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

Abstract

Background: Bronchoscopic examination including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is well established for lung cancer diagnosis and staging. Sedation using fentanyl and midazolam is recommended during bronchoscopic examinations. Meanwhile, inadvertent oversedation is a clinical problem. The objective of this research was to estimate the frequency of apnea episodes by endtidal capnography under fentanyl and midazolam sedation during bronchoscopy.Methods: Eighty-five patients were enrolled retrospectively between August 2017 and March 2018 at Okayama Medical Center. Apnea was defined as the cessation of airflow for more than 10 seconds. We reviewed medical records, including capnographic data, by cap-ONE YG-227T (NIHON KOHDEN, Tokyo, Japan) during flexible bronchoscopy under fentanyl and midazolam sedation.Results: Patients received 49.4±20.6 µg of fentanyl [mean ± standard deviation (SD)] and 4.35±2.0 mg of midazolam (mean ± SD). The patients included 52 males and 33 females; the median age was 71 (range, 31-88) years were enrolled. Apnea episodes were recorded (median duration 18 seconds) in 85 patients (100%). Prolonged apnea episodes with more than 30 seconds occurred in 56 patients (65.8%). Furthermore, the median time was 32 (range, 5-102) seconds whose delay between the onset of an apnea episode and decline in the SpO 2 level of ≥4% from baseline.Conclusions: End-tidal capnography, cap-ONE YG-227T was effective for detecting the occurrence of apnea in patients undergoing a bronchoscopic examination under fentanyl and midazolam sedation.Monitoring might be useful for preventing inadvertent oversedation.

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

“…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) .…”

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

“…FB is, however, an invasive procedure, and to relieve the patient’s anxiety, pain, stress, coughing, and hemodynamic fluctuations, as well as to facilitate the procedure, FB is usually performed under moderate to deep sedation, according to the complexity and expected duration, without compromising hemodynamics and oxygenation. Neuromuscular blocking agents (NMBAs) are utilized unless contraindicated ( Minami et al, 2021 ; Tao et al, 2022 ). However, there is still no standardized sedation protocol available for outpatients undergoing FB despite the rapid development of newer drugs (ie remifentanil (RF), dexmedetomidine (Dex), and remimazolam) and equipment (ie supraglottic airways and mechanical jet ventilators).…”