Dextromethorphan Role on Cough Suppression and Patient Procedure Tolerance in Flexible Bronchoscopy

Mehvish  Aqil; Mehr Muhammad Imran; Umar Usman; Saqib Musharaf; Zaheer Ahmed; Ali Hamad

doi:10.51253/pafmj.v74iSUPPL-2.5315

Authors

Mehvish Aqil Department of Pulmonology, District Head Quarters Hospital, Faisalabad Pakistan
Mehr Muhammad Imran Department of Pulmonology, District Head Quarters Hospital, Faisalabad Pakistan
Umar Usman Department of Pulmonology, District Head Quarters Hospital, Faisalabad Pakistan
Saqib Musharaf Department of Pulmonology, Gulab Devi Hospital, Lahore Pakistan
Zaheer Ahmed Department of Medicine, Allied Hospital, Faisalabad Pakistan
Ali Hamad Department of Pulmonology, District Head Quarters Hospital, Faisalabad Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74iSUPPL-2.5315

Keywords:

Cough, Dextromethorphan, Flexible bronchoscopy, Premedication

Abstract

Objective: To determine the role of Dextromethorphan on cough suppression and patient procedure tolerance in flexible bronchoscopy.

Study Design: Quasi-experimental study.

Place and Duration of Study: Pulmonology Department, District Head Quarters Hospital, Faisalabad Pakistan, from Oct 2019 to Mar 2020.

Methodology: Patients were divided into Group-1 and Group-2. Group-1 was given syrup Dextromethorphan 20miligram one hour before bronchoscopy and Group- 2 was given a placebo one hour before procedure. During procedure, oxygen saturation and blood pressure were recorded continuously by monitor. 10cm Visual analogue scale was used to chart their cough perception where 0 taken as no cough and 10 as incessant cough. Patients recorded their tolerability of procedure after 2 hours on 10cm visual analogue scale.

Results: Mean age of whole study population, Group-A and Group-B was 48.80+11.24, 46.63+11.70 and 47.72+11.43 respectively. Females were 25(41.7%) and males were 35(58.3%). Both groups have same mean SpO2 with supplemental oxygen. Four patients had an oxygen saturation below 90% during flexible bronchoscopy in both groups (p-value 0.647). Similar doses of Midazolam were used in the Dextromethorphan and placebo groups (p-value 0.879). The perception of cough by the patient, assistant staff and bronchoscopist in Dextromethorphan group 1 was significantly low (p-value 0.041, 0.0001, 0.037 respectively). Duration of procedure was also significantly lower in Dextromethorphan group p-value 0.0001.

Conclusion: Dextromethorphan use in addition to Midazolam and local anesthetic during flexible bronchoscopy results in

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References

Paradis TJ, Dixon J, Tieu BH. The role of bronchoscopy in the diagnosis of airway disease. J Thorac Dis 2016; 8: 3826–3837.

Du Rand I, Barber P, Goldring J, Lewis R, Mandal S, Munavvar M et al. British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax 2011; 66(Suppl 3): iii1-iii21.

Jose R, Shaefi S, Navani N. Sedation for flexible bronchoscopy: current and emerging evidence.EUR RESPIR REV 2013; 22: 106-116.

Hong KS, Choi EY, Park DA, Park J. Safety and Efficacy of the Moderate Sedation During Flexible Bronchoscopic Procedure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine (Baltimore) 2015; 94: e1459.

Stolz D, Chhajed PN, Leuppi JD, Brutsche M, Pflimlin E, Tamm M. Cough suppression during flexible bronchoscopy using combined sedation with Midazolam and hydrocodone: a randomised, double blind, placebo-controlled trial. Thorax 2004; 59: 773–776.

Leiten E, Martinsen E, Bakke P, Eagan T, Grønseth R. Complications and discomfort of bronchoscopy: a systematic review.Eur Clin Respir J 2016; 3: 33324.

Riachy M, Khayat G, Ibrahim I, Aoun-Bacha Z, Dabar G, Bazarbachi T et al. Sedation regimens comparison during flexible bronchoscopy: Dexmedetomidine, alfentanil and lidocaine. Eur. Respir. J 2015; 46: PA321.

Mohan A, Madan K, Hadda V, et al. Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations. Lung India 2019; 36(Supplement): S37-S89.

Stolz D. Cough suppression during flexible bronchoscopy using combined sedation with Midazolam and hydrocodone: a randomised, double blind, placebo controlled trial. Thorax 2004; 59: 773-776.

Amini S, Peiman S, Khatuni M, Ghalamkari M, Rahimi B. The Effect of Dextromethorphan Premedication on Cough and Patient Tolerance During Flexible Bronchoscopy. J Bronchology Interv Pulmonol 2017; 24: 263-267.

Danks RA, Rogers M, Aglio LS, Gugino LD, Black PM. Patient tolerance of craniotomy performed with the patient under local anesthesia and monitored conscious sedation. Neurosurgery 1998; 42: 28-36.

Leiten EO, Martinsen EM, Bakke PS, Eagan TM, Grønseth R. Complications and discomfort of bronchoscopy: a systematic review.Eur Clin Respir J 2016; 3: 33324.

Heidegger T, Schnider TW. “Awake” or “Sedated”: Safe flexible bronchoscopic intubation of the difficult airway.Anesth. Analg 2017; 124: 996-997.

Ost DE, Ernst A, Lei X, Kovitz KL, Benzaquen S, Diaz-Mendoza J, Greenhill S etal. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE registry. Am. J. Respir. crit. CareMed 2016; 193: 68-77.

Kobayashi F, Saraya T, Oda M, Sakuma S, Watanabe M, Takata S, et al. Novel predictive factors for patient discomfort and severe cough during bronchoscopy: A prospective questionnaire analysis. PloS one 2020 Oct 19; 15(10): e0240485.

Herth F, Shah P, Gompelmann D. Interventional Pulmonology. 1st Ed. London: European Respiratory Society; 2017. Chapter 1, Flexible Bronchoscopy; p.1-18.

Rex DK, Bhandari R, Desta T, DeMicco MP, Schaeffer C, Etzkorn K, et al. A phase III study evaluating the efficacy and safety of remimazolam (CNS 7056) compared with placebo and Midazolam in patients undergoing colonoscopy. Gastrointestinal endoscopy. 2018 Sep 1; 88(3): 427-437.

Schwarz Y, Greif J, Lurie O, Tarrasch R, Weinbroum AA. Dextromethorphan premedication reduces Midazolam requirement: objective and subjective parameters in peribronchoscopy. Respiration 2007; 74: 314-319.