Remifentayl versus midazolam effect on the pressor response during flexible fibroptic bronchoscopy

ABSTRACT

Patient premedication before flexible fibroptic bronchoscopy [FFB] is variable, depending on the personal experience of individual operators. Conscious sedation would he justified by a significant improvement in a patient's tolerance, outweighing sedation-related risks. A prospective, randomized. open study was performed to compare the effect of conscious sedation with midazolam in one group and remifentanil in the other group on a pressor response, patient's tolerance and cardio respiratory parameters during routine FFB. sixty patients, undergoing a diagnostic FF13 was randomly allocated into two groups, group A [30 patients received midazolam at a dose of 0.025-0.05 mg/kg bolus dose and if required maintains of 1-2 microgram/Kg/mm and group E receiving rernifentanil infusion at a rate of 0.25-0.73 microgram kg/minute, titrated to keep heart rate and blood pressure within 20% of the baseline and A modified Ramsay scale was used to assess the baseline sedation level and to titrate midazolam and remifentanil throughout the procedure, the global tolerance score to the examination on VAS1*, vomiting, asphyxia, cough. pain [0=nonexistent; 100=unbearable], Hemodynamic disturbance included the incidence of increased blood pressure [systolic blood pressure>20% of baseline], tachycardia [HR>110 bpm or>20% of baseline] hypotension [systolic blood pressure 8'] mm Hg or > 20% decrease from baseline], bradycardia [HR30% decrease from baseline]. Respiratory disturbance; included respiratory rate [<8 breaths per minute] and reductions in arterial saturation [SaO[2]<92%]. FFB was better tolerated in male patients [p<0.05], in patients with less pre-FFB anxiety score, and in the remifentanil group] [p<0.01] The fall in SpO[2] and the increase in the mean HR were not significantly different between two groups. Overall improved patient tolerance during routine FFB with conscious sedation using remifentanil and without any increased cardio-respiratory risks and attenuating the pressor response