Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

Agostini, L; Facciolongo, Nicola; Lusuardi, Mirco; Casalini, Eleonora; Galeone, Carla; Lasagni, Luciano; Zucchi, Luigi

doi:10.4081/monaldi.2017.768

“…This is in agreement with the results of a study by Daisuke et al [19] Some studies suggest that the advantage of opioids compared to benzodiazepines is the suppression of cough and pain. [17,20,21] Our results allude to the fact that patient cooperation and physician's comfort level were significantly better in the fentanyl-midazolam group.…”

Section: Discussionsupporting

confidence: 59%

“…In the fentanyl-midazolam group, among the patients who answered the questionnaire, 190/211 were willing to undergo a repeat bronchoscopy in the future, if required. In Lorenzo's study, [17] 95.9% of sedated patients would "definitely return" for EBUS-TBNA. In addition to patient satisfaction, operator satisfaction is equally important.…”

Section: Discussionmentioning

confidence: 97%

Safety and efficacy of fentanyl combined with midazolam in bronchoscopy under bispectral index-guided conscious sedation

Zhang

¹

,

Zhou

²

,

Xiong

³

et al. 2020

Preprint

0

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Background: Sedation combined with local anesthesia during bronchoscopy is widely accepted in America and Europe, and receiving great attention in China. This study aimed to investigate the safety and efficacy of fentanyl combined with midazolam for bispectral index (BIS) titrated conscious sedation during bronchoscopy in the Chinese population. Methods: Data from 436 patients who underwent bronchoscopy under local anesthesia (LA group) or BIS-guided conscious sedation combined with local anesthesia (FM group) were retrospectively analyzed. The analysis included vital signs, adverse events recorded during the procedure, and questionnaire information, such as patient tolerance and satisfaction, operator satisfaction, and the cough score noted after the procedure. Results: A total of 225 patients in the LA group, and 211 in the FM group were enrolled in the study. The blood pressure and oxygen saturation were significantly higher in the LA group than in the FM group during bronchoscopy (P<0.001). The heart rate was significantly faster in the LA group at T3max, T3min and T4 than in the FM group. The incidence of hypoxia and bradycardia was higher in the FM group than in the LA group, whereas incidence of hypertension and tachycardia was lower. Patient satisfaction and tolerance of the procedure were significantly better in the FM group. visual analog scale (VAS) scores for cough and operator satisfaction were better in the FM group than in the LA group. Sub-group analysis (inspection, biopsy and transbronchial biopsy guided by radial endobronchial ultrasound (rEBUS-TBB)) indicated that the vital signs, adverse event(hypoxia) and patient satisfaction of the two groups were similar to the previous results. However, the VAS scores for operators’ satisfaction was no significant difference between the two groups in patients undergoing inspection. Conclusions: The conscious sedation regimen of fentanyl combined with midazolam monitored by BIS during bronchoscopy is safe and effective. Although the incidence of hypoxia and bradycardia was higher, the patient’s tolerance and physician’s satisfaction were significantly improved, especially during lengthy procedures, such as intrabronchial biopsy and transbronchial biopsy guided by radial endobronchial ultrasound. Trial registration: The study was approved by the ethics committee of Changzhou first people's Hospital (2019-020). Key words: bronchoscopy, bispectral index, conscious sedation, midazolam, fentanyl.

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“…This is in agreement with the results of a study by Daisuke et al [19] Some studies suggest that the advantage of opioids compared to benzodiazepines is the suppression of cough and pain. [17,20,21] Our results allude to the fact that patient cooperation and physician's comfort level were…”

Section: Discussionsupporting

confidence: 53%

“…In the fentanyl-midazolam group, among the patients who answered the questionnaire, 190/211 were willing to undergo a repeat bronchoscopy in the future, if required. In Lorenzo's study, [17] 95.9%…”

Section: Discussionmentioning

confidence: 96%

Safety and efficacy of fentanyl combined with midazolam in bronchoscopy under bispectral index-guided conscious sedation

he

¹

,

zhang

²

,

Zhou

³

et al. 2020

Preprint

1

0

View full text Add to dashboard Cite

Background: Sedation combined with local anesthesia during bronchoscopy is widely accepted in America and Europe, and receiving great attention in China. This study aimed to investigate the safety and efficacy of fentanyl combined with midazolam for bispectral index (BIS) titrated conscious sedation during bronchoscopy in the Chinese population. Methods: Data from 436 patients who underwent bronchoscopy under local anesthesia (LA group) or BIS-guided conscious sedation combined with local anesthesia (FM group) were retrospectively analyzed. The analysis included vital signs, adverse events recorded during the procedure, and questionnaire information, such as patient tolerance and satisfaction, operator satisfaction, and the cough score noted after the procedure. Results: A total of 225 patients in the LA group, and 211 in the FM group were enrolled in the study. The blood pressure and oxygen saturation were significantly higher in the LA group than in the FM group during bronchoscopy (P<0.001). The heart rate was significantly faster in the LA group at T3max, T3min and T4 than in the FM group. The incidence of hypoxia and bradycardia was higher in the FM group than in the LA group, whereas incidence of hypertension and tachycardia was lower. Patient satisfaction and tolerance of the procedure were significantly better in the FM group. visual analog scale (VAS) scores for cough and operator satisfaction were better in the FM group than in the LA group. Sub-group analysis (inspection, biopsy and transbronchial biopsy guided by radial endobronchial ultrasound (rEBUS-TBB)) indicated that the vital signs, adverse event(hypoxia) and patient satisfaction of the two groups were similar to the previous results. However, the VAS scores for operators’ satisfaction was no significant difference between the two groups in patients undergoing inspection. Conclusions: The conscious sedation regimen of fentanyl combined with midazolam monitored by BIS during bronchoscopy is safe and effective. Although the incidence of hypoxia and bradycardia was higher, the patient’s tolerance and physician’s satisfaction were significantly improved, especially during lengthy procedures, such as intrabronchial biopsy and transbronchial biopsy guided by radial endobronchial ultrasound. Trial registration: The study was approved by the ethics committee of Changzhou first people's Hospital (2019-020).

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“…Similarly, the study by Agostini et al showed a very high patient satisfaction, a full cough control and a safe procedure with a cost reduction during EBUS-TBNA under conscious sedation using Meperidine and Midazolam [23].…”

Section: Discussionmentioning

confidence: 77%

Deep sedation versus minimal sedation during endobronchial ultrasound transbronchial needle aspiration

Conte

¹

,

Spagnol

²

,

Confalonieri

³

et al. 2018

Monaldi Arch Chest Dis

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The sedation plays an important role in the endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) procedure. The sedation can be Minimal (anxiolysis), Moderate (conscious sedation) or Deep. The ACCP guidelines suggest that moderate or deep sedation (DS) is an acceptable approach. In fact, several studies compare moderate versus deep sedation, but no study has been carried out to compare deep sedation versus minimal. We carried out a retrospective study to compare the Deep versus Minimal sedation (MiS) in patients undergoing EBUS-TBNA. The primary end point was the diagnostic accuracy. The secondary end points were adequacy and sensitivity. We evaluated the LN size sampling, procedural time, complications and patient tolerance. Thirty-six patients underwent EBUS-TBNA, 16 under DS and 20 under MiS. The overall diagnostic accuracy for correct diagnosis was 92.9% in DS group and 94.1% in MiS group (p=0.554). Sample adequacy, defined as the percentage of patients with a specific diagnosis by EBUS-TBNA, was 87.5% (14 of 16) and 85% (17 of 20) for the DS group and MiS group, respectively, (p=0.788); the sensitivity was 92.9% in the DS group (95% CI, 73-100%) and 92.9% in the MiS group (95% CI, 77-100%) (p=0.463). There were no major complications in either group. Minor complications were 4 in MiS and 1 in DS (p=0.355). The patients in the MiS group recalled the procedure more often compared to the other group (p=0.041). The majority of the patients would agree to undergo the same procedure again in the future in both groups (p=0.766). In our experience EBUS-TBNA performed under MiS has comparable accuracy, adequacy, sensitivity, complications and patient satisfaction to DS, even if the sample was small. Future prospective multicenter studies are needed to confirm our results.

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Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

Cited by 12 publications

References 29 publications

Safety and efficacy of fentanyl combined with midazolam in bronchoscopy under bispectral index-guided conscious sedation

Safety and efficacy of fentanyl combined with midazolam in bronchoscopy under bispectral index-guided conscious sedation

Safety and efficacy of fentanyl combined with midazolam in bronchoscopy under bispectral index-guided conscious sedation

Deep sedation versus minimal sedation during endobronchial ultrasound transbronchial needle aspiration

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