Comparison of dexmedetomidine or ketamine used in endobronchial ultrasound applications

Sedation or general anesthesia is required for the patient to tolerate the procedure and perform endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) easily. EBUS-TBNA can be performed under minimal, moderate or deep sedation. We aimed to compare the effects of dexmedetomidine or ketamine combined with standart drugs, on hemodynamics, respiratory functions, inspiratory peak airway pressure (Ppeak), cough scores, total amount of lidocaine, patient and operator satisfaction, time to leave the recovery unit, postoperative nausea and vomiting, and pain scores. After obtaining ethics committee approval, 42 patients were randomly divided into two groups: dexmedetomidine-propofol fentanyl (group DPF) and ketamine-propofol-fentanyl (group KPF). Bolus dose of dexmedetomidine 1 mcg/kg over 10 minutes infusion was carried out and continued with an infusion rate of 0,2-0,7 mcg/kg/hour in group DPF patients, but the infusion rate was slowed down when the heart rate dropped below 60 bpm. Patients in Group KPF received ketamine 0,3 mg/kg bolus. A loading dose of propofol 0,1-0,5 mg/kg over 3-5 minutes and infusion rate of 1,5-4,5 mg/kg/hour, and a bolus dose of fentanyl 0,7 mcg/kg over 3-5 minutes were given as standart drugs to patients belonging both groups. Propofol infusion was titrated to achieve a Quantitative Sedation Score of 3-4 and the procedure was allowed. More often observation of hypertension in ketamine than dexmedetomidine group was seen as one of the results. Respiratory depression interpreted as desaturation and need for rescue maneuver in this study, was not statistically significant between the groups. Total lidocaine amounts and cough scores were found to be similar in both groups. Although the number of patients whose Ppeak pressure decreased compared to the control was higher in the ketamine group than in the dexmedetomidine, no statistically significant difference was found between the two groups. The time until the Aldrete score became 9 and the duration of stay in the postoperative recovery unit were found to be higher in the dexmedetomidine group. No difference was found between the groups in terms of postoperative pain scores. Patient and operator satisfaction were found to be similar in both groups. As a result, patient characteristics should be taken into consideration in the selection of dexmedetomidine or ketamine sedation in patients who will undergo EBUS-TBNA. Keywords: endobronchial ultrasound-guided transbronchial needle aspiration, dexmedetomidine, ketamine, complication, sedation, Ppeak pressure