Premedication for fibreoptic bronchoscopy.

Abstract

ABSTRACr A randomised, double-blind trial of atropine, atropine plus papaveretum, and atropine plus diazepam given intramuscularly as premedication for fibreoptic bronchoscopy in 60 patients showed no difference between the three regimens as assessed by bronchoscopist or patient. Bronchoscopists frequently attributed a sedative action to atropine alone and their assessment of tolerance and sedation was more optimistic than that of the patients. In a second study comparing intravenous diazepam (10 mg) with saline, after prior intramuscular atropine (0.6 mg), both the bronchoscopists and the patients noted a significant sedative effect of diazepam, and coughing was reduced by diazepam.Premedication for fibreoptic bronchoscopy frequently consists of an intramuscular injection of an anticholinergic agent and an opiate or benzodiazepine 30-60 minutes before the procedure. The anticholinergic agent is necessary to prevent vasovagal phenomena,' reflex bronchoconstriction, and bradycardia. It also helps to decrease secretions in the pharynx and airways. Opiates are given both for their antitussive effect and for sedation and a combination of anticholinergic agent and opiate is often used as premedication before general anaesthesia.Because of dissatisfaction with this regimen we compared the effects of atropine alone and in combination with either diazepam or papaveretum in 60 consecutive patients undergoing fibreoptic bronchoscopy. Since the study showed that none of these three combinations was satisfactory, we went on to assess the use of diazepam given intravenously at the time of the bronchoscopy. < 50 kg, 15 mg 50-70 kg or > 65 years, 20 mg > 70 kg and < 65 years). All drugs were given intramuscularly 20-40 minutes before patients came to the bronchoscopy suite. Patients and bronchoscopists were unaware of the premedication given, the order being randomised and chosen from a set of sealed envelopes. Topical anaesthesia was used for the oropharynx, larynx, and airways in the usual manner.2 The nasal route was used when possible, and was always attempted first. Bronchoscopy was performed with the patient supine. The same two experienced bronchoscopists performed the procedures and the assessments in both studies and in all cases an assistant was present.Immediately after the bronchoscopy the bronchoscopist answered three questions on the sedative effect of the premedication, the extent of coughing, and the patient's tolerance. Two bronchoscopists were concerned in the assessment and each question had four possible answers (table 1). Between one and three hours after the bronchoscopy the patient completed questions on the sedative effect of the premedication and tolerance of the procedure (table 1). Patients were also asked for their opinion on the worst part of the procedure. Assessment of premedication in the first few hours after bronchoscopy has been shown to reflect accurately the subsequent attitude of the patients.3The three premedications were compared in pairs by the Kolomgorov-Smirnov two-sample test.4INTRA...

Midazolam in Flexible Bronchoscopy Premedication

“…We used modified versions of previously reported questionnaires 7,12,13 to assess the patient's, operator's, or nurse's reported outcomes of the bronchoscopy. The patient questionnaire included 19 items investigating the satisfaction with the different parts of the flexible bronchoscopic procedure, the willingness to repeat the procedure if necessary, and the symptoms experienced during the procedure (Table 1 shows the English translation of the questionnaire).…”

It is time for patients to undergo bronchoscopy without discomfort

“…The old argument that up to half of the major complications of bronchoscopy are sedation related [7] is not confirmed by several more recent studies. In fact, even after comparing different sedative drugs versus placebo, no difference in the complication rate between sedated and nonsedated patients has been found [8][9][10][11][12][13][14], except for a slight but manageable increase in hypoxaemia risk with the use of midazolam and alfentanil [14] and a prolonged hospital stay after the procedure [10]. In fact, the use of sedation, when compared with placebo, resulted in improved overall tolerance and patient perception of bronchoscopy [9][10][11][12][13][14], reduced cough [8,12,14], and better predisposition of patients to repeating the procedure [10,[12][13][14].…”

Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomised trial

“…Operators often tend to minimise patient discomfort [3][4][5] and, although FB can be performed without sedation [6][7][8], a recent survey revealed that 80% of patients prefer to be sedated during FB [4].…”