Prospective analysis of efficacy and safety of an individualized-midazolam-dosing protocol for sedation during prolonged bronchoscopy

Ogawa, Tatsuya; Imaizumi, Kazuyoshi; Hashimoto, Izumi; Shindo, Yuichiro; Imai, Nobuhisa; Uozu, Sakurako; Shimokata, Tomoya; Ito, Satoru; Hashimoto, Naozumi; Sato, Mitsuo; Kondo, Masashi; Hasegawa, Yoshinori

doi:10.1016/j.resinv.2013.09.003

Cited by 24 publications

(25 citation statements)

References 22 publications

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“…The papers reported desaturation rates between 0.7 and 76.3% (80, 81). Rates around 75.0% (duration not defined) were observed in both subjects with (78) and without supplemental oxygen (77, 81). Fruchter et al aimed at conscious sedation (propofol), which is defined as being able to rouse the patient by mild prodding or shaking (78).…”

Section: Resultsmentioning

confidence: 99%

“…Grendelmeier et al reported more mid-range results, with desaturation less than 90% in 16.4% of 440 patients going through bronchoscopy with propofol sedation, with conscious sedation defined as onset ptosis (59). Of note is that only two out of 10 studies specified a level of hypoxaemia at which they considered bronchoscopy contra-indicated (77, 79). …”

Section: Resultsmentioning

confidence: 99%

“…Elevation of body temperature was reported in seven prospective studies (57, 65, 77, 84–87) and one retrospective study with prospective recordings of temperature (55). The studies comprised 50–539 subjects (57, 85).…”

Section: Resultsmentioning

confidence: 99%

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Complications and discomfort of bronchoscopy: a systematic review

Leiten

Martinsen

Bakke

et al. 2016

European Clinical Respiratory Journal

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ObjectiveTo identify bronchoscopy-related complications and discomfort, meaningful complication rates, and predictors.MethodWe conducted a systematic literature search in PubMed on 8 February 2016, using a search strategy including the PICO model, on complications and discomfort related to bronchoscopy and related sampling techniques.ResultsThe search yielded 1,707 hits, of which 45 publications were eligible for full review. Rates of mortality and severe complications were low. Other complications, for instance, hypoxaemia, bleeding, pneumothorax, and fever, were usually not related to patient characteristics or aspects of the procedure, and complication rates showed considerable ranges. Measures of patient discomfort differed considerably, and results were difficult to compare between different study populations.ConclusionMore research on safety aspects of bronchoscopy is needed to conclude on complication rates and patient- and procedure-related predictors of complications and discomfort.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Complications and discomfort of bronchoscopy: a systematic review

Leiten

Martinsen

Bakke

et al. 2016

European Clinical Respiratory Journal

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“…At all times during the procedure, the operators were able to refer to three monitors, which showed the actual bronchoscopic image, the VBN image, and the fluoroscopic image at the same time. All procedures were performed under local anesthesia and a safe method of sedation with individually calculated doses of intravenous midazolam (11,12).…”

Section: The Procedures and Sedationmentioning

confidence: 99%

Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

et al. 2016

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Objective Endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopic navigation (VBN) improves the diagnostic yield in patients with peripheral pulmonary lesions (PPLs). Most previous reports on EBUS-GS-guided transbronchial biopsy (TBB) have included patients with benign and malignant diseases. We aimed to determine the factors that predicted a successful diagnosis by EBUS-GS-guided TBB diagnostic in patients with small peripheral lung cancer, with a focus on the high-resolution computed tomography (HRCT) findings before bronchoscopy. Methods We retrospectively reviewed the medical records of 173 consecutive patients with 175 small (! 30 mm) PPLs who were diagnosed with primary lung cancer between June 2010 and October 2013 at Nagoya University Hospital. All patients underwent EBUS-GS-guided TBB with VBN using a ZioStation computer workstation (Ziosoft, Osaka, Japan). We analyzed the patient characteristics, HRCT findings, diagnostic yield, and the diagnostic factors in small peripheral lung carcinoma. Results The EBUS probe position was within the PPL in 83 of the 175 lesions (47%) and 112 (64.0%) cases were successfully diagnosed by EBUS-GS-guided TBB. A univariate analysis revealed that the following factors were associated with a significantly higher diagnostic yield: CT bronchus sign positivity, a lesion of >20 mm in diameter, a solid nodule, and a probe position that was within the lesion. The following factors were not significant: the lesion location, the number of biopsies, and the lung cancer histology. A multivariate analysis revealed that the following factors significantly affected the diagnostic yield: CT bronchus sign positivity [odds ratio (OR) =2.479]; a probe position that was within the lesion (OR=2.542); and a solid nodule (OR=2.304). Conclusion The significant factors that were significantly associated with a successful diagnosis using EBUS-GS-guided TBB in small peripheral lung carcinoma were as follows: CT bronchus sign positivity, a solid nodule, and a probe position that was within the lesion.

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“…Recently, an individualized midazolam-dosing protocol was reported. The results indicated that the loading dose should be 0.075 mg/kg for men aged <65 years and women aged <70 years, while a dose of 0.05 mg/kg should be applied to men aged >66 years and women aged >71 years, with subsequent doses of one-half the loading dose to be administered every 20 min (10). There are several guidelines and randomized control trials with regard to midazolam administration; however, to the best of our knowledge, no studies have evaluated patient discomfort and tolerability according to the administration procedure used, including the small-dose administration procedure.…”

Section: Discussionmentioning

confidence: 99%

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

Matsumoto

Otsuka

Kato

et al. 2015

Experimental and Therapeutic Medicine

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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.

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Prospective analysis of efficacy and safety of an individualized-midazolam-dosing protocol for sedation during prolonged bronchoscopy

Cited by 24 publications

References 22 publications

Complications and discomfort of bronchoscopy: a systematic review

Complications and discomfort of bronchoscopy: a systematic review

Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

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

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