Analgosedation during flexible fiberoptic bronchoscopy: Comparing the clinical effectiveness and safety of remifentanil versus midazolam/propofol

Abstract

Background: There are limited data regarding the efficacy and safety of remifentanil sedation for diagnostic bronchoscopy. The aim of this study was to evaluate the clinical efficacy and safety of remifentanil by comparing it with those of conventional drugs, midazolam and propofol. Methods: A retrospective study of 186 patients who underwent diagnostic bronchoscopy at Chonbuk National University Hospital was performed. Patients were classified into the remifentanil group and midazolam/propofol group according to the drugs used during bronchoscopy. Results: Of the 186 patients, 111 patients received remifentanil and 75 received midazolam/propofol during the bronchoscopy. The proportion of patients who required bronchoscopy for endobronchial inspection alone was significantly higher in the midazolam/propofol group than in the remifentanil group (93.3% vs. 71.2%; p < 0.001). In contrast, the proportion of patients who required more invasive procedures, such as bronchoscopic biopsy, bronchoalveolar lavage, or transbronchial lung biopsy, was significantly higher in the remifentanil group than in the midazolam/propofol group (27.8% vs. 6.7%; p < 0.001). The recovery time was significantly shorter in the remifentanil group than in the midazolam/propofol group (mean 6.4 min vs. 11.6 min, p < 0.001). There was no significant difference between the groups with regard to safety events including desaturation, hypotension, and arrhythmia. Conclusions: Despite the higher proportion of patients who underwent more invasive procedures in the remifentanil group than in the midazolam/propofol group, there was no significant difference in safety events between the groups. Those in the remifentanil group also demonstrated a faster recovery time than those in the midazolam/propofol group.

Sedation for bronchoscopy in children: A prospective randomized double‐blinded trial

“…Procedural sedation with propofol alone 10,11 or in combination with remifentanil 8,12,13 also proved to be useful for pediatric flexible fiberoptic bronchoscopy. It is the subject of scientific debate whether the routine addition of an opioid to the sedation regimen is beneficial for the bronchoscopy procedure 14 . The antitussive and analgesic effect of opioids might lead to a reduction in coughing, which improves the conditions for the bronchoscopist, and increases patient comfort, thus enhancing patient safety.…”

“…In adults, several sedation regimens for flexible bronchoscopy were compared during the last years. They revealed divergent and even partially opposing results concerning the use of opioids relating to coughing, desaturations, and patient/examiner satisfaction 14,17–20 . Therefore, the choice of medication is not standardized and mainly depends on personal preferences and experience.…”