Conditions: Sedation
Keywords: bronchoscopy
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 50
Healthy volunteers: no

Brief summary:
This protocol hopes to determine whether the use of dexmedetomidine-ketamine can reduce the use of standard of care fentanyl-midazolam sedation during bronchoscopy. This may result in less respiratory depression while providing better compliance with the procedure.

Detailed description:
All patients enrolled in the study will be undergoing bronchoscopy, which is typically performed with sedation. All procedural sedation carries some risk. Several features of the study may lower the risk of sedation relative to that of conventional sedation. An anesthesiologist will be present throughout the procedure. Continuous monitoring of respiration with RIP will be employed. Administration of sedation will be via a volumetric syringe pump. Benefits specific to dexmedetomidine-ketamine include the lack of respiratory depression and greater hemodynamic stability.

Arms:
arm 1: midazolam load fentanyl load midazolam demand fentanyl demand benadryl demand arm 2: dexmedetomidine load ketamine load dexmedetomidine maintenance ketamine maintenance midazolam demand fentanyl demand benadryl demand

Interventions: intervention 1: Dexmedetomidine load intervention 2: Ketamine load intervention 3: Midazolam load intervention 4: Fentanyl load intervention 5: Dexmedetomidine maintenance intervention 6: Ketamine maintenance intervention 7: Midazolam demand intervention 8: Fentanyl demand intervention 9: Benadryl demand
Intervention descriptions: intervention 1: Dexmedetomidine 1 µg/kg prior to bronchoscopy intervention 2: Ketamine 30 mg bolus prior to bronchoscopy intervention 3: 2 mg bolus prior to bronchoscopy intervention 4: 50 µg bolus prior to bronchoscopy intervention 5: 0.5 µg/kg/hour for the duration of bronchoscopy (58.5 minutes average) intervention 6: 8 µg/kg/min for the duration of bronchoscopy (58.5 minutes average) intervention 7: 0.5 mg demand bolus at discretion of pulmonologist intervention 8: 12.5 µg demand bolus at discretion of pulmonologist intervention 9: 25 mg bolus after 6th and 13th demand midazolam/fentanyl bolus

Protocol document: