Safety and Efficacy of Nebulised Dexmedetomidine as an Adjuvant to Topical Anaesthesia in Patients Undergoing Endobronchial Ultrasound under Moderate Sedation: A Randomised Double-blinded Controlled Study

Abstract

Introduction: Anaesthetic sedatives are widely used for bronchoscopy and Endobronchial Ultrasound (EBUS) to ensure patient cooperation and minimise patient discomfort. Dexmedetomidine is an α2 adrenergic agonist used for sedation. Aim: To evaluate the safety and efficacy of nebulised dexmedetomidine in EBUS. Materials and Methods: In this randomised double-blinded controlled study, conducted in the Department of Anaesthesiology and Pulmonary Medicine at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India from 2020 to 2022, 52 patients aged between 18 and 70 years undergoing EBUS were included. Patients were randomly assigned to the study group (S) and the control group (C). Group C received nebulised lidocaine (2%) 10 mL for 10-15 minutes in a sitting position. Group S received nebulised lidocaine (2%) 8 mL + Dexmedetomidine 2 mL (1 mcg/kg) for 10-15 minutes in a sitting position. Haemodynamic parameters, cough severity scores, patient and operator satisfaction scores, Midazolam requirements, and any complications were recorded and compared. The data were analysed statistically using the Student’s t-test and Chi-square test, whichever was feasible. A p-value of <0.05 was considered statistically significant. Results: The demographic parameters including the mean age (years) of 46.3±14.01 in Group C vs. 44.5±14.35 in Group S, mean weight (kg) of 61.6±8.27 in Group C vs. 63.5±10.06 in Group S, and male/female ratio of 12/14 in Group C vs. 9/17 in Group S were comparable. Haemodynamic parameters were better postnebulisation in Group S compared to Group C. The authors observed that the incidence of coughing was significantly higher in Group C compared to Group S (73.1% vs. 46.2%). It was found that Group C had a significantly higher requirement for midazolam doses compared to Group S (53.8% vs. 19.2%). When the patient satisfaction score assessed on the Numerical Rating Scale (NRS) was analysed, it was found that Group S patients were highly satisfied compared to Group C patients, and the difference was highly significant (p-value <0.05). No drug or procedure-related complications were observed in the two groups. Conclusion: The present study demonstrated that nebulised dexmedetomidine-lidocaine was well-tolerated during bronchoscopies under moderated sedation and was associated with stable Haemodynamics, decreased incidence of severe coughing, and a lower consumption of sedation drugs.

Keywords

• haemodynamics
• lignocaine
• nebulisation
• numerical rating scale