Journal Article

Efficacy and safety of remimazolam versus dexmedetomidine for patients undergoing flexible fiberoptic bronchoscopy: A randomized, clinical trial

Zou, Jingcheng, Li, Xue, Fan, Wen, Zuo, Xiaozhuo, Sun, Kai, Zhou, Laiying, Yan, Min, Gu, Mengting, Yao, Yuanyuan

2024

Overview

Remimazolam's benefits for patients undergoing painless flexible fiberoptic bronchoscopy remain uncertain. We aimed to compare the efficacy and safety of remimazolam and dexmedetomidine in flexible fiberoptic bronchoscopy (FFB). Randomized controlled trial. University hospital. Between April 2021 and September 2022, patients undergoing painless flexible fiberoptic bronchoscopy were recruited. The patients were randomly assigned with a 1:1 ratio to remimazolam-remifentanil group (RR group) or dexmedetomidine-remifentanil group (DR group). The primary outcome was the procedure interruption rate during bronchoscopy. Secondary outcomes were hemodynamic changes, resuscitation time, rescue medication usage rate and dose, satisfaction scores of patients and bronchoscopists, operation-related complications, and adverse events. A total of 363 patients were included for final analysis. The interruption rates of bronchoscopy were 8.2 % in the RR group and 39.2 % in the DR group (P < 0.05). The rescue medication usage rate (4.4 % vs. 38.7 %, P < 0.05) and dose (1.51 ± 8.15 mg vs. 13.17 ± 18.86 mg, P < 0.05) were lower in the RR group compared with the DR group. The incidence of oxygen desaturation was significantly lower in the RR group than in the DR group (14.3 % vs. 44.2 %, P < 0.05). Hemodynamic changes in patients in the DR group were significant, with longer recovery time and lower satisfaction scores for both inpatients and bronchoscopists (P < 0.05), compared with the RR group. However, there were no significant differences between groups in terms of operation-related complications (P > 0.05) except for postoperative dizziness, which was more common in the DR group (P < 0.05). Remimazolam is effective and safe in painless flexible fiberoptic bronchoscopy. It allows a lower procedure interruption rate and incidence of oxygen desaturation, providing better hemodynamic stability compared to dexmedetomidine. •Remimazolam, an ultra-short-acting benzodiazepine, induced better sedation during bronchoscopy than dexmedetomidine.•Remimazolam had a better safety profile than that of dexmedetomidine.•Remimazolam anesthesia had higher bronchoscopist and patient satisfaction score.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Aged / Anesthesia / Benzodiazepines / Benzodiazepines - administration & dosage / Benzodiazepines - adverse effects / Bronchoscopy / Bronchoscopy - adverse effects / Bronchoscopy - instrumentation / Bronchoscopy - methods / Cardiac arrhythmia / Catheters / Chronic obstructive pulmonary disease / Dexmedetomidine / Dexmedetomidine - administration & dosage / Dexmedetomidine - adverse effects / Drug dosages / Female / Fiber Optic Technology / Flexible fiberoptic bronchoscopy / Hemodynamics / Hemodynamics - drug effects / Humans / Hypnotics and Sedatives - administration & dosage / Hypnotics and Sedatives - adverse effects / Hypotension / Intubation / Lungs / Male / Medical personnel / Metabolites / Middle Aged / Narcotics / Pain Medicine / Patient Satisfaction / Patients / Remifentanil - administration & dosage / Remifentanil - adverse effects / Remimazolam / Sedation / Substance abuse treatment / Treatment Outcome