Abstract
Background: Sedation during flexible bronchoscopy (FB) is undisputed. Although suggested, benzodiazepines and opiates combination is underused due to fear of complications.
Aim: To prospectively compare safety and tolerance of FB sedation using incremental midazolam (M) versus combined midazolam/fentanyl (MF) administration.
Methods: Consecutive patients referred for FB were enrolled. After administration of 2% lidocaine aerosol, sedation with midazolam (1-5 mg) alone or combined with fentanyl (0.025-.005mg) was given. Decision relied on clinical parameters (fear,anxiety,cough and restlessness) and on staff judgment regarding performed interventions.Nurses took active role estimating sedation need. Patients completed verbal analogue scales (VAS) and overall tolerance questionnaires.Bronchoscopists completed tolerance VAS and complications questionnaires.
Results: 68 patients (53 males, aged 65 ±12) enrolled.31 received only M (mean 2.23 mg) while 37 received combined sedation (mean 2.74mg M and 0.033 mg F).No sedation related complications were reported.Increased duration of FB and interventional procedures (EBUS, TBNA, Electro-Cryotherapy) were associated with combined MF sedation and increased M dosage (p < 0.05). Patients & bronchoscopists reached high VAS scores (>8/10).Discomfort and adverse effect scores were equally minimal.
Conclusion:Both regimens are safe and effective in reducing anxiety and cough while increasing FB tolerance. Selection can be based on prolonged duration and need for interventional modalities. Trained endoscopy nurses are effective in incrementing sedation during bronchoscopy in an “as needed” basis.
- © 2012 ERS