bronchoscopy

ZHANG Qiudi，HE Qian，ZHOU Jun， GUAN Shuhong，XU Xiong，XU Qianqian，DAI Pei，ZHANG Sujuan.   

  1. Department of Pulmonary and Critical Care Medicine，the Third Affiliated Hospital of Soochow University，Changzhou 213003，China 

  • Online:2022-07-25 Published:2022-07-25
  • Contact: ZHANG Sujuan E⁃mail：zsj67720@czfph.com

Abstract:

Objective To investigate the feasibility of two conscious sedation regimens guided by bispectral index（BIS）without anesthesiologist involved during bronchoscopy. Methods Patients who underwent bronchoscopy in the Third Affiliated Hospital of Medical College of Suzhou University from September 2018 to July 2019，were divided into local anesthesia group（group A，lidocaine）and sedation group（BIS guided，without anesthesiologist involved）according to the patients′ decision. Patients in the the sedation group were numbered according to the order of examination，randomly divided into group B（dexmedetomidine combined with midazolam）and group C （fentanyl combined with midazolam）. Vital signs at different time points and adverse events were recorded during bronchoscopy. The sedation effect were evaluated by operators and patients respectively. Results A total of 658 patients were in the study（225 cases in group A，222 in group B，211 in group C）. The complexity of scope insertion assesed by operators and sedation effect evaluated by patients in sedation group was better than those in group A （P < 0.001），while has no significant difference between group B and C；The cough VAS score，satisfaction VAS score evaluated by operators in group C were better than those in group A and B（P < 0.001）；As to the adverse events：the incidence of hypoxemia and bradycardia in sedation group was higher while hypertension and tachycar⁃ dia was lower than that in group A. In group B，the incidence of hypoxemia was lower while that of bradycardia was higher than that in group C（P < 0.001）；Vital signs：The fluctuation of blood pressure was minimal in group B， and maximum in group A（P < 0.001）；Compared to pre⁃operation，the heart rate increased more in group A than that of group C，while declined in group B（P < 0.001）. Conclusion Compared to local anesthesia，conscioussedation guided by BIS without anesthesiologist involved was safe and effective. Compared with the two sedation protocols，dexmetomidine combined with midazolam appeared less hypoxemia，reduced the fluctuation of blood pressure and heart rate during bronchoscopy，though was prone to hypotension and bradycardia. 

Key words:

bronchoscopy, conscious sedation, bispectral index, Midazolam, Dexmedetomi? dine, Fentanyl