Discomfort during bronchoscopy performed after endobronchial intubation with fentanyl and midazolam: a prospective study

Abstract

Objective: Although endobronchial intubation during a bronchoscopic examination is useful for invasive procedures, it is not routine practice in Japan. The present study evaluated discomfort due to endobronchial intubation using fentanyl and midazolam sedation during bronchoscopy. Methods: Thirty-nine patients were enrolled prospectively from November 2014 to September 2015 at Okayama University Hospital. Fentanyl (20 µg) was administered to the patients just before endobronchial intubation, and fentanyl (10 µg) and midazolam (1 mg) were added as needed during the procedure. A questionnaire survey was administered 2 h after the examination. In the questionnaire, patient satisfaction was scored using a visual analog scale as follows: excellent (1 point), good (2 points), normal (3 points), uncomfortable (4 points) and very uncomfortable (5 points). An additional question ('Do you remember the bronchoscopic examination?') was also asked. Predefined parameters (blood pressure, heart rate, oxygen saturation and complications) were recorded. Results: The enrolled patients included 22 males and 17 females; their median age was 70 (range: 28-88) years. The patients received a mean dose of 47.9 µg of fentanyl (range: 30-90 µg) and 2.79 mg of midazolam (range: 1-7 mg). In total, 28 patients (71.7%) agreed to undergo a second bronchoscopic examination; the mean levels of discomfort and for the re-examination were 2.07 points each. About 41% of the patients remembered the bronchoscopic examination. No severe complications were reported. Conclusion: Endobronchial intubation using fentanyl and midazolam sedation during an invasive bronchoscopic procedure might be recommended. Clinical Trial Registration: UMIN000015578 in the UMIN Clinical Trials Registry

Distress during Bronchoscopy in Patients Who Underwent Endobronchial Intubation Using Fentanyl and Midazolam without Throat Anesthesia: A Prospective Study

“…The JSRE Safety Measures Committee 2020 recommended the omission of throat spray anesthesia before bronchoscopic examination during the coronavirus disease 2019 pandemic, suggesting that sedation using the combination of an opioid and midazolam should be used to prevent aerosol generation. In fact, our previous study showed that throat anesthesia using Jackson's spray may lead to patient distress 6,7) . The omission of throat spray anesthesia may prevent aerosol generation and reduce patient distress.…”

“…Additionally, pethidine chloride, fentanyl, and propofol were used in 10.9%, 4.4%, and 4.2% of facilities 2) . The combination of an opioid (fentanyl or pethidine) and midazolam allowed the performance of safe bronchoscopy in a timely manner for Japanese patients [3][4][5][6][7][8] . The spray was administered directly into the oropharynx before the procedure and was an important prerequisite for the successful performance of brochoscopy 9) .…”

End-tidal capnographic monitoring during flexible bronchoscopy under fentanyl and midazolam sedation

“…Inadvertent oversedation sometimes causes respiratory depression and oxygen desaturation (17), although sedation is necessary and recommended for bronchoscopic procedures (11)(12)(13). It has been published that the nadir on SpO 2 decline could be delayed by 45-60 seconds after an apnea episode (18).…”

“…When fentanyl is administered with other sedatives, an initial dose of 25-50 μg is recommended with additional doses of 25 μg, as required, until the desired effect is achieved. The recommended dose of midazolam is 0.01-0.1 mg/kg (12,13). As Japanese are, on average, physically smaller than Westerners, we selected a lower dose of fentanyl.…”

“…British Thoracic Society guidelines in adults also recommend using these drugs for diagnostic flexible bronchoscopy (10). We showed previously, for the first time, that sedation with fentanyl and midazolam was safe and effective during bronchoscopic examinations in Japanese patients (11,12). Furthermore, we reported that sedation with fentanyl and midazolam facilitated the diagnosis of peripheral pulmonary lung cancers (13).…”