Monitored Anesthesia Care with Dexmedetomidine Supplemented by Midazolam/Fentanyl versus Midazolam/Fentanyl Alone in Patients Undergoing Pleuroscopy: Effect on Oxygenation and Respiratory Function.

Andreas Kostroglou,Charalampos Siristatidis,Michail Papapanou,Tatiana Sidiropoulou,Emmanouil I Kapetanakis,Ioannis Tomos,Konstantinos Kostopanagiotou,Periklis Tomos,Paraskevi Matsota

doi:10.3390/jcm10163510

Andreas Kostroglou, Charalampos Siristatidis + Show 7 more

Open Access

https://doi.org/10.3390/jcm10163510

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Abstract

Although pleuroscopy is considered a safe and well tolerated procedure with a low complication rate, it requires the administration of procedural sedation and analgesia. The purpose of this study was to assess the effects of dexmedetomidine administration on oxygenation and respiratory function in patients undergoing diagnostic or therapeutic pleuroscopy. Through a prospective, single center, cohort study, we studied 55 patients receiving either a dexmedetomidine intravenous infusion supplemented by midazolam/fentanyl (Group DEX + MZ/F) or a conventional sedation protocol with midazolam/fentanyl (Group MZ/F). Our primary outcome was the changes in lung gas exchange (PaO2/FiO2 ratio) obtained at baseline and at predetermined end points, while changes in respiratory mechanics (FEV1, FVC and the ratio FEV1/FVC) and PaCO2 levels, drug consumption, time to recover from sedation and adverse events were our secondary endpoints (NCT03597828). We found a lower postoperative decrease in FEV1 volumes in Group DEX + MZ/F compared to Group MZ/F (p = 0.039), while FVC, FEV1/FVC and gas exchange values did not differ between groups. We also found a significant reduction in midazolam (p < 0.001) and fentanyl consumption (p < 0.001), along with a more rapid recovery of alertness postprocedure in Group DEX + MZ/F compared to Group MZ/F (p = 0.003), while pain scores during the postoperative period, favored the Group DEX + MZ/F (p = 0.020). In conclusion, the use of intravenous dexmedetomidine during pleuroscopy is associated with a smaller decrease in FEV1, reduction of the consumption of supplementary sedatives and analgesics and quicker awakening of patients postoperatively, when compared to midazolam/fentanyl. Therefore, dexmedetomidine administration may provide clinically significant benefits in terms of lung mechanics and faster recovery of patients undergoing pleuroscopy.

Highlights

Pleuroscopy is being increasingly used by chest physicians and has become, after bronchoscopy, the second most commonly utilized endoscopic procedure in the field of respiratory medicine [1,2]
It is considered as a safe procedure with very low complication rates in experienced hands [4,5], it requires the administration of procedural sedation and analgesia
From 5 August, 2018 to 30 June, 2020, 64 patients scheduled for pleuroscopy were assessed for eligibility, and four patients who did not meet the inclusion criteria were excluded from the study

Summary

Introduction

Pleuroscopy is being increasingly used by chest physicians and has become, after bronchoscopy, the second most commonly utilized endoscopic procedure in the field of respiratory medicine [1,2]. It is considered to be an important part of a specialist pleural disease service [3] It is considered as a safe procedure with very low complication rates in experienced hands [4,5], it requires the administration of procedural sedation and analgesia. The latter is essential for both alleviating patients’ discomfort by reducing their anxiety and minimizing the pain, and for providing better procedural conditions for the operator [6]. The presence of an anesthesiologist during the procedure is mandatory, especially for the management of high-risk patients [7]. Its onset time is less than five minutes, while its maximum effect is expected to occur within the first 15 min [9]

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