RT Journal Article
SR Electronic
T1 Incremental midazolam versus midazolame/rentanyl sedation during flexible bronchoscopy. Safety and tolerance in relation to the complexity of intervention
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P3576
VO 40
IS Suppl 56
A1 Grigoris Stratakos
A1 Ioannis Kokkonouzis
A1 Penny Moraitaki
A1 Philip Emmanouil
A1 Nikos Koufos
A1 Evangelia Stoubi
A1 Dimitra Tsiboura
A1 Filomila Zikopoulou
A1 Fotis Sampsonas
A1 Manos Alchanatis
A1 Nikolaos Koulouris
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/P3576.abstract
AB 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.