Comparison of dexmedetomidine and propofol in sedation in patientsundergoing endobronchial ultrasound-gui̇ded transbronchial needleaspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) can be performed under minimal sedation, moderate sedation, deep sedation, or general anesthesia in different centers. According to the American College of Chest Physicians (ACCP) guidelines, specific to EBUS-TBNA, the use of moderate or deep sedation in addition to local anesthesia is recommended during the procedure. In our study, we aimed to compare desaturation, hemodynamic parameters, cough scores, lidocaine dose injected into the vocal cords, use of rescue maneuvers (jaw thrust, Ambu mask, mechanical ventilation), patient and physician satisfaction, time to discharge from the recovery unit, postoperative nausea and vomiting, and postoperative pain scores in patients undergoing EBUS-TBNA under moderate sedation. After obtaining ethics committee approval, 100 patients were randomized into two groups: dexmedetomidine-fentanyl (DF group) and propofol- fentanyl (PF group). Patients in the DF group received 1 mcg/kg dexmedetomidine as a loading dose within 10 minutes, followed by an infusion rate of 0.2-0.7 mcg/kg/h. Patients in the DF group received 0.7 mcg/kg fentanyl within 3-5 minutes. Patients in the PF group received 1 mcg/kg of fentanyl within 3-5 minutes. Propofol was administered as a loading dose of 0.1-0.5 mg/kg over 3-5 minutes, followed by a maintenance dose of 1.5-4.5 mg/kg/h. All patients received medications to achieve a Sedation-Agitation Scale score of 3-4 and a Bispectral Index (BIS) of 60-80. There was no significant difference between the groups in terms of desaturation. Bradycardia and hypotension were more common in the DF group, while tachycardia was more common in the PF group. The amount of additional lidocaine and fentanyl used was higher in the PF group. Patient satisfaction was similar in both groups, while physician satisfaction was higher in the DF group. There was no significant difference in the use of rescue maneuvers, postoperative nausea and vomiting, and postoperative pain scores. The duration of stay in the postoperative recovery unit was longer in the DF group. In conclusion, both dexmedetomidine and propofol infusions can be used in patients undergoing EBUS-TBNA, depending on the patient's characteristics.