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Dexmedetomidine for Awake Bronchoscopy: Our Experience

Vaddineni Jagadish, Assistant Professor, Department of Anesthesia, Narayana Medical College & Hospital, Nellore, Andhra Pradesh 524003, India. , Valluri Anil Kumar1 , Vaddineni Jagadish2

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Indian Journal of Anesthesia and Analgesia 5(1):p 9-12, January-February 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5118.2

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Abstract

Background: Respiratory physicians are showing interest in using Dexmedetomidine for awake sedation, since, it is safe and useful when the patient is having spontaneous breathing and also cost-effective. We evaluated the safety and efficacy of dexmedetomidine in a small cohort of thirty patients undergoing awake bronchoscopy under topical anaesthesia using 10% Xylocaine. Methods: Premedication was with midazolam and rescue medication was fentanyl. Dexmedetomidine was infused at one g/kg infused over 10 minutes. The bronchoscope was inserted after bolus infusion followed by maintenance infusion of Dexmedetomidine started with 0.2g/kg/h and titrated optionally to 0.7g/kg/h. We recorded the pre- and intraprocedural vital signs and Ramsay sedation score were recorded every 10 minutes, in addition to adverse events, duration of the procedure, use of rescue sedation with fentanyl one g/kg, and physicians and patient’s satisfaction. Patients were discharged as per the modified post anesthetic discharge scoring system. Results: Mean Duration of procedure was 30±10 min. Percentage of patients requiring rescue sedation was 3/30 (10%). 3/30 (10%) of patients had hypotension, 6/30 (20%) had bradycardia and 1/30 (3.3%) had amnesia. The mean time to recovery was 25±10 min. The physician and patient’s satisfaction score (range, 1 to 5) were five and four respectively. Conclusion: Dexmedetomidine alone is safe, provides satisfaction to both doctors and patients, with fewer anticipated and spontaneously recoverable side effects.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5118.2

Keywords

Awake Bronchoscopy; Patient Satisfaction; Dexmedetomidine. 

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