A randomized double-blind controlled trial comparing three sedation regimens during flexible bronchoscopy: Dexmedetomidine, alfentanil and lidocaine

Clinical usefulness of nebulized dexmedetomidine for conscious sedation in daycare flexible bronchoscopy in Southern India

BACKGROUND

Sedative agents used in bronchoscopy require trained personnel to administer and monitor the patient. This increases the procedure cost, duration, and inpatient stay. Inhalational administration of sedative agents can be a practical solution to the issue. Dexmedetomidine in the inhalational form could give results similar to the intravenous form without significant adverse events.

MATERIALS AND METHODS

The study is prospective, randomized, and double-blinded study. Patients needing bronchoscopy were randomized to receive the nebulized form of either dexmedetomidine or saline (0.9%) before bronchoscopy. The study parameters are assessed and recorded before, during, and after bronchoscopy. Data collected are analyzed using the SPSS software.

DISCUSSION

The side effects limit using commonly administered sedation agents in bronchoscopy, such as midazolam, fentanyl, and dexmedetomidine. The nebulized dexmedetomidine is safe with proven efficacy when compared to the placebo. Proceduralist-administered conscious sedation reduces the overall cost and shortens inpatient stays. Attenuation of hemodynamic parameters by dexmedetomidine could be an advantage for the physician in reducing an untoward cardiac event.

CONCLUSION

Dexmedetomidine in the nebulized form improves the comfort of patients during the procedure. It blunts the pressure response during bronchoscopy and could be a safer and cost-effective agent in its nebulized form for conscious sedation in bronchoscopy. The study is approved by the institutional ethics committee (IEC KMC MLR 10-2021-310).

Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis

BACKGROUND

Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population.

METHODS

A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others.

RESULTS

A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, I2 = 39%) and bradycardia (OR = 3.60 [2.29, 5.67], p < 0.00001, I2 = 0%), and a lower incidence of desaturation (OR = 0.40 [0.25, 0.66], p = 0.0003, I² = 60%).

CONCLUSION

DEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications.

Safety and Efficacy of Dexmedetomidine for Bronchoscopy: A Systematic Review and Meta-Analysis

(1) Background: Anesthetic sedatives are widely used for bronchoscopy, and controversy surrounds the safety and efficacy of dexmedetomidine compared to other sedatives. The aim of this study is to evaluate the safety and efficacy of dexmedetomidine in bronchoscopy through a systematic review. (2) Methods: PubMed, Embase, Google Scholar, and Cochrane Library electronic databases were searched for a randomized controlled study of dexmedetomidine (Group D) or other sedative drugs (Group C) for bronchoscopy. Data extraction, quality assessment, and risk of bias analysis were performed in accordance with the preferred reporting items for systematic review and meta-analysis requirements. Meta-analysis was performed using RevMan 5.2. (3) Results: Nine studies were included, with a total of 765 cases. Compared to Group C, the incidence of hypoxemia (OR = 0.40, 95% CI (0.25, 0.64) p = 0.0001, I² = 8%) and tachycardia (OR = 0.44, 95% CI (0.26,0.74), p = 0.002, I² = 14%) were lower, but bradycardia (OR = 3.71, 95% CI (1.84, 7.47), p = 0.0002, I² = 0%) was higher in Group D; no significant difference was observed in other outcome indicators. (4) Conclusions: Dexmedetomidine reduces the incidence of hypoxemia and tachycardia during bronchoscopy but is more likely to provoke bradycardia.

Comparison of high-flow nasal cannula and conventional oxygen therapy for high-risk patients during bronchoscopy examination: protocol for a randomized controlled trial

INTRODUCTION

High-flow nasal cannula (HFNC) has been proven to improve oxygenation and avoid intubation in hypoxemic patients. It has also been utilized during endoscopy examination to reduce the incidence of hypoxia. However, little is known about the effects of HFNC versus conventional oxygen therapy (COT) on oxygenation during bronchoscopy examination via nasal route; particularly, no study has compared the use of HFNC with that of COT at similar F_IO₂ for patients who have high-risk factors of desaturation during bronchoscopy examination.

METHODS AND ANALYSIS

This randomized controlled trial will be implemented in four academic centers in China. Patients who have high-risk factors including hypoxemia, hypercapnia, morbid obesity, and narrow airway will be enrolled to use HFNC or COT during bronchoscopy examination. In the HFNC group, the initial gas flow will be set at 50 L/min with a fraction of inspired oxygen (F_IO₂) at 0.45, if the patient tolerates, the flow can be increased to 60L/min at most, while in the COT group, oxygen flow will be set at 6 L/min via a conventional nasal cannula. After 5 min pre-oxygenation, the bronchoscope will be inserted via the nasal route. Vital signs, oxygenation (SpO₂), and transcutaneous CO₂ (PtCO₂) will be continuously monitored. The primary outcome is the incidence of hypoxemia, defined as SpO₂ < 90% for 10 s during bronchoscopy examination, and secondary outcomes include the need for treatment escalation and adverse events.

DISCUSSION

Hypoxia is a common complication of bronchoscopy, our study attempted to demonstrate that HFNC may reduce the probability of hypoxia during bronchoscopy in high-risk patients. The results will be disseminated through peer-reviewed journals and national and international conferences.

TRIAL REGISTRATION

http://www.chictr.org.cn/ : ChiCTR2100055038. Registered on 31 December 2021.

The impact of alfentanil supplementation on the sedation of bronchoscopy: A meta-analysis of randomized controlled trials

BACKGROUND

The efficacy of alfentanil supplementation for the sedation of bronchoscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of alfentanil supplementation on the sedation during bronchoscopy.

METHODS

We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through December 2019 for randomized controlled trials (RCTs) assessing the effect of alfentanil supplementation versus placebo for the sedation during bronchoscopy. This meta-analysis is performed using the random-effect model.

RESULTS

Five RCTs are included in the meta-analysis. Overall, compared with control group for bronchoscopy, alfentanyl supplementation is associated with significantly reduced coughing scores (Std. MD = -0.55; 95% CI = -0.96 to -0.14; P = 0.009) and dose of propofol (Std. MD = -0.34; 95% CI = -0.64 to -0.04; P = 0.03), but reveals the increase in hypoxemia (RR = 1.56; 95% CI = 1.17 to 2.08; P = 0.002).

CONCLUSIONS

Alfentanyl supplementation benefits to reduce coughing scores and dose of propofol for bronchoscopy, but increases the incidence of hypoxemia. The use of alfentanyl supplementation for bronchoscopy should be with caution.

Dexmedetomidine versus propofol sedation in flexible bronchoscopy: a randomized controlled trial

Background

Dexmedetomidine (DEX), is a highly selective alpha2 adrenoceptor (α2-AR) agonist, successfully used in various procedures including flexible bronchoscopy. Randomized controlled trials (RCTs) evaluating DEX sedation during bronchoscopy report equivocal results regarding respiratory and hemodynamic outcomes.

Methods

We conducted an RCT to evaluate the efficacy and safety of dexmedetomidine compared to propofol for sedation during bronchoscopy. The primary outcome was the number of desaturation events, secondary outcomes were transcutaneous Pco2 level, hemodynamic adverse events and physician and patient satisfaction.

Results

Overall, 63 patients were included, 30 and 33 in the DEX and propofol groups, respectively. The number of desaturation events was similar between groups, median (IQR) 1 (0–1) and 1 (0–2) in the DEX and control groups, respectively (P = 0.29). Median desaturation time was 1 (0–2) and 1 (0–3) minutes in the DEX and control groups, respectively (P = 0.48). Adverse events included hypotension, 33% vs 21.1% in intervention and control groups, respectively (P = 0.04), bradycardia, cough, and delayed recovery from sedation. Total adverse events were 22 and 7 in DEX and propofol groups, respectively (P = 0.009).

Conclusion

Dexmedetomidine sedation during bronchoscopy did not show differences in oxygen saturation and transcutaneous CO2 level in comparison to propofol. Moreover, DEX sedation required a significantly higher number of rescue boluses, due to inadequate sedation and was associated with a higher rate of adverse events.

Trial registration NCT04211298, registration date: 26.12.2019.

Clinical usefulness of intermediate-dose dexmedetomidine (0.75 μg/kg) in flexible bronchoscopy - A prospective, randomized, double-blinded study

BACKGROUND:

Dexmedetomidine, although an effective drug for conscious sedation during flexible bronchoscopy, has occasional side effects on the cardiovascular system which need to be addressed.

MATERIALS AND METHODS:

Patients between 18 and 65 years, requiring diagnostic flexible bronchoscopy, found eligible, after screening, were randomized to either receive 0.75 μg/kg intravenous dexmedetomidine over 10 min or intravenous midazolam 0.035 mg/kg over 1 min. Composite score was used as the primary outcome measure. Additional parameters recorded were: Hemodynamic variables, oxygen saturation, Ramsay sedation score, for pain intensity and distress Numerical Rating Scale, number of rescue medication doses, ease of doing bronchoscopy, Visual Analog Scale score for cough and response of the patient 24 h after bronchoscopy.

RESULTS:

In each group, 24 patients were enrolled. The composite score was in the ideal category in 24 patients in dexmedetomidine group and 21 in midazolam group, at nasopharynx (P = 0.234). The corresponding values at the level of trachea were 23 and 16 (P = 0.023). In dexmedetomidine group, patient response after 24 h of bronchoscopy showed quality of sedation to be excellent in 0 subjects, good in 13, fair in 9 and poor in 2 and discomfort to be nil in 7, mild 10, moderate in 7 and severe in 0. The corresponding values in midazolam group for quality of sedation were 0, 4, 14, 6, and for discomfort 0, 10, 14, 0. The Visual Analog Scale (VAS) for cough revealed a mean score of 0.800 and 1.812 (P = 0.011) during and 2.092 and 3.542 (P = 0.016) 24 h after bronchoscopy in the respective study groups.

CONCLUSION:

Low-dose dexmedetomidine (0.75 μg/kg single dose) appears to provide better patient comfort and equivalent safety profile when compared with midazolam.

Complications and discomfort after research bronchoscopy in the MicroCOPD study

Background

Data on discomfort and complications from research bronchoscopy in chronic obstructive pulmonary disease (COPD) and asthma is limited. We present complications and discomfort occurring within a week after bronchoscopy, and investigate personal and procedural risk factors.

Methods

239 subjects with COPD, asthma or without lung disease underwent research bronchoscopies as part of a microbiome study of the lower airways (the MicroCOPD study). Bronchoscopy was done in the supine position with oral scope insertion with the option of light conscious alfentanil sedation. Sampling consisted of protected specimen brushes, bronchoalveolar lavage, small volume lavage and for some, endobronchial biopsies. Bleeding, desaturation, cough, haemodynamic changes, dyspnoea and other events that required an unplanned intervention or early termination of bronchoscopy were prospectively recorded. Follow-up consisted of a telephone interview where subjects rated discomfort and answered questions about fever sensation and respiratory symptoms in the week following bronchoscopy.

Results

An unplanned intervention or early termination of bronchoscopy was required in 25.9% of bronchoscopies. Three subjects (1.3%) experienced potentially severe complications, of which all recovered without sequelae. COPD subjects experienced more dyspnoea than controls. Sedation and lower age was associated with less unplanned intervention or premature termination. About half of the subjects (47.7%) reported fever. Discomfort was associated with postprocedural fever, dread of bronchoscopy, higher score on the COPD Assessment Test and never-smoking. In subjects undergoing more than one bronchoscopy, the first bronchoscopy was often predictive for complications and postprocedural fever in the repeated bronchoscopy.

Conclusion

Research bronchoscopies were not associated with more complications or discomfort in COPD subjects. 47.7% experienced postbronchoscopy fever sensation, which was associated with discomfort.

Fixed dexmedetomidine infusion versus fixed-dose midazolam bolus as primary sedative for maintaining intra-procedural sedation during endobronchial ultrasound-guided transbronchial needle aspiration: a double blind randomized controlled trial

Objective: The utility and safety of fixed dexmedetomidine infusion was compared to fixed-dose midazolam bolus among patients undergoing EBUS-TBNA.Methods: In this randomized double-blind study, 197 patients were assigned to receive dexmedetomidine (Group D, 1 μg/kg before, and 0.6 μg/kg/hour during, procedure) or midazolam (Group M, 2 mg before procedure) sedation. The primary outcome was number of rescue midazolam boluses administered to achieve Ramsay Sedation Scale (RSS) score of two or more. We also studied sedation depth during procedure, adverse hemodynamic and hypoxemic events, bronchoscopist and patient satisfaction, and time-to-discharge from recovery room.Results: Rescue midazolam requirement was significantly lesser in 99 Group D (0.9 ± 1.2 boluses) than in 98 Group M (2.0 ± 2.4 boluses), subjects. Mean RSS score was significantly higher in Group D subjects (2.5 ± 0.7 vs. 2.3 ± 0.7). Significantly more subjects in Group D developed hypotension (46 vs. 27) or bradycardia (37 vs. 5), but none required specific intervention. Bronchoscopists reported significantly greater overall procedure satisfaction in Group D subjects.Conclusion: Fixed dexmedetomidine infusion reduced need for rescue sedation during EBUS-TBNA, and allowed slightly faster post-procedure recovery, as compared to fixed-dose midazolam bolus. However, it caused hypotension and bradycardia more frequently.Clinical trial registration: www.clinicaltrials.gov identifier is NCT02713191.

Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study

OBJECTIVE

Propofol for procedural sedation and analgesia (PSA) for colonoscopy can result in a high prevalence of severe respiratory depression. Studies have shown that intravenous (IV) infusion of lidocaine can reduce propofol requirements significantly and increase the ventilatory response to carbon dioxide in humans. We tested the hypothesis that IV lidocaine could improve propofol-induced respiratory depression in obese patients during colonoscopy.

METHODS

Ninety obese patients scheduled for painless colonoscopy were randomized to receive lidocaine (1.5 mg/kg, then 2 mg/kg/h, IV) or the same volume of 0.9% saline. Intraoperative sedation was provided by propofol. The primary outcome was the number of oxygen-desaturation episodes. Secondary outcomes were: the number of apnea episodes; total propofol consumption; time to the first hypoxia episode; time to consciousness loss; intraoperative hemodynamic parameters; awakening time; adverse events; duration of post-anesthesia care unit (PACU) stay; satisfaction of endoscopists and patients.

RESULTS

Demographic characteristics between the two groups were comparable. The number of oxygen-desaturation episodes in group L (1.49±1.12) decreased by 0.622 (P=0.018) compared with that in group N (2.11±1.32), and the number of apnea episodes in group L decreased by 0.533 (P<0.001). Kaplan-Meier curves showed that the median time to the first hypoxia episode was longer in group L (86.78 s) than that in group N (63.83 s) (Log rank P=0.0008). The total propofol consumption, awakening time, and duration of PACU stay were reduced in group L. There was no significant difference in the prevalence of adverse events (P>0.05 for all). Satisfaction scores for endoscopists and patients in group L were higher than that in group N (P<0.001).

CONCLUSION

Intravenous infusion of lidocaine could significantly reduce the number of oxygen-desaturation and apnea episodes in obese patients during painless colonoscopy. This method is worthy of clinical promotion.

CLINICAL TRIALS REGISTRATION

ChiCTR2000028937.

-Effects of Local Anesthetics on Smooth Muscle Tissue in Rat Trachea: An In Vitro Study

OBJECTIVES

We evaluated the muscle responses of rat trachea to LA drugs, such as lidocaine and prilocaine, in terms of airway spasms.

MATERIALS AND METHODS

A total of 16 male rats were used. After ketamine anesthesia, the tracheal ring of each rat was removed and placed in the organ bath in the Krebs solution. The rat tracheal veins were randomly divided into two groups based on the LA applied at the basal tonus level: group 1 (n=8), lidocaine; group 2 (n=8), prilocaine. Second, the baths were washed. Supramaximal contraction was obtained by applying acetylcholine to the tracheal rings (n=16) at a basal tonus level. The rat tracheas with supramaximal contraction were randomly divided into two groups: group 3 (n=8), lidocaine; group 4 (n=8), prilocaine. The contraction responses of each group were recorded and statistically compared.

RESULTS

Lidocaine constituted a significant relaxation response in the tracheal tissue in both basal tonus and supramaximal tonus levels. Moreover, it was observed that the relaxation of lidocaine was higher in the supramaximal contraction than in the basal tonus tension level. However, for prilocaine, no significant change was observed in both tonus levels.

CONCLUSION

This study suggests that lidocaine as a LA drug should be preferred as the first choice in patients with respiratory risk, and that its use over prilocaine should be preferred, if supported by advanced clinical studies.

Comparison of midazolam and low-dose dexmedetomidine in flexible bronchoscopy: A prospective, randomized, double-blinded study

BACKGROUND

Dexmedetomidine is a clinically useful drug for providing sedation, but concern regarding its cardiovascular side effect profile can limit its widespread use during routine diagnostic flexible bronchoscopy (FB).

MATERIALS AND METHODS

Patients between 18 and 65 years of age, who required diagnostic FB, were screened. Eligible patients were randomized to either receive 0.5 μg/kg intravenous dexmedetomidine over 10 min or intravenous midazolam 0.035 mg/kg over 1 min. If required, rescue medication (intravenous midazolam 0.5 mg bolus) was administered. The primary outcome measure was the composite score. Other parameters observed were numerical rating scale, hemodynamic variables, oxygen saturation, number of doses of rescue medication, visual analog scale score for cough, ease of bronchoscopy, Ramsay Sedation Score, and postprocedure patient response after 24 h of bronchoscopy.

RESULTS

A total of 54 patients were enrolled, 27 in each group. Total composite score (mean ± standard deviation) in dexmedetomidine and midazolam group at nasopharynx was 7.04 ± 2.19 and 6.59 ± 1.55 (P = 0.387), respectively. The corresponding values at the level of trachea were 9.22 ± 3.69 and 8.63 ± 2.13 (P = 0.475). In the dexmedetomidine group, patient response after 24 h of bronchoscopy showed the quality of sedation to be excellent in three patients, good in 10, fair in 11, and poor in 3 and discomfort to be nil in 14, mild 7, moderate in 3, and severe in 3. The corresponding values in the midazolam group for the quality of sedation were 0, 9, 18, 0 and for discomfort 10, 16, 1, 0. Other parameters did not reveal any statistically significant difference.

CONCLUSION

Dexmedetomidine at a dose of 0.5 μg/kg may provide clinically useful conscious sedation, comparable to midazolam.

Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy: a randomized trial

Background

Dexmedetomidine plus opioid infusion after topical anaesthesia with nebulized lidocaine for cough suppression is a commonly used method for flexible bronchoscopy. Recently, the use of dexmedetomidine as an additive to local anaesthetics has been reported to have several advantages over conventional intravenous administration. However, there are no data regarding the use of nebulized dexmedetomidine-lidocaine for topical anaesthesia as a premedication for flexible bronchoscopy. Therefore, this study compared the tolerability and safety of nebulized dexmedetomidine with that of conventional intravenous administration in patients undergoing bronchoscopy with moderate sedation.

Methods

Sixty patients requiring flexible bronchoscopy were randomly assigned to three groups: (I) nebulized dexmedetomidine + lidocaine, n=20; (II) intravenous dexmedetomidine + nebulized lidocaine, n=20; and (III) nebulized lidocaine alone (no dexmedetomidine), n=20. The patients' coughing scores were assessed and graded. Our primary hypothesis was that nebulized dexmedetomidine-lidocaine could reduce the incidence of moderate to severe coughing. The secondary endpoints were the rates of glottis closure, complete jaw relaxation and limb movement during the procedure; the elapsed time until recovery; and the dosages of vasoconstrictors and atropine.

Results

The incidence of moderate to severe coughing was 15% in the nebulized dexmedetomidine group, 50% in the intravenous dexmedetomidine group and 55% in the no dexmedetomidine group. The nebulized dexmedetomidine group had the lowest incidence of moderate to severe coughing (P=0.019). Nebulized dexmedetomidine showed a protective effect for reducing coughing compared with intravenous dexmedetomidine [P=0.008, odds ratio (OR): 0.273, 95% confidence interval (CI): 0.089-0.833]. No differences in the rates of complete jaw relaxation and limb movement during the procedure were observed among the three groups (all P>0.05). The rates of glottis closure were similar (20%, 25%, and 35%; P>0.05). The elapsed time until recovery in the nebulized dexmedetomidine group was significantly shorter than that in the intravenous dexmedetomidine group (10.60±1.39 vs. 15.10±1.45, P<0.001). The vasoconstrictor dosages were significantly lower in the nebulized dexmedetomidine group than in the intravenous dexmedetomidine group (P<0.001).

Conclusions

Nebulized dexmedetomidine-lidocaine inhalation as a premedication for flexible bronchoscopy was well tolerated during bronchoscopies performed under moderate sedation and was associated with a reduced incidence of moderate to severe coughing, a shorter recovery time and reduced vasoconstrictor consumption.

Observation of the clinical efficacy of dexmedetomidine in flexible bronchoscopy under general anesthesia: clinical case experience exchange

Object

To investigate the clinical efficacy and safety of dexmedetomidine in flexible bronchoscopy under general anesthesia.

Methods

A total of 114 patients were randomly divided into intervention group A and control group B. Group A received dexmedetomidine, fentanyl, and propofol as anesthesia, while Group B received fentanyl and propofol only. Changes in heart rate, mean arterial pressure, pulse oxygen saturation, stress indices (blood cortisol, adrenaline, and norepinephrine levels), incidence of adverse events, anesthesia dose, duration of procedure, and recovery time were compared between the groups at specific time points T0, T1, and T2 during bronchoscopy.

Results

There was no statistical difference between the groups at T0. At T1 and T2, pulse oxygen saturation, mean arterial pressure, heart rate, and stress indices in group A were significantly more favorable than those in group B. The incidence of adverse events (5.26%) in group A was significantly lower than that in group B (17.54%), and patients in group A required less propofol and had a faster recovery time than patients in group B.

Conclusion

Dexmedetomidine use in flexible bronchoscopy under general anesthesia is safe and effective and decreases the stress response in synergy with propofol to provide hemodynamic stability.

Pregabalin and dexmedetomidine conscious sedation for flexible bronchoscopy: a randomized double-blind controlled study

BACKGROUND

Conscious sedation is usually required during flexible bronchoscopy. Sedation should be achieved without respiratory depression or loss of consciousness. The present study was designed to evaluate the effect of pregabalin premedication on reducing the amount of sedatives and to show its advantages for patients undergoing flexible bronchoscopy with dexmedetomidine.

METHODS

Seventy patients undergoing elective flexible bronchoscopy were randomly divided into two groups of 35 patients each. All patients received premedication one hour before the procedure. PG group received 150 mg pregabalin and C group received placebo. All patients were sedated with dexmedetomidine infusion to achieve optimum sedation. During the procedure peripheral oxygen saturation, respiratory rate, hemodynamics, Ramsay sedation Score, cough score, and total amount of dexmedetomidine used were recoded. After the procedure patients' and pulmonologists' satisfaction were compared.

RESULTS

The total amount of dexmedetomidine used in PG was less compared to C group (P=0.01). Sedation score was higher in PG group at the time of theatre admission (P<0.001). Cough score was higher, but insignificant in group C (P=0.08). Patients' and pulmonologists' satisfaction scores were higher in group PG (P=0.007 and 0.001 respectively). The heart rate and mean arterial pressure were lower in the C group (P=0.02 and 0.03 respectively). Postoperative care unit stay was less in group PG with less analgesic requirements.

CONCLUSIONS

Conscious sedation facilitates flexible bronchoscopy. Premedication with pregabalin can reduce the amount of sedatives. Dexmedetomidine with pregabalin premedication has many advantages over dexmedetomidine alone.