Eficacia del midazolam para la sedación en la broncoscopia flexible. Un estudio aleatorizado

Viedma, Enrique Cases; Pallarés, Javier Pérez; García, Miguel Ángel Martínez; Reyes, Raquel López; Moret, Francisca Sanchís; Aldás, Joaquín

doi:10.1016/j.arbres.2010.02.007

Cited by 22 publications

(5 citation statements)

References 25 publications

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“…Other studies have found better patient acceptance and bronchoscopy conditions with midazolam, but most of them are with much higher doses of midazolam (2–2.5 mg boluses followed by 1 mg supplements or >0.03 mg/kg bolus). However, these studies have also shown that it was achieved with serious adverse effects such as oxygen desaturation [ 11 , 12 , 21 , 22 ], inability on part of the patient to maintain the airway requiring verbal/tactile stimulation or airway manoeuvres or ventilator assistance or flumazenil for antagonizing the effects of midazolam [ 11 , 21 ], considerable reduction in both the inspiratory and expiratory muscle strengths (both maximum inspiratory and expiratory pressures) [ 23 ], and hiccups [ 24 ]. This can be a very important limiting factor and deterrent for the use of higher doses of midazolam (>0.02 mg/kg or >1-2 mg bolus) when the responsibility for monitoring and managing the adverse effects rests on the pulmonologist or otorhinolaryngologist.…”

Section: Discussionmentioning

confidence: 99%

“…A study that used combination of propofol with dexmedetomidine demonstrated that there were lower instances of oxygen desaturation with this combination as compared to propofol remifentanil combination [ 14 ]. Several studies that have used higher doses of midazolam (>0.02 mg/kg) have documented risk of oxygen desaturation during the procedure despite prophylactic oxygen administration to all patients [ 11 , 12 , 21 , 22 ]. In one study, midazolam in a dose of 0.07–0.1 mg/kg IV administered two minutes prior to bronchoscopy resulted in episodes of desaturation to 85% despite O 2 therapy, requiring administration of higher O 2 concentrations as well as requirement for flumazenil to reverse the effects of midazolam in one patient [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy

et al. 2015

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Dexmedetomidine, an α 2 agonist, has demonstrated its effectiveness as a sedative during awake intubation, but its utility in fiberoptic bronchoscopy (FOB) is not clear. We evaluated the effects of midazolam and dexmedetomidine on patient's response to FOB. The patients received either midazolam, 0.02 mg/kg (group M, n = 27), or dexmedetomidine, 1 µg/kg (group D, n = 27). A composite score of five different parameters and a numerical rating scale (NRS) for pain intensity and distress were used to assess patient response during FOB. Patients rated the quality of sedation and level of discomfort 24 h after the procedure. Ease of bronchoscopy, rescue medication requirement, and haemodynamic variables were noted. Ideal or acceptable composite score was observed in 15 and 26 patients, respectively, in group M (14.48 ± 3.65) and group D (9.41 ± 3.13), p < 0.001. NRS showed that 11 patients in group M had severe pain and discomfort as compared to one patient with severe pain and two with severe discomfort in group D during the procedure, p < 0.001. Rescue midazolam requirement was significantly higher in group M (p = 0.023). We conclude that during FOB, under topical airway anaesthesia, IV dexmedetomidine (1 µg/kg) provides superior patient comfort and tolerance as compared to IV midazolam (0.02 mg/kg).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy

et al. 2015

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“…Various agents such as diazepam, midazolam, lorazepam, propofol, and fospropofol have been compared with placebo, and it has been consistently demonstrated that administration of sedation is beneficial for patient comfort and tolerance without causing significant hemodynamic disturbance. [100102103104105106107] A meta-analysis of nine studies evaluated the safety and efficacy of moderate sedation during bronchoscopy and found that the willingness to return for repeat procedure was greater in the sedation group and duration of procedure was shorter, while hypoxic episodes were comparable in both groups. [108]…”

Section: Premedicationmentioning

confidence: 99%

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

et al. 2019

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Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

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“…The BIS monitor has been found to be useful for dosing drugs and reducing recovery time in patients under sedation in diagnostic and therapeutic procedures [33,34,35]. In fiberoptic bronchoscopy, it has been estimated that BIS levels for appropriate sedation are between 65 and 85 [36,37,38,39], and its ability to reduce the dose of sedatives has not been demonstrated [39]. EBUS is a longer procedure that requires a higher level of sedation, and the only information available on the use of BIS is limited to the control of the depth of sedation; its potential for reducing the dose of sedatives in a group of patients with respiratory disease, which may increase adverse events, has never been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Bispectral Index Monitoring Reduces the Dosage of Propofol and Adverse Events in Sedation for Endobronchial Ultrasound

Quesada

Júdez²,

Ubieto³

et al. 2016

Respiration

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Background: Current guidelines recommend monitoring the anesthetic depth of sedation during respiratory endoscopy by using clinical scales despite their subjective nature and the potential change in the level of sedation caused by frequent stimulation. Monitoring by means of the bispectral index (BIS) has shown its utility in reducing the use of drugs and their adverse events in general anesthesia, but evidence in prolonged sedation is insufficient. Objective: Our objective was to evaluate BIS in patients undergoing endobronchial ultrasound (EBUS). Methods: A randomized cohort study of 90 patients with mediastinal lymph node involvement and/or lung or mediastinal lesions for whom EBUS was indicated, comparing the modified observer's assessment of alertness/sedation scale clinical evaluation (n = 45) versus the BIS evaluation (n = 45) of sedation with propofol-remifentanil, was conducted in order to evaluate the clinical parameters, doses used, adverse events, and tolerance of the procedure. Results: We found a shorter waking time and a significantly lower dose of total propofol in the BIS group. Significantly fewer overall adverse events were recorded in the BIS group and included desaturation, hypotension, and bradypnea. Tolerance was better in the BIS group. No significant differences were found in terms of cough, memory of the procedure, or the level of difficulty of EBUS on the part of the pulmonologists. Conclusions: BIS monitoring of sedation in EBUS makes it possible to reduce the dosage of propofol, thereby shortening the waking time and reducing adverse events. This form of monitoring should be taken into consideration in the future for systematic use in prolonged sedation, as in the case of EBUS.

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Eficacia del midazolam para la sedación en la broncoscopia flexible. Un estudio aleatorizado

Cited by 22 publications

References 25 publications

Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy

Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

Bispectral Index Monitoring Reduces the Dosage of Propofol and Adverse Events in Sedation for Endobronchial Ultrasound

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