• Junghyun Kim, Sun Mi Choi, Young Sik Park, Chang-Hoon Lee, Sang-Min Lee, Chul-Gyu Yoo, Young Whan Kim, and Jinwoo Lee.
• From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine (JK, SMC, YSP, C-HL, S-ML, CGY,YWK, JL), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea (JK).
• Eur J Anaesthesiol. 2021 May 1; 38 (5): 534-540.

BackgroundDesaturation is a common complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Dexmedetomidine (DEX), a commonly used sedative in intensive care, is associated with less respiratory depression compared with other sedatives.ObjectiveWe compared DEX with midazolam (MDZ) when used as a sedative during EBUS-TBNA.DesignA randomised, parallel, double-blinded trial.SettingA university-affiliated teaching hospital between June 2014 and July 2015.PatientsA total of 102 patients who underwent EBUS-TBNA were randomly allocated to two groups (48 DEX group, 54 MDZ group).InterventionsDEX group received 0.25 to 0.75 μg kg-1 h-1 (start with 0.5 μg kg-1 h-1, modulated in three steps from 0.25 to 0.75 μg kg-1 h-1) of DEX after a loading dose of 0.25 μg kg-1 h-1 for 10 min to maintain a Ramsay Sedation Scale (RSS) of 3 to 5. If the patient was agitated, 1 mg of MDZ bolus was used as a rescue drug. Patients in the MDZ group initially received 0.05 mg kg-1 of MDZ as a bolus. For maintenance and rescue, 1 mg of MDZ bolus was used.Main Outcome MeasuresThe primary outcome was the presence of oxygen desaturation. Secondary outcomes were level of sedation (Ramsay Sedation Scale score), cough score, sedation and procedure satisfaction score.ResultsThe baseline characteristics of the patients, duration of EBUS-TBNA procedures and the use of rescue MDZ were not different between the groups. There was no significant difference in desaturation events between the DEX and MDZ groups (56.3 and 68.5%, respectively; P = 0.20). The level of sedation and the sedation satisfaction scores were similar between the two groups. However, cough score was significantly lower in the DEX group (41.9 vs. 53.4; P = 0.02).ConclusionThe use of DEX during EBUS-TBNA was not superior to MDZ in terms of oxygen desaturation.Trial RegistrationClinicaltrials.gov identifier: NCT02157818.Copyright © 2020 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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