Comfort and safety of bronchoscopy performed under sedation and local anesthesia in elderly patients

Abstract

Although sedation for bronchoscopy improves patient comfort, there is a risk of oversedation in elderly patients. Only a few studies have evaluated the efficacy and safety of sedation for bronchoscopy in elderly patients. This study retrospectively analyzed records of 210 patients who underwent transbronchial brushing and/or biopsy under midazolam sedation at National Hospital Organization Omuta National Hospital between June 2017 and October 2019. Patients were administered 1 mg midazolam following 10 mL 4% lidocaine inhalation. When sedation was insufficient, 0.5 mg midazolam was administered additionally. Diagnostic yield, incidence of complications, amount of oxygen supplementation, decreases in percutaneous oxygen saturation (SpO 2 ), changes in blood pressure, and degree of comfort were analyzed. Patients were divided into the elderly (n = 102) and non-elderly (n = 108) groups. No significant differences were observed in diagnostic yield and procedure time between the 2 groups, and no severe adverse events were noted in the elderly group. The degree of comfort during bronchoscopy was significantly higher in the elderly group. In patients administered < 2 mg midazolam, the amount of oxygen supplementation and decreases in SpO 2 were significantly smaller in the elderly group compared to the non-elderly group. The risk of adverse events related to midazolam sedation in bronchoscopy does not increase with age, and sedation improves comfort during flexible bronchoscopy in elderly patients. Moreover, a total dose of midazolam <2 mg is safe for elderly patients undergoing bronchoscopy.

Remimazolam alone or in combination with dexmedetomidine in patients receiving bronchoscopy: a randomized-controlled trial

“…Statement of key ndings is a consensus that topical anesthesia, analgesic and sedative agents should be recommended for all physicians performing bronchoscopy except for the cases of contradictions [18,19]. Propofol is safe and effective and has been widely used for sedation during bronchoscopy [4,20].…”

To establish a risk prediction model for the occurrence of hypoxemia during painless bronchoscopy

“…Electronic bronchoscopy is one of the important invasive methods for the diagnosis of diseases of the respiratory system. [1] It can penetrate deep into the sub-bronchus and examine directly into the upper respiratory tract, trachea and bronchus, collect respiratory secretions and cell specimens, and biopsy of the respiratory tract, lung, and mediastinum. [2] As the bronchoscope is inserted without anesthesia, the airway will be mechanically stimulated, and may easily stimulate coughing, breath-holding, suffocation, fear, restlessness, etc.…”

Safety and Efficacy of Flexible Bronchoscopy in Elderly Patients: A Retrospective Comparative Study

“…A previous study on FB in elderly patients indicated a correlation between age and the incidence of pneumothorax, 6 whereas other studies suggested that FB was well-tolerated in elderly patients with no notable increase in complications. 7 , 8 Moreover, most previous studies included only a few octogenarians. Therefore, evidence of the effectiveness and safety of FB in elderly patients is insufficient and controversial.…”