Perbandingan efek dexmedetomidin dengan midazolam pada pasien yang menjalani sedasi prosedural pada tindakan bronkoskopi

Abstract

Background: Bronchoscopy is an airway procedure that often provokes coughing, discomfort, and cardiovascular responses. Procedural sedation is therefore required to improve patient tolerance while maintaining spontaneous breathing, circulation, and timely recovery. Dexmedetomidine and midazolam are commonly selected for this purpose, although their pharmacologic characteristics and clinical effects are not identical

Purpose: To analyze the comparative effects of dexmedetomidine and midazolam for procedural sedation during bronchoscopy, focusing on hemodynamic response, respiratory variables, Ramsay Sedation Scale (RSS), Modified Aldrete Score (MAS), and adverse events.

Method: This quantitative study used a quasi-experimental method with a one-group pretest-posttest design and was conducted from February to March 2026 at Dr. Mohammad Hoesin Provincial General Hospital in Palembang. The sampling technique used was purposive sampling, with a sample size of 74 participants divided into a dexmedetomidine group and a midazolam group. The independent variable in this study was the type of medication, while the dependent variable was the effectiveness of sedation during bronchoscopy. Data analysis included univariate analysis in the form of frequency distributions and bivariate analysis using the ANOVA test.

Results: Most baseline characteristics were comparable between groups. Dexmedetomidine was associated with lower systolic blood pressure, mean arterial pressure, and heart rate during early post-sedation and intra-procedural observation, with a consistently lower heart rate from 10 minutes after sedation until 10 minutes after bronchoscopy (p<0.001). Respiratory rate and oxygen saturation remained clinically stable in both groups. Midazolam achieved deeper sedation during bronchoscopy (RSS 4.46±0.69 vs 4.19±0.46; p=0.012), whereas dexmedetomidine demonstrated faster post-procedural recovery, shown by higher MAS values at 15, 30, and 60 minutes (p<0.001). No hypotension, tachycardia, bradycardia, desaturation, or arrhythmia was recorded.

Conclusion: Dexmedetomidine provides a favorable clinical profile for bronchoscopy sedation by preserving respiration, moderating hemodynamic response, and supporting faster recovery. Midazolam remains effective when a deeper intra-procedural sedation level is required

Keywords: Bronchoscopy; Dexmedetomidine; Midazolam; Modified Aldrete Score; Procedural Sedation; Ramsay Sedation Scale.