Dexmedetomidine hydrochloride produces less respiratory depression compared with remifentanil, during monitored anaesthesia care in patients with lung cancer undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), according to study results presented at the 2015 Annual Meeting of the Canadian Anesthesiologists’ Society (CAS).
Dexmedetomidine did, however, produce more hypotension after surgery, more use of local anaesthetics during surgery, and a delayed discharged time.
“We wanted to see if dexmedetomidine would be safer [in terms of respiratory depression] than remifentanil,” explained lead author Patrick St-Pierre MD, FRCPC, Pierre-Boucher Hospital, Longueuil, and University of Montreal, Montreal, Quebec, speaking here on June 22.
Dr. St-Pierre and colleagues compared a group of 60 patients who received remifentanil intravenous bolus 0.5 mcg/kg given in 2 minutes with a group of patients who received dexmedetomidine 0.4 mcg/kg intravenous bolus given in 10 minutes. Patient characteristics were similar. “These were patients who were treated in an ambulatory setting, who were to go home the same day,” Dr. St-Pierre noted.
The study’s primary outcome was major respiratory adverse events, defined as apnoea, oxygen desaturation, and bradypnoea, while secondary outcomes included hypotension, pain, recall, discharge time, nausea and vomiting, and operator satisfaction as well as patient satisfaction.
Investigators excluded patients with severe renal or hepatic failure, patients with unstable angina and/or myocardial infarction in the last 6 weeks, as well as those with body mass index of 34 or greater.
The median number of apnoea and oxygen desaturation episodes was greater in the remifentanil arm of the study (P = .010 and P = .01, respectively).
The use of dexmedetomidine, however, led to a longer post-procedure discharge time (P < .0001) and an increased need for intratracheal lidocaine during the procedure (P = .0091). In addition, the use of dexmedetomidine was linked with more low blood-pressure events (P = .0015).
Other secondary outcomes such as pain, cough, vocal-cord mobility, and patient satisfaction were comparable in both study arms.
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