COMPARISON OF DEXMEDETOMIDINE-PROPOFOL WITH FENTANYL-PROPOFOL COMBINATION IN FLEXIBLE FIBREOPTIC BRONCHOSCOPY

Dr. Masrat Jan*, Dr. Wasim Muhammad Bhat, Dr. Arif Amin Bhat and Prof. Basharat Ahad

ABSTRACT

Background: Flexible fibreoptic brochoscopy is a widely used therapeutic and diagnostic procedure. Currently different anaesthetic agents are used for sedation during fibreoptic bronchoscopy. The primary aim of our study is to compare the respiratory and hemodynamic variables between dexmedetomidine-propofol with fentanyl-propofol during flexible bronchoscopy. Our secondary aim is to see cough reflex response, recovery time, number of propofol rescue doses used and satisfaction of bronchoscopist. Patients and methods: 100 patients were enrolled in the study and were randomised into two groups. [Group D (Dexmedetomidine-propofol) and Group F (Fentanyl-propofol)]. In group D, dexmedetomidine was given 1μg /kg slowly over a period of 10 minutes and group F received fentanyl 1μg/kg for sedation. An infusion of propofol at the rate of 100 μg/kg/min was started in both the groups for maintenance. Hemodynamic and respiratory parameters were recorded at baseline and at 5, 10, 15 and 20 minutes after induction and comparison was made between the two groups. Secondary objectives were cough reflex scores and discomfort level as assessed by the bronchoscopists. Results: The mean heart rate, systolic blood pressure and diastolic blood pressure were less in group D than Group F and were statistically significant. The mean respiratory rate and SPO2 was statistically insignificant between the two groups. The RSS score at 5, 10 and 15 minutes between the two groups is statistically significant. The recovery time for D group was longer than the F group and was statistically significant. The development of bradycardia and hypotension was more in group D than in group F and was statistically significant. The number of propofol rescue doses between the two groups was statistically insignificant. Conclusion: Although Group D has better sedation score than group F during bronchoscopic procedures, but at the same time it also causes hemodynamic instability. Recovery time is also more in the group D group than group F. Therefore, we conclude that combination of fentanyl-propofol is better modality than dextmedetomidine-propofol in bronchoscopic procedures.

Keywords: Dexmedetomidine-propofol, Fentanyl-propofol, bronchoscopists.