Abstract：Objective To investigate the safe and effective dose of intranasal dexmedetomidine in elderly patients undergoing fiberoptic bronchoscopy. Methods Seventy-five elderly patients who underwent fiberoptic bronchoscopy in the first Medical Center of PLA General Hospital from February 2021 to December 2021 were selected and randomly divided into three groups , with 25 patients in each group: the dexmedetomidine 1 μg/Kg group (group D1), the dexamethasone 2 μg/Kg group (group D2) and the normal saline group (control group, group C). At thirty minutes before the examination, intranasal instillation was performed according to the group and the calculated dose, and the sedation score (Ramsay score), patients' comfort level, and operator satisfaction during the examination were recorded. Heart rate (HR), mean arterial pressure (MAP), saturation of pulse oximetry (SPO2%) were recorded respectively before nasal instillation (T0), before surgery (T1), before fiberoptic bronchoscope reaches the carina (T2), at the time of biopsy (T3), at the end of surgery (T4), and at the time of exiting the operation room (T5). The frequency and degree of choking and the adverse reactions such as body movement, nausea and vomiting were also recorded. Results The Ramsay scores of group D1 and group D2 were higher than those in group C, and the Ramsay score of group D2 was higher than that in group D1 (P<0.05). The patient satisfaction scores and operator satisfaction scores in groups D1 and D2 were higher than those in group C (P<0.05). The heart rate in group D2 was lower than in group C at T2-4, and the mean arterial pressure in group D2 was lower than in group C at T2-5 (P<0.05). The incidence of choking in group D1 and D2 was lower than in group C(P<0.001), the incidence of choking in group D2 was lower than in group D1(P<0.05), and the additional frequency of local anesthetics in groups D1 and D2 was less than in group C (P<0.001). There was no significant difference in the incidence of adverse reactions such as nausea, vomiting, and poorly-functioning memory. Conclusion Preoperative intranasal administration of dexmedetomidine in elderly patients is safe and effective for fiberoptic bronchoscopy, with good sedative effect, stability hemodynamics, and low incidence of adverse reactions, and 2 μg/kg intranasal sedation has a better sedative effect, which is worthy of clinical application.
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2022, Vol. 33 
