Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children: a prospective randomized controlled study.

Objectives: To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children.
Methods: A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group ( n =60) and an observation group ( n =58) using a random number table. The observation group received intravenous pumping of dexmedetomidine hydrochloride (2 μg/mL) at 1 μg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by dexmedetomidine hydrochloride pumped intravenously at 0.5-0.7 μg/(kg·h) 10 minutes later to maintain anesthesia. The control group was given intravenous pumping of propofol at 2 mg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by propofol pumped intravenously at 4-6 mg/(kg·h) 10 minutes later to maintain anesthesia. Fiberoptic bronchoscopy was performed after the children were unconscious. Heart rate (HR), respiratory rate, blood oxygen saturation, and mean arterial pressure (MAP) were recorded before inserting the bronchoscope (T ₀ ), at the time of inserting the bronchoscope (T ₁ ), when the bronchoscope reached the glottis (T ₂ ), when the bronchoscope reached the carina (T ₃ ), and when the bronchoscope entered the bronchus (T ₄ ). The intraoperative peak airway pressure (Ppeak), examination time, degree of sedation, extent of amnesia, incidence of adverse reactions, postoperative awakening time, and postoperative agitation score were also recorded.
Results: Compared with the control group, the observation group had significantly decreased MAP at T ₁ to T ₄ and HR at T ₁ to T ₃ ( P <0.05). Compared with that at T ₀ , MAP was significantly increased at T ₁ to T ₄ in the control group and at T ₃ in the observation group ( P <0.05). HR was significantly higher at T ₁ to T ₃ than at T0 ( P <0.05). Compared with the control group, the observation group showed significantly lower intraoperative Ppeak value, incidence of intraoperative adverse reactions, and postoperative agitation score, significantly shorter examination time, and better effects of amnesia and anesthesia ( P <0.05). There was no significant difference in the degree of intraoperative sedation and postoperative awakening time between the two groups ( P >0.05).
Conclusions: Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.