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      Sufentanil target controlled infusion (TCI) versus remifentanil TCI for monitored anaesthesia care for patients with severe tracheal stenosis undergoing fiberoptic bronchoscopy: protocol for a prospective, randomised, controlled study

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          Abstract

          Introduction

          The use of monitored anaesthesia care (MAC) is necessary and ubiquitous for fiberoptic bronchoscopy. Anaesthetic management of patients with severe tracheal stenosis has always been a challenge. The efficacy and safety of the MAC with sufentanil target controlled infusion (TCI) and remifentanil TCI in patients with severe tracheal stenosis are still unknown.

          Methods analysis

          This study is a prospective, investigator-initiated, two-arm, randomised control trial to compare the efficacy and safety of sufentanil TCI with remifentanil TCI in patients with severe tracheal stenosis undergoing fiberoptic bronchoscopy. 270 patients will be randomly assigned to the sufentanil TCI group or remifentanil TCI group, with a 1:1 ratio in two groups. The primary outcome is the incidence of hypoxaemia (an oxygen saturation of <90%). The secondary outcome investigates the severity of hypoxaemia, cough severity, haemodynamic variables, sedation scores and satisfaction scores.

          Ethics and dissemination

          The study has been approved by the Medical Ethics Committee of Shanghai Pulmonary Hospital (approval No. K19-122). The results will be submitted for publication in peer-reviewed journals.

          Trial registration number

          ChiCTR2100043380.

          Related collections

          Most cited references22

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          • Abstract: not found
          • Article: not found

          British Thoracic Society guidelines on diagnostic flexible bronchoscopy.

          (2001)
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            Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians.

              • Record: found
              • Abstract: found
              • Article: not found

              Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy.

              The safety profiles and efficacies of remifentanil and dexmedetomidine (a sedative-analgesic without respiratory depression) for sedation during flexible bronchoscopy were investigated. Seventy-two patients undergoing elective flexible bronchoscopy were randomly assigned to a propofol-remifentanil group (Group PR, n=36) or a propofol-dexmedetomidine group (Group PD, n=36). The primary outcome was the incidence of oxygen desaturation. Haemodynamic variables, adverse events, need of oral cavity suction, cough scores, satisfaction scores of patients and bronchoscopists, levels of sedation, and recovery times were also compared. The incidence of oxygen desaturation was significantly lower in the PD group than in the PR group (P=0.01). There were no significant differences between groups in terms of level of sedation, oxygen saturation, mean arterial pressure, heart rate over time, cough scores, or patient satisfaction scores (P>0.05). However, cough scores and bronchoscopist satisfaction scores (P<0.01) were lower in the PD group. In addition, topical anaesthesia (P<0.01) was required more frequently and recovery time (P=0.00) was significantly longer in the PD group. However, oral suction (P=0.03) was required less frequently in the PD group. Dexmedetomidine was associated with fewer incidents of oxygen desaturation and a reduced need for oral cavity suction than remifentanil during flexible bronchoscopy. However, dexmedetomidine was associated with a longer recovery time and poorer bronchoscopist satisfaction score.

                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2022
                30 August 2022
                : 12
                : 8
                : e058662
                Affiliations
                [1 ]departmentDepartment of Anaesthesiology , Shanghai Pulmonary Hospital, School of Medicine, Tongji University , Shanghai, China
                [2 ]departmentSchool of Life Sciences and Technology , Tongji University , Shanghai, China
                [3 ]departmentDepartment of Anaesthesiology , Changhai Hospital, Naval Medical University , Shanghai, China
                Author notes
                [Correspondence to ] Dr Jianming Liu; drliujianming@ 123456163.com

                WW and YZ are joint first authors.

                Author information
                http://orcid.org/0000-0002-8001-153X
                Article
                bmjopen-2021-058662
                10.1136/bmjopen-2021-058662
                9438080
                36041770
                87ae9a8c-1e0b-4453-a145-1c9a2574beca
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 31 October 2021
                : 09 August 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100017950, Shanghai Municipal Health Commission;
                Award ID: 201940366
                Categories
                Anaesthesia
                1506
                1682
                Protocol
                Custom metadata
                unlocked

                Medicine
                adult anaesthesia,endoscopic surgery,bronchoscopy,chronic airways disease,respiratory tract tumours

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