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Gao S, Wang T, Cao L, Li L, Yang S. Clinical effects of remimazolam alone or in combination with dexmedetomidine in patients receiving bronchoscopy and influences on postoperative cognitive function: a randomized-controlled trial. Int J Clin Pharm 2023; 45:137-145. [PMID: 36346544 DOI: 10.1007/s11096-022-01487-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Remimazolam and dexmedetomidine are commonly used as sedatives. However, the effects and safety of remimazolam alone or in combination with dexmedetomidine have not been investigated. AIM We sought to investigate the clinical effects of remimazolam alone or in combination with dexmedetomidine in bronchoscopy, and their influence on cognitive function. METHOD Ninety eligible patients who underwent bronchoscopy under intravenous anesthesia were randomly divided into three groups: propofol control, remimazolam, and remimazolam plus dexmedetomidine. The primary outcome was the incidence of perioperative hypoxemia. Secondary outcomes included induction and maintenance doses of remimazolam, hemodynamic variables, scores for modified Observer's Assessment of Alertness/Sedation (MOAA/S), coughing, limb movement, incidence of adverse events, patient satisfaction, bronchoscopist satisfaction, incidence of post-operative cognitive dysfunction (POCD), time to loss of consciousness (LoC), and time to awake. RESULTS The incidence of hypoxemia, hypotension, and bronchoscopist satisfaction score were significantly decreased, and time to LoC and time to awake were markedly longer in the remimazolam and remimazolam plus dexmedetomidine groups than in the propofol control group (p < 0.05). The remimazolam group had significantly decreased induction and maintenance doses of remimazolam and a shorter time to LoC than the remimazolam plus dexmedetomidine group (p < 0.05). Scores for coughing, limb movement, MOAA/S, and post-operative patient satisfaction were comparable among the three groups. POCD was not induced in any of the groups. CONCLUSION Remimazolam is safe and effective for painless bronchoscopy, with a low incidence of adverse reactions, and exhibits a good synergistic effect with dexmedetomidine. TRIAL REGISTRATION This trial protocol had been registered on Chinese Clinical Trial Registry (ChiCTR2000041435, date: 2020 12 26.
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Affiliation(s)
- Shenqiang Gao
- Department of Anesthesiology, Taian City Central Hospital, Taishan District, No.29, Longtan Road, Taian, 271000, Shandong Province, China
| | - Tingting Wang
- Department of Anesthesiology, Taian City Central Hospital, Taishan District, No.29, Longtan Road, Taian, 271000, Shandong Province, China
| | - Li Cao
- Department of Anesthesiology, Taian City Central Hospital, Taishan District, No.29, Longtan Road, Taian, 271000, Shandong Province, China
| | - Linyan Li
- Department of Anesthesiology, Shandong First Medical University, Taian, 271016, Shandong Province, China
| | - Shengqiang Yang
- Department of Anesthesiology, Taian City Central Hospital, Taishan District, No.29, Longtan Road, Taian, 271000, Shandong Province, China.
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Yan Q, Sheng B, Huang X, Lin K, Lin J, Ye X. Effect of different doses of midazolam combined with fentanyl during painless bronchoscopy in adults. Am J Transl Res 2023; 15:563-572. [PMID: 36777843 PMCID: PMC9908445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/15/2022] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To investigate the clinical effect of different doses of midazolam combined with fentanyl during painless bronchoscopy in adult patients. METHODS In this retrospective study, a total of 200 patients who underwent painless bronchoscopy in The First People's Hospital of Wenling from January 2018 to January 2021 were selected as research subjects. These patients were assigned into an experimental group and a control group with 100 patients in each group. Patients from the experimental group were sedated with an intravenous infusion of 0.05 mg/kg midazolam and 0.2 μg/kg fentanyl, while patients from the control group were sedated using 0.1 mg/kg midazolam and 0.2 μg/kg fentanyl. The changes in heart rate (HR), saturation of pulse oximetry (SpO2), systolic blood pressure (SBP), and diastolic blood pressure (DBP) before and at 10 minutes after administration were compared between the two groups. Ramsay sedation scale, RSS agitation scale, awaking time, incidence of adverse reactions, and anesthetic effects were also compared. RESULTS After medication, there was no significant difference in terms of HR, SBP, or DBP values between the two groups. The SpO2 value in the experimental group was higher than that in the control group (96.93±1.10% vs. 94.78±0.83%, P<0.05). Ramsay sedation scale of patients from the experimental group after medication was (3.88±0.66), which was significantly higher than that of the control group (2.32±0.63), while RSS agitation score in the experimental group was (1.08±0.16), lower than that of the control group (2.32±0.63). The awaking time in the experimental group was shorter than that in control group (43.60±3.30 min vs. 50.19±4.45 min, P<0.05). Moreover, the incidence of mild cough or no cough in the experimental group was significantly better than in the control group (P<0.05). The overall incidence of adverse reactions in the experimental group was lower than that of the control group (5.00% vs. 13.00%, P<0.05). In addition, the anesthetic effect in the experimental group was better than that of the control group (90% vs. 80%, P<0.05). CONCLUSION The use of 0.05 mg/kg midazolam combined with 0.2 μg/kg fentanyl in adult painless bronchoscopy has little effect on SpO2 levels, possesses a good sedative and anesthetic effect, and reduces the awaking time, restlessness response, and adverse reactions.
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Min K, Wu Y, Wang S, Yang H, Deng H, Wei J, Zhang X, Zhou H, Zhu W, Gu Y, Shi X, Lv X. Developmental Trends and Research Hotspots in Bronchoscopy Anesthesia: A Bibliometric Study. Front Med (Lausanne) 2022; 9:837389. [PMID: 35847815 PMCID: PMC9279861 DOI: 10.3389/fmed.2022.837389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/13/2022] [Indexed: 01/07/2023] Open
Abstract
Background This study discusses the developmental trends and research hotspots in bronchoscopy anesthesia in the past six decades. Methods The original and review articles published from 1975 to June 2021 related to bronchoscopy anesthesia were retrieved from the Web of Science Core Collection (WoSCC). Three different scientometric tools (CiteSpace, VOSviewer, and Bibliometrix) were used for this comprehensive analysis. Results There was a substantial increase in the research on bronchoscopy anesthesia in recent years. A total of 1,270 publications were retrieved up to June 25, 2021. Original research articles were 1,152, and reviews were 118, including 182 randomized controlled trials (RCTs). These publications were cited a total of 25,504 times, with a mean of 20.08 citations per publication. The US had the largest number of publications (27.6%) and the highest H-index of 44. The sum of publications from China ranked second (11.5%), with an H-index of 17. Keyword co-occurrence and references co-citation visual analysis showed that the use of sedatives such as dexmedetomidine in the process of bronchoscopy diagnosis and treatment was gradually increasing, indicating that bronchoscopy anesthesia was further progressing toward safety and comfort. Conclusion Based on a bibliometric analysis of the publications over the past decades, a comprehensive analysis indicated that the research of bronchoscopy anesthesia is in a period of rapid development and demonstrated the improvement of medical instruments and surgical options that have significantly contributed to the field of bronchoscopy anesthesia. The data would provide future directions for clinicians and researchers in relation to bronchoscopy anesthesia.
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Affiliation(s)
- Keting Min
- Graduate School, Wannan Medical College, Wuhu, China
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yutong Wu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Sheng Wang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao Yang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huimin Deng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Juan Wei
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaowei Zhang
- Department of Anesthesiology, Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Huanping Zhou
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wanli Zhu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Gu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuan Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Xuan Shi
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Xin Lv
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Zarogoulidis P, Matthaios D, Kosmidis C, Hohenforst-Schmidt W, Tsakiridis K, Mpaka S, Boukovinas I, Drougas D, Theofilatou V, Zaric B, Courcoutsakis N, Nikolaidis G, Huang H, Bai C. Effective early diagnosis for NSCLC: an algorithm. Expert Rev Respir Med 2021; 15:1437-1445. [PMID: 34403620 DOI: 10.1080/17476348.2021.1969916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Lung cancer still remains undiagnosed for most patients until the disease is inoperable. AREAS COVERED We performed search on PubMed with the keywords: EBUS, radial-EBUS, bronchoscopy, lung cancer, electromagnetic navigation, ct-biopsy, transthoracic biopsy. We present diagnostic equipment and imaging techniques such as positron emission tomography, endoscopical navigation systems, endobronchial ultrasound, radial-endobronchial ultrasound, transthoracic ultrasound biopsy, and computed tomography guided biopsies. EXPERT OPINION However, lack of early disease symptoms remains the most important issue and therefore we should direct our efforts to screening and early disease diagnosis. An algorithm is proposed for biopsy upon initial disease diagnosis.
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Affiliation(s)
- Paul Zarogoulidis
- 3rd Department of Surgery, ``ahepa`` University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.,Pulmonary Oncology Department, ``Bioclinic`` Private Hospital, Thessaloniki, Greece
| | | | | | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany
| | - Kosmas Tsakiridis
- Thoracic Oncology Department, ``Interbalkan`` European Medical Center, Thessaloniki, Greece
| | - Sofia Mpaka
- Oncology Department, ``Interbalkan`` European Medical Center, Thessaloniki, Greece
| | - Ioannis Boukovinas
- Oncology Department, ``Bioclinic`` Private Hospital, Thessaloniki, Greece
| | - Dimitris Drougas
- Nuclear Medicine Department, ``Bioiatriki`` Private PET-CT Laboratory, Thessaloniki, Greece
| | - Vasiliki Theofilatou
- Nuclear Medicine Department, ``Bioiatriki`` Private PET-CT Laboratory, Thessaloniki, Greece
| | - Bojan Zaric
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Nikolaos Courcoutsakis
- Radiology Department, Democritus University of Thrace, General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George Nikolaidis
- Surgery Department, ``General Clinic`` Euromedica, Thessaloniki, Greece
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
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