A Prospective Analysis of the Efficacy and Complications Associated With Deep Sedation With Midazolam During Fiberoptic Bronchoscopy

Haga, Takahiro; Fukuoka, Mizuki; Morita, Mizuo; Cho, Kohei

doi:10.1097/lbr.0000000000000261

Cited by 10 publications

(12 citation statements)

References 17 publications

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“…Prior studies assessing subject comfort with differing methods of sedation have had conflicting conclusions. A randomised prospective trial of conscious sedation versus deep sedation assessing presence or absence of distress with a post-procedure questionnaire suggests more subjects experience distress under conscious sedation [ 14 ]. However, as identified by the authors, the use of a binary question in this study may not be as precise as a linear scale, such as that used in our trial.…”

Section: Discussionmentioning

confidence: 99%

“…Clinicians’ understanding of patient comfort is crucial to appropriate care of patients. Prior studies have not assessed comfort as a primary outcome in a randomised prospective study of bronchoscopy, rather only reporting comfort as a secondary outcome or using a limited binary (distress versus no distress) assessment [ 14 – 16 ]. In addition, the impressions of patient comfort of other procedural staff, including bronchoscopy nurses, is important.…”

Section: Introductionmentioning

confidence: 99%

“…Recent papers have shown the diagnostic accuracy of flexible bronchoscopy and endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) with conscious sedation is noninferior to deep sedation or general anaesthesia [ 15 – 23 ]. Trials assessing complications with conscious sedation versus general anaesthesia have conflicting results, and this appears to be due to differing definitions of complications [ 14 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

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A randomised study of comfort during bronchoscopy comparing conscious sedation and anaesthetist-controlled general anaesthesia, including the utility of bispectral index monitoring

et al. 2021

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BackgroundThe difference in patient comfort with conscious sedation (CS) versus general anaesthesia (GA) for bronchoscopy has not been adequately assessed in a randomised trial. This study aimed to assess if patient comfort during bronchoscopy with CS is non-inferior to GA.Methods96 subjects were randomized to receive CS or GA for bronchoscopy. The primary outcome was subject comfort. Secondary outcomes included: Willingness to undergo a repeat procedure if necessary andlevel of sedation assessed clinically and by Bispectral Index (BIS) monitoring.ResultsThere was no significant difference between subject comfort scores (difference −0.01 (95% CI −0.63, 0.61 on a 10 point scale,, p=0.97) or willingness to undergo a repeat procedure (97.7% versus 91.8%, (95% CI −4.8%, 15.5%); p=0.37). Deeper levels of sedation in the GA cohort was confirmed with both clinical and BIS. There was no significant difference in diagnostic accuracy (CS: 93.9% (95% CI 80.4%, 98.3%) versus GA: 86.5% (95% CI 72.0%, 94.1%); p=0.43). There were more complications (29.6% (95% CI 18.2%, 44.2%) versus 6.1% (95% CI 2.1%, 16.5%); p<0.01) in the GA group. There was no relationship between high BIS scores and subject discomfort. BIS levels of less than 40 during a procedure was associated with increased complications.ConclusionCS is not inferior to GA in providing patient comfort during bronchoscopy despite lighter sedation and is associated with fewer complications and comparable diagnostic accuracy. BIS monitoring may have a role in preventing complications associated with deeper sedation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A randomised study of comfort during bronchoscopy comparing conscious sedation and anaesthetist-controlled general anaesthesia, including the utility of bispectral index monitoring

et al. 2021

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“…Our decision to systematically administer midazolam without a combination of an opioid was based on the fact that outcomes should not be influenced by a second drug. Midazolam is used regularly in bronchoscopy [9]. Its use in bronchoscopy is well established due to its rapid onset of action, short half-life, and sedative properties [21].…”

Section: Discussionmentioning

confidence: 99%

“…Sedation or anesthesia during endoscopic procedures may increase the risk of complications, with hypoxemia being one of the most significant ones [9] which can lead to myocardial infarction and death [10, 11]. Therefore, in some countries, manipulation of these drugs is performed only in the presence of an anesthesiologist, although thoracoscopy is a minimally invasive technique [4].…”

Section: Introductionmentioning

confidence: 99%

Local Anesthesia Thoracoscopy with versus without Midazolam: A Randomized Controlled Trial

et al. 2020

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Background: Medical thoracoscopy is the gold standard for the diagnosis of pleural diseases. To date, no consensus exists regarding the choice of sedative and analgesic agents in patients undergoing local anesthetic thoracoscopy (LAT), and questions are raised as to whether sedatives may add to respiratory side effects. Objective: The aim of the study was to test the hypothesis that administration of midazolam associated with lidocaine versus lidocaine alone in patients with LAT adds to respiratory side effects. Methods: We randomly assigned 80 patients to a 1:1 study to 2 groups: local anesthesia by lidocaine (n = 40) versus lidocaine and midazolam (n = 40), with the primary end point being the mean lowest oxygen saturation. The secondary end points were cardiovascular parameters, complications, days of drainage, hospital stay, and patients’ quality of life (QoL) as assessed by a visual analog scale (VAS). Results: The mean age of all patients was 66.6 ± 13.1 years. The study comprised 50 males (62.5%). No difference was observed in the demographics between the 2 groups. No significant difference was observed between the 2 groups in oxygen saturation (primary end point). A significant difference was observed in favor of the midazolam group regarding the QoL assessed by VAS. Conclusion: Midazolam does not add to respiratory side effects when it is used with lidocaine for LAT, while patients’ QoL is actually improved in this group. Therefore, in our department, we changed our startegy in favor of the association of lidocaine and midazolam.

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Conscious Sedation During Bronchoscopy: How Far We’ve Come

et al. 2017

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A Prospective Analysis of the Efficacy and Complications Associated With Deep Sedation With Midazolam During Fiberoptic Bronchoscopy

Abstract: In the present study, deep sedation had a beneficial effect on patient tolerance to FB. Although oxygen desaturation during FB represents a potentially serious complication, deep sedation may be considered to be a useful premedication for FB.

Cited by 10 publications

References 17 publications

A randomised study of comfort during bronchoscopy comparing conscious sedation and anaesthetist-controlled general anaesthesia, including the utility of bispectral index monitoring

A randomised study of comfort during bronchoscopy comparing conscious sedation and anaesthetist-controlled general anaesthesia, including the utility of bispectral index monitoring

Local Anesthesia Thoracoscopy with versus without Midazolam: A Randomized Controlled Trial

Conscious Sedation During Bronchoscopy: How Far We’ve Come

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