Moderate sedation with dexmedetomidine–remifentanil is safer than deep sedation with propofol–remifentanil for endobronchial ultrasound while providing comparable quality: a randomized double-blind trial

ABSTRACT

Objective

We compared dexmedetomidine-remifentanil vs. propofol-remifentanil in terms of safety and quality during sedation for Endobronchial ultrasonography (EBUS).

Methods

A randomized, double-blind trial. Outpatients undergoing EBUS randomly received 1 μg/kg/hour dexmedetomidine or a target concentration of 2.5 μg/mL propofol, both combined with remifentanil initially targeted at 1.5 ng/mL and subsequently titrated. Additional sedatives were restricted. The primary outcome was the need for airway rescue interventions to treat oxygen desaturation.

Results

Twenty-eight patients received dexmedetomidine-remifentanil and 27 received propofol-remifentanil. Airway rescue interventions were fewer in the dexmedetomidine group vs. the propofol one (23 vs. 76% patients, relative risk 3.21 (95% CI 1.55–6.64, P < 0.002)). Desaturation in the dexmedetomidine group was always resolved by increasing nasal oxygen flow, whereas additional interventions were needed in 60% of patients receiving propofol. Hypotension was more frequent in the propofol group, while hypertension, bradycardia and coughing were similar in both. Bronchoscopists’ and patients’ satisfaction were similar, although in the dexmedetomidine group two patients needed additional sedatives and two patients would not repeat the sedation technique.

Conclusion

Moderate sedation with dexmedetomidine-remifentanil for EBUS is safer than deep sedation with propofol-remifentanil but it would occasionally need additional sedatives to ensure patient satisfaction.

KEYWORDS:

• Deep sedation
• dexmedetomidine
• endobronchial ultrasound
• moderate sedation
• propofol
• remifentanil

Acknowledgments

Assistance with the study: we thank Mercè Martín and Núria Cuberas, nurses of the bronchoscopy suite for their assistance in assuring blinding during the procedures. We are also grateful to Xavier Duran and the staff of the Methodological and Biostatistical Advisory Service of the IMIM, Barcelona, for their help with the statistical analysis, and Sergi Sabaté for his advice on methods. Mary Ellen Kerans gave guidance on English language expression in some versions of the manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Silvia Bermejo, Begoña Covas and Lluís Gallart contributed to study conception and design, data interpretation and providing the draft.

Albert Sánchez-Font and Víctor Curul contributed to study conception and design and critical revision for important intellectual content.

Teresa Silva-Costa-Gomes, Anna Mases and Àlex Pérez-Ramos contributed to data analysis and interpretation and critical revision for important intellectual content.

All authors contributed to data collection and to approve the final manuscript version.

Additional information

Funding

This paper was not funded.