Flexible bronchoscopy under conscious sedation with midazolam and fentanyl can be safely performed by nonanesthesiologists

Abstract

RESEARCH LETTER Flexible bronchoscopy under conscious sedation with midazolam and fentanyl... 869contraindications to use midazolam or fentanyl, diminished communication capacity, and cognitive disorders. The study was approved by the Ethics Committee at Jagiellonian University, Kraków, Poland.In all patients, topical anesthesia was used according to current guidelines. 4 Most patients received a bolus of midazolam (2.5 mg) and fentanyl (0.05 mg) before the examination. If necessary, both medications were titrated in incremental doses during FB to achieve adequate analgosedation. The initial dose of fentanyl was not administered in 23 patients for one of the following reasons: exacerbation of chronic obstructive pulmonary disease, respiratory failure, or advanced age with several comorbidities. A bronchofiberoscope was introduced through a mouthpiece 3 minutes after drug administration. During the whole procedure, vital parameters were monitored including oxygen saturation, blood pressure, and electrography; adverse events were also recorded. The level of patient sedation was continuously assessed according to the Ramsey sedation scale.6 The study personnel were trained in acute life support and study nurses had specialization in anesthesia and intensive care. During the whole procedure, the patient's spontaneous ventilation was sustained with oxygen administered through a nasal cannula if needed (in 282 patients, approximately 3.5 l/min of O 2 ). Monitoring was continued following FB until complete recovery from sedation was observed. If needed, patients were administered antagonists-flumazenil and naloxone-to reverse drug reaction. Immediate anesthesiologist support was available at all time during the study in case of need.A statistical analysis was performed using the Statistica software (version 10.0; StatSoft, Inc., Introduction Flexible bronchoscopy (FB) is one of the most commonly used diagnostic and therapeutic tools in current respiratory medicine.1 It is an invasive method that is unpleasant for the patient and is preferably performed under analgosedation. 2 According to several studies, relieving the patient's anxiety during the endoscopic procedure shortens the time of the procedure and prevents adverse events. 3 There are no exact guidelines on how to perform analgosedation; however, most authors agree that using only topical anesthesia is insufficient and suggest using moderate sedation, previously known as conscious sedation. 4This approach enables the medical personnel to stay in verbal contact with the patient and, at the same time, to relieve unpleasant symptoms. In several countries, mainly in Europe, moderate sedation in endoscopic procedures is restricted only to anesthetists despite several reports on the safety and cost-effectiveness of sedation applied by nonanesthesiologists. [5][6][7] Between the years 2013 and 2014, we performed a prospective observational study that aimed to assess factors that influence anxiety and satisfaction in patients undergoing FB under analgosedation.8 In thi...

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

“…The American College of Chest Physicians and BTS guidelines recommend diagnostic flexible bronchoscopy under conscious sedation (4,5). Bronchoscopy under conscious sedation with a combination of midazolam with fentanyl in this study could be safely performed and confirmed the previous study (12). Conscious sedation may lead to avoid pneumothorax.…”

Proceduralist Given Sedation is Safe and Feasible in Pediatric Flexible Bronchoscopy

“…Studies from other parts of the world also suggest that sedation technique performed by nonanesthesiologists during bronchoscopy is safe and cost-effective. 1,8,14 The major side effect was observed in two of our patients and both patients recovered fully. One patient needed brief endotracheal intubation and mechanical ventilation and the second patient required ICU monitoring for a sudden rise in blood pressure (20% of baseline) which improved spontaneously within 1 hour.…”

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

“…Two prospective studies have demonstrated that sedation could be safely administered by a nonanesthesiologist without increased risk of complications. [121122] In a survey done in Switzerland among 229 pulmonologists, it was found that in 84% of bronchoscopies, propofol was administered without anesthesiologist and sedation-related morbidity and mortality were low. [123] Although propofol administered by a trained physician has been found to be safe, it must be remembered that it is a respiratory depressant with a narrow therapeutic range and has no available reversal agent.…”