Comparison of dexmedetomidine to propofol for sedation of endobronchial ultrasound-guided transbronchial needle aspiration

Abstract

Background: Dexmedetomidine, a sedative agents viaα2 adrenergic agonist, provides light sleep-like sedation with little respiratory suppression. The study aims to evaluate the efficacy and safety of dexmedetomidine sedation compared with propofol in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Method: Patients requiring elective EBUS-TBNA were randomized into: Dexmedetomidine (D, n=10), dexmedetomidine 1ug/kg infusion for 10 minutes and 0.5~1.4ug/kg/hour or propofol (P, n=15), the effect-site concentration targeted to 2.0ug/ml ±0.2ug/ml to achieve stable vital signs and The Observer Assessment of Alertness and Sedation scale (OAA/S) 3~2. Vital signs and bispectral index (BIS) during bronchoscopy and recovery time were recorded. Patients’ tolerance, awareness and cooperation during bronchoscopy were evaluated by 100 mm-visual analog scale (VAS, 0: no bother; 100: the worst intolerance).

Results: The lowest mean arterial blood pressure in D was higher than P (83.0±9.2 vs. 71.4±15.3mmHg, p=0.03). The lowest heart rate was significant lower in D than P (58.9±9.4 vs. 70.9±12.4 beat/min, p=0.03). The mean BIS during sedation was significant higher in D than P (p<0.001). Oxygenation, recovery time, tolerance and awareness were similar in both groups. The cooperation is better in D compared to D (p=0.01).

Conclusion: Dexmedetomidine provided a lighter sedation, reduced heart rate without compromised blood pressure and tolerance of patients undergoing EBUS-TBNA compared to propofol. Dexmedetomidine sedation provided better patient cooperation for of EBUS-TBNA.