Elsevier

Respiratory Medicine

Volume 102, Issue 7, July 2008, Pages 978-983
Respiratory Medicine

Benzodiazepine and opioid sedation attenuate the sympathetic response to fiberoptic bronchoscopy. Prophylactic labetalol gave no additional benefit. Results of a randomized double-blind placebo-controlled study

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Summary

Background

Hypertension and tachycardia are common during fiber-optic bronchoscopy (FOB), and this may lead to cardiac ischemia. The prophylactic addition of a beta-adrenergic anatagonist might mask this response and prevent the deleterious cardiovascular effects of FOB.

Methods

We performed a randomized double-blind placebo-controlled trial of labetalol 10 mg iv given with midazolam-alfentanil sedation. We monitored heart rate (HR) and systolic/diastolic blood pressure (SBP/DBP) throughout the bronchoscopy and calculated the rate-pressure product (RPP=(HR×SBP)/100). One-hundred twenty patients were enrolled.

Results

In the placebo group, there was no rise in HR, SBP, DBP or RPP, and there was no difference between the placebo and labetalol groups. Adverse events during bronchoscopy were similar in both groups. In a subgroup of patients undergoing interventional bronchoscopy, there was a trend towards lower SBP (p=0.06).

Conclusions

Patients undergoing FOB under adequate midazolam-alfentanil sedation do not develop excessive sympathetic drive that may lead to cardiac stress. The addition of labetalol did not confer additional benefit or risk to the patients. (ClinicalTrials.gov number, NCT00394537).

Keywords

Beta adrenergic antagonists
Bronchoscopy
Myocardial ischemia
Blood pressure
Heart rate

Abbrevations

ACE
Angiotensin converting enzyme
ARB
Angiotensin receptor blocker
BP
Blood pressure
CCB
Calcium channel blocker
COPD
Chronic obstructive pulmonary disease
DBP
Diastolic blood pressure
FOB
Fiberoptic Bronchoscopy
HR
Heart Rate
IHD
Ischemic heart disease
ILD
Interstitial lung disease
RPP
Rate-pressure product
SBP
Systolic blood pressure
SpO2
Oxygen saturation
VAS
Visual analogue scale

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