The use of dexmedetomidine as a sedative during flexible bronchoscopy

Moderate sedation is recommended during bronchoscopy, in order to improve patient comfort during the procedure and to facilitate the performance of the bronchoscopist. Dexmedetomidine (a selective α-2 adrenoceptor agonist) has sedative and analgesic properties, and contrary to other sedatives does not cause respiratory depression. The objective of the study was to assess the use of Dexmedetomidine as a sedative adjuvant to local anesthesia in selected patients meeting certain criteria for light sedation during flexible bronchoscopy. Twenty six patients who received dexmedetomidine plus local anesthesia (group D, 14 males, 12 females, age 66±11 yrs), and 23 consecutive patients who received only local anesthesia (group C, 17 males, 6 females, age 61.0±13 yrs) were analyzed. Dexmedetomidine was given in a loading dose 0.6-1 μg/kg over 10 min, followed by a continuous infusion at rate adjusted (0.4-0.8 μg/kg/hour) to maintain a level of 2 to 3 on Ramsay sedation scale (RSD). The procedure was prematurely terminated in 4 patients, 2 in each group. Maximum heart rate was significantly lower in group D compared to group C (87±13 vs. 97±16 beats/min). Excellent cooperation was observed in 42% in group D and 22% in group C. The duration of the procedure and the recovery time did not differ between groups. No remarkable side effects attributed to Dexmedetomidine were noted. We conclude that during flexible bronchoscopy the use of Dexmedetomidine as a potent adjuvant sedative to local anesthesia is safe and may facilitate the procedure and improve patient comfort.