Efficacy and Safety of Dexmedetomidine During Bronchoscopy in Patients With Moderate to Severe COPD or Emphysema

Dexmedetomidine (Precedex) is a sedative with a profile which is very appealing for short procedures, but its use in bronchoscopy has not yet been studied. This pilot study examines the efficacy and safety of dexmedetomidine during bronchoscopy in patients with pulmonary compromise. Patients were prospectively enrolled. Dexmedetomidine was administered before and during the procedure. Small doses of midazolam and fentanyl were given immediately before insertion of the bronchoscope and as needed subsequently. Ten patients with moderate to severe pulmonary compromise were enrolled. No patient exhibited marked hypotension or hypertension, bradycardia, apnea, or desaturation during the procedure or during recovery. No procedure was terminated because of medication side effects. The mean dose of midazolam was 2.2±1.7 mg and of fentanyl was 43±56 mcg, significantly less than dosing for historical controls. This study of dexmedetomidine in patients at high risk for respiratory complications demonstrates efficacy and safety. Doses of the adjunct medications midazolam and fentanyl were minimal. Hypertension and tachycardia normally caused by bronchoscopy were not observed. Known side effects of dexmedetomidine were not problematic. The data are sufficient to warrant additional prospective, randomized trials comparing dexmedetomidine sedation for bronchoscopy with conventional conscious sedation using only midazolam and fentanyl.