Evaluation of discomfort and tolerability to bronchoscopy according to different sedation procedures with midazolam

Abstract

Abstract. Patients frequently experience great discomfort during a bronchoscopy for the diagnosis of lung neoplasms. Sedation is generally recommended during bronchoscopy; however, few studies have evaluated the discomfort and tolerability of patients to a bronchoscopy with regard to the administration procedures. The aim of the present study was to evaluate the discomfort and tolerability of patients undergoing a bronchoscopy using different sedation procedures with midazolam. The retrospective survey of sedation during bronchoscopy involved the comparison of two periods: January-March 2012 (first period) and July-September 2012 (second period). A numerical rating score, which ranged between 1 (best) and 5 (worst) according to the subjective view of the patients, was used to rate patient discomfort, pain, sensation, time and tolerability to the bronchoscopy. In the first period, 2.5 mg midazolam was administered prior to the initiation of surgery, and additional doses of midazolam was added in 2.5-mg increments whenever the patient deviated from the target sedation level. In the second period, 2.0 or 3.0 mg midazolam was administered prior to the initiation of surgery, and additional midazolam doses were administered in 1.0-mg increments until the patients were sedated to the target sedation level. In total, 60 and 68 valid responses were obtained in the first and second periods, respectively. The patients in the second period exhibited significantly improved discomfort and pain scores during the bronchoscopy and higher rates of consent to re-examination, as compared with the patients in the first period (1.89±1.40 vs. 2.78±1.52, P<0.001; 1.48±1.13 vs. 2.00±1.37, P= 0.005; 2.45±1.62 vs. 3.13±1.47, P= 0.013, respectively). The amount of midazolam administered was significantly higher in the second period. There were no fatal complications during the bronchoscopy in either period. In conclusion, the present study observed that the administration of additional midazolam in small doses, until the target sedation level is achieved, is a safe procedure that is associated with significantly less discomfort and pain during bronchoscopy and a greater consent to re-examination when compared with the administration of a fixed dose of midazolam.

Level and predictors of anxiety in patients undergoing diagnostic bronchoscopy

“…These results are in agreement with earlier reports that establish the fact that performing bronchoscopy for an outpatient can lead to anxiety and discomfort. [28] One of the key reasons that have been cited for this condition is that there has not been sufficient optimization of the levels of sedation customized for outpatient bronchoscopy. Generally, sedation is performed with the same protocol regardless of whether the patients were outpatient or inpatient.…”

Identification of factors during bronchoscopy that affect patient reluctance to undergo repeat examination: Questionnaire analysis after initial bronchoscopy

“…Although it is certainly necessary to minimize discomfort during bronchoscopy, it cannot be eliminated. In previous studies investigating factors that influence anxiety and satisfaction experienced by patients undergoing bronchoscopy, patients who showed willingness to be re-examined and underwent multiple bronchoscopies were on average more satisfied with their physicians’ explanations of the procedure [10,11]. Although patients fear a variety of things before bronchoscopy, such as pain, breathing difficulties, and oropharyngeal irritation, doctors tend to explain "why" but not "how" the procedure is performed [7].…”

Pulmonologist-Administered Balanced Propofol Analgosedation during Interventional Procedures: An Italian Real-Life Study on Comfort and Safety

“…BP are commonly performed by pulmonologists as the gold standard technique for directly visualizing the airways; this procedure is performed under sedation in absence of contraindication [20]. Midazolam and opioids are currently used for BP, with the inclusion of EBUS-TBNA due to their easy application and rapid onset with good subject's satisfaction [21,22]. However, the midazolam effect may have a delayed recovery time [23].…”