A double-blinded randomized control trial for conscious sedation in post thoracic surgery patients undergoing flexible bronchoscopy suction sputum / 上海交通大学学报（医学版）

ABSTRACT

Objective • To compare the efficacy and safety of propofol and dexmedetomidine in conscious sedation in post thoracic surgery patients undergoing flexible bronchoscopy suction sputum. Methods • A total of 90 post thoracic surgery patients who would receive suctioning sputum by fiberoptic bronchoscope were randomly divided into three groups, i.e. control group, propofol group, and dexmedetomidine group. The control group received intravenous injection of saline. A bolus dose of 1% propofol (0.4 mg/kg) followed by a 1-2 mg/(kg • h) continuous injection was applied in the propofol group. In the dexmedetomidine group, a bolus dose of dexmedetomidine (1 μg/kg) intravenously injected, followed by a 0.6 μg/(kg • h) continuous injection. The vital signs and Ramsay score were recorded before taking drugs, before sucking sputum, sucking sputum, sucking sputum immediately, 0.5 h after sucking sputum, and 1 h after sucking sputum. Difficulty in entering glottis, adverse events, and visual pain score were also recorded and compared. Results • Compared with the dexmedetomidine group, the heart rate and mean arterial pressure in the propofol group and the control group were higher before and after flexible bronchoscopy suction sputum (all P<0.05). Compared with the control group, the mean arterial pressure in the propofol group was lower before sucking sputum and sucking sputum immediately (both P<0.05). Compared with the control group, Ramsay sore in propofol group was higher before sucking sputum and sucking sputum (P=0.026, P=0.026), and Ramsay score in the dexmedetomidine group was higher before sucking sputum, 0.5 h after sucking sputum and 1 h after sucking sputum (P=0.015, P=0.000, P=0.000). The incidence of adverse events was lower in the dexmedetomidine group than that in the control group (P=0.004). The visual pain score was lowest in the propofol group and highest in the control group. Conclusion • Both dexmedetomidine and propofol can be used in conscious sedation during flexible bronchoscopy suction sputum after thoracic surgery. The use of propofol can make patients much more comfortable. Compared with propofol, patients with dexmedetomidine have a lower incidence of adverse events, and their heart rate and blood pressure are more stable during sputum suction. Therefore, dexmedetomidine may be more suitable for patients combined with cardiovascular disease.