Midazolam in the Fiber-optic Bronchoscopy Premedication: Effects on Patient-Related and Procedure-Related Outcomes

Ravenna, F; Contoli, Marco; Marangoni, Elisabetta; Romanazzi, Cristiana; Gnesini, Giulia; Artioli, Denise; Ravenna, C; Papi, Alberto

doi:10.1378/chest.1113960

Cited by 1 publication

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 24 Ravenna et al analyzed the safety of FB under midazolam in adult patients and reported desaturation in some cases within 10 minutes post administration of midazolam. 25 However, we did not find significant desaturation during BAMS, and our study reproduced the results cited by de Blic et al 23 …”

Section: Discussionsupporting

confidence: 92%

“… Model reimbursement columns have been added to the existing table, which indicates maximum reimbursement for each current procedural terminology code/codes for a locality (MAC locality 0111205 was taken as a sample locality). Source: The table has been reproduced from the article “Moderate Sedation Changes for Bronchoscopy in 2017” with permission from Elsevier 25 . …”

Section: Resultsmentioning

confidence: 99%

“… Source: The table has been reproduced from the article “Moderate Sedation Changes for Bronchoscopy in 2017” with permission from Elsevier 25 . …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Flexible Bronchoscopy Under Bronchoscopist-Administered Moderate Sedation Versus General Anesthesia: A Comparative Study in Children

Mondal

Dalal

Sathiyadevan

et al. 2018

Pediatric Allergy, Immunology, and Pulmonology

View full text Add to dashboard Cite

Background: Flexible bronchoscopy (FB) can be performed under bronchoscopist administered moderate sedation (BAMS) with a midazolam/fentanyl combination or general anesthesia (GA). However, the outcome of BAMS has not been well established in children. Currently, most of the centers prefer FB under GA. Both techniques have their advantages and disadvantages with implications for safety, complications, and diagnostic yield. The primary objective of our study was to evaluate the safety, time efficiency, and cost-effectiveness of FB under BAMS as compared with FB under GA in a similar setting.Methods: We performed a retrospective chart review to compare BAMS versus GA for FB in children. We recruited BAMS children (n = 295) from University of Florida (UF) Health Shands Children's Hospital, and GA children (n = 100) from Penn State Children's Hospital (PSHCH). Both the groups had similar indications, complexities, and procedural environments. Comparisons of various time-intervals including preprocedure time, sedation-induction time, scope time, and post-procedure time among different BAMS versus GA age-groups were the primary outcomes. The secondary outcomes were the determination of the rates of complications, the dosages of sedative/anesthetic, cost-effectiveness, and sedation patterns under BAMS.Results: FB under BAMS required significantly higher preprocedure times and sedation-induction times (P < 0.001** and P < 0.001** respectively) but shorter scope and post-procedure times compared with the GA group times (P < 0.001** and P < 0.001** respectively). Younger children had a deeper level of sedation for an extended period under BAMS. The costs for the sedation services and the complication rates were lower in the BAMS group compared with the GA group.Conclusion: Our study demonstrated the feasibility of BAMS in children. FB under BAMS had an advantage of lower cost and fewer procedural complications compared with FB under GA. Despite that, the safety of BAMS could not be conclusively established from this retrospective study. Moreover, BAMS can potentially compromise the diagnostic yield because the bronchoscopist is also responsible for monitoring sedation and managing the airway.

show abstract

Section: Discussionsupporting

confidence: 92%