Midazolam in Flexible Bronchoscopy Premedication

Contoli, Marco; Gnesini, Giulia; Artioli, Denise; Ravenna, C; Sferra, Stella; Romanazzi, Cristina; Marangoni, Elisabetta; Guzzinati, Ippolito; Pasquini, C.; Papi, Alberto; Ravenna, F

doi:10.1097/lbr.0b013e3182a10b7a

Cited by 14 publications

(10 citation statements)

References 14 publications

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“…Commonly experienced sensations included a terrible taste, feeling their throat was swollen, choking and inability to swallow. Discomfort relating to throat spray has been reported in other studies (Contoli et al, 2013;Lo et al, 2011), and an older study found that a significant number of patients with asthma had airway constriction related to the administration of local anaesthetic (McAlpine & Thomson, 1989). Similarly to the participants in our study, previous studies have reported shortness of breath, cough and sore throat associated with bronchoscopy (Houghton, Raghuram, Sullivan, & O'Driscoll, 2004;Ni, Lo, Lin, Fang, & Kuo, 2010).…”

supporting

confidence: 55%

High‐risk respiratory patients' experiences of bronchoscopy with conscious sedation and analgesia: A qualitative study

Saxon

Fulbrook

Fong

et al. 2017

Journal of Clinical Nursing

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These findings have implications for patient preparation pre- and post-bronchoscopy in terms of what they might expect, and to discuss what has happened after the procedure. Some practices of the bronchoscopy team during the procedure may need modification. For example, in anticipation of the possibility that the patient may be aware, healthcare professionals should provide patient-focused explanations of what is happening during the procedure, as well as providing ongoing reassurance that everything is going as planned.

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supporting

confidence: 55%

High‐risk respiratory patients' experiences of bronchoscopy with conscious sedation and analgesia: A qualitative study

Saxon

Fulbrook

Fong

et al. 2017

Journal of Clinical Nursing

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“…However, this drug may depress the ventilatory drive and finally cause apnoea as its sedative pharmacology variability of different patients, especially in those with comorbidities and taking other respiratory depressant drugs at the same time. [25,26] As a short-acting and rapid recovery anesthetic agent, propofol has been widely used in many clinical fields such as gastrointestinal endoscopy, thyroplasty, bronchoscopy, interventional or radiological procedures, and awake bronchoscopy intubation for its hypnotic effect. However, because of the narrow therapeutic index between moderate sedation and respiratory depression, propofol is now strongly recommended for use only by anesthesiologists with close monitoring.…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of dexmedetomidine-remifentanil in children undergoing flexible bronchoscopy

Jin²,

Zhang³

et al. 2017

Medicine

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Flexible bronchoscopy is more and more used for diagnosis and management of various pulmonary diseases in pediatrics. As poor coordination of children, the procedure is usually performed under general anesthesia with spontaneous or controlled ventilation to increase children and bronchoscopists’ safety and comfort. Previous studies have reported that dexmedetomidine (DEX) could be safely and effectively used for flexible bronchoscopy in both adulate and children. However, there is no trial to evaluate the dose-finding of safety and efficacy of dexmedetomidine-remifentanil (DEX-RF) in children undergoing flexible bronchoscopy.The objective of this study is to evaluate the dose-finding of safety and efficacy of DEX-RF in children undergoing flexible bronchoscopy.One hundred thirty-five children undergoing flexible bronchoscopy with DEX-RF were divided into 3 groups: Group DR1 (n = 47, DEX infusion at 0.5 μg·kg–1 for 10 minutes, then adjusted to 0.5–0.7 μg kg–1 h–1; RF infusion at 0.5 μg kg–1 for 2 minutes, then adjusted to 0.05–0.2 μg kg–1 min–1), Group DR2 (n = 43, DEX infusion at 1 μg kg–1 for 10 minutes, then adjusted to 0.5–0.7 μg kg–1 h–1; RF infusion at 1 μg kg–1 for 2 minutes, then adjusted to 0.05–0.2 μg kg–1 min–1), Group DR3 (n = 45, DEX infusion at 1.5 μg kg–1 for 10 minutes, then adjusted to 0.5–0.7 μg kg–1 h–1; RF infusion at 1 μg kg–1 for 2 minutes, then adjusted to 0.05–0.2 μg kg–1 min–1). Ramsay sedation scale of the 3 groups was maintained 3. Anesthesia onset time, total number of intraoperative children movements, hemodynamics (heart rate, arterial pressure, pulse oxygen saturation (SpO2), respiratory rate), total cumulative dose of dexmedetomidine and remifentanil, the amount of midazolam and lidocaine, time to first dose of rescue midazolam and lidocaine, postoperative recovery time, adverse events, bronchoscopist satisfaction score were recorded.Anesthesia onset time was significantly shorter in DR3 group (14.23 ± 5.45 vs 14.45 ± 5.12 vs 11.13 ± 4.51 minutes, respectively, of DR1, DR2, DR3, P = 0.003). Additionally, the perioperative hemodynamic profile was more stable in group DR3 than that in the other 2 groups. Total number of children movements during flexible bronchoscopy was higher in DR1 group than the other 2 groups (46.81% 22/47 vs 34.88% 15/43 vs 17.78% 8/45, respectively, of DR1, DR2, DR3, P = 0.012). Total doses of rescue midazolam and lidocaine were significantly higher in DR1 and DR2 groups than that of DR3 group (P = 0.000). The time to first dose of rescue midazolam and lidocaine was significantly longer in DR3 group than DR1 and DR2 groups (P = 0.000). Total cumulative dose of dexmedetomidine was more in DR2 and DR3 groups (P = 0.000), while the amount of remifentanil was more in DR1 and DR2 groups (P = 0.000). The time to recovery for discharge from the PACU was significantly shorter in DR1 group compared with the other 2 groups (P = 0.000). Results from bronchoscopist satisfaction score showed significantly higher in DR2 and DR3 groups than that of DR1 group (P = 0.02...

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“…Because of its short elimination half-life and a fast onset of action, midazolam is a first-choice drug among the benzodiazepines. However, its pharmacological effects vary among patients, and it may depress the ventilatory drive and finally cause apnea, especially in patients with co-morbidities who are taking other respiratory depressant drugs [20, 21]. As a short-acting anesthetic agent with rapid recovery, propofol has been widely used in many clinical fields such as gastrointestinal endoscopy, thyroplasty, bronchoscopy, interventional or radiological procedures, and during awake bronchoscopy intubation, for its hypnotic effect [22, 23].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine plus sufentanil for pediatric flexible bronchoscopy: A retrospective clinical trial

Dang

Yang

et al. 2017

Oncotarget

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Several studies have reported the use of dexmedetomidine (DEX) plus opioids for flexible bronchoscopy in both adults and children. To determine whether DEX plus sufentanil (SF) is safe for children, 142 children undergoing flexible bronchoscopy were assigned to one of three groups, each of which received the same SF loading dose and similar DEX and SF maintenance doses, but different loading doses of DEX: DS1 (DEX 0.5 μg·kg–1), DS2 (DEX 1.0 μg·kg–1), and DS3 (DEX 1.5 μg·kg–1). The Ramsay sedation scale was maintained at 3 in all groups. Results showed that anesthesia onset time was shorter, and the perioperative hemodynamic profile was more stable, in the DS3 group. The number of intraoperative movements was also lowest in the DS3 group. The time to first dose of rescue midazolam and lidocaine was significantly longer, but the total corresponding accumulated doses were lower in the DS3 group. Although the time to recovery prior to discharge from the post anesthesia care unit was longer, the overall incidence of tachycardia was lower in the DS3 group, and it received the highest bronchoscopist satisfaction score among the three groups. We therefore conclude that high-dose DEX plus SF can be safely and efficaciously used in children undergoing flexible bronchoscopy.

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Midazolam in Flexible Bronchoscopy Premedication

Abstract: In our study, premedication with midazolam increased the patient-reported tolerance of the bronchoscopy. However, the absence of premedication did not affect the diagnostic yield of the procedure.

Cited by 14 publications

References 14 publications

High‐risk respiratory patients' experiences of bronchoscopy with conscious sedation and analgesia: A qualitative study

High‐risk respiratory patients' experiences of bronchoscopy with conscious sedation and analgesia: A qualitative study

The safety and efficacy of dexmedetomidine-remifentanil in children undergoing flexible bronchoscopy

Dexmedetomidine plus sufentanil for pediatric flexible bronchoscopy: A retrospective clinical trial

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