Patient-controlled Sedation During Flexible Bronchoscopy

Abstract

Background: Patient-controlled sedation (PCS) is a documented method for endoscopic procedures considered to facilitate early recovery. Limited data have been reported, however, on its use during flexible bronchoscopy (FB). Methods: This study hypothesized that PCS with propofol during FB would facilitate early recovery, with similar bronchoscopist and patient satisfaction compared with nurse-controlled sedation (NCS) with midazolam. A total of 150 patients were randomized 1:1:1 into a control group (premedication with morphine-scopolamine and NCS with midazolam), PCS-MS group (premedication with morphine-scopolamine and PCS with propofol), and PCS-G group (premedication with glycopyrronium and PCS with propofol). Results: The procedures included transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy, and/or multistation endobronchial ultrasound. FB duration values in median (range) were 40 (10 to 80), 39 (12 to 68), and 44 (10 to 82) minutes for the groups NCS, PCS-MS, and PCS-G, respectively. An overall 81% of the patients in the combined PCS groups were ready for discharge (modified Post Anaesthetic Discharge Scoring System, score 10) 2 hours after bronchoscopy compared with 40% in the control group (P<0.0001). Between PCS groups, 96% of the PCS-G group patients were ready for discharge compared with 65% in the PCS-MS group (P=0.0002) at 2 hours. Bronchoscopists’ and patients’ satisfaction scores were high in all groups. Postdischarge quality scores showed no differences among the groups. Conclusion: PCS with propofol during FB is feasible, as it shortened recovery time without compromising procedure conditions for bronchoscopists or patients. A rapid postsedation stabilization of vital signs facilitates surveillance before the patient leaves the hospital.

Patient‐controlled sedation with propofol for endoscopic procedures—A cost analysis

“…Therefore, PCS is a cost-saving method for sedation during endoscopic procedures that can also improve procedure feasibility and patient satisfaction without affecting patient safety. 14,15 All procedures under PCS might not be possible to continue and require full anaesthesia to complete. With a bedside anaesthetic nurse and an anaesthesiologist immediately available, this can be accomplished.…”

“…The first study evaluated ERCP 14 and was conducted at the Surgical Clinic between January 2011 and May 2012. The second study examined bronchoscopy 15 and was conducted at the Department of Pulmonary Medicine between April 2016 and May 2017.…”

“…Further details on design, protocol, enrolment, eligibility and randomisation have been described elsewhere. 14,15…”

Response Letter to the editor

“…Instead, we added 5 minutes for the start/preparation respectively completion/dismantling of the procedure (10 minutes in total) to the measured procedural time. Our main finding that PCS is a cost-saving method was primarily based on reduced costs for hospital stay and avoidance of aborted procedures that had to be The patients in both studies 3,4 had adequate and sufficient sedation upon insertion of endoscope and during the procedure. The post-procedural assessment by the patients using PCS in both studies showed significantly higher satisfaction of the procedure compared with patients administrated midazolam.…”

“…BG, LN, LB, AN, and FS contributed substantially to the study design, cost analysis and interpretation, and writing of the manuscript. Benjamin Grossmann 1,2 Andreas Nilsson 2,3 Folke Sjöberg 1,4 Lars Bernfort 5 Lena Nilsson 2,3 1…”