Patient Satisfaction With Conscious Sedation for Bronchoscopy

Putinati, S; Ballerin, Licia; Corbetta, Lorenzo; Trevisani, Lucio; Potena, A

doi:10.1378/chest.115.5.1437

Cited by 141 publications

(105 citation statements)

References 28 publications

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“…Rather old studies suggested that sedation was implicated as the cause of major averse events resulting from FOB [3,30]. More recent studies did not confirm these findings [31,32]. Sedation, in combination with topical anaesthesia and mechanical obstruction from the endoscope, results in hypoxemia [29].…”

Section: Discussionmentioning

confidence: 99%

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

D’Ippolito

Foresi²,

Castagnetti

et al. 2016

Monaldi Arch Chest Dis

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Aim. To evaluate the indications and the safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL), protected specimen brushing (PSB), endobronchial biopsy (EBB), and transbronchial biopsy (TBB) in a population of very elderly patients. Methods. We performed a retrospective study of all adult patients, aged 50 years or older, who underwent FOB in the Bronchology Unit of the University of Parma Hospital between 1 January, 2003 and 31 April, 2005. Bronchoscopy records of 436 consecutive patients, including 191 patients, 75 yrs of age and older (“very elderly”; =>75 yrs), were reviewed. Results. Patients aged 75 years were no different with regard to gender, BMI, baseline FEV1/FVC ratio, baseline SaO2, and blood pressure. The primary indication in patients aged <75 years, was to assist in the diagnosis of a pulmonary mass of unknown aetiology (33%) and to remove secretions in the very elderly patients (31%). Indications for FOB and sampling procedures in the two groups were similar. Approximately 30% of patients in each group required supplemental oxygen during the procedure and fever occurred in 9.2% and 10.3% of patients, respectively.Hypertension and bleeding were relatively rare and did not occur more often in the very elderly. Conclusions. Indication for FOB did not vary with age and adverse events in both groups were uncommon and generally not severe.

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Section: Discussionmentioning

confidence: 99%

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

D’Ippolito

Foresi²,

Castagnetti

et al. 2016

Monaldi Arch Chest Dis

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“…Foram definidos os seguintes critérios de exclusão: idade > 80 ou < 18 anos, insuficiência respiratória (pO 2 < 60 mmHg e/ou pCO 2 > 45 mmHg), insuficiência renal, instabilidade hemodinâmica, doença neurológica, plaquetas < 50 000/mm 3 , DPOC grave (FEV 1 < 50%; depressão respirató-ria e hipoventilação na sequência de sedação podem causar insuficiência respiratória aguda em doentes com limitação grave do fluxo aéreo), alteração do estado de consciência ou défice cognitivo que inviabilizassem a resposta a questionários escritos.…”

Section: População Em Estudounclassified

Sedation with midazolam in flexible bronchoscopy – A prospective study

Rolo

Mota

Coelho

et al. 2012

Revista Portuguesa de Pneumologia (English Edition)

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ResumoIntrodução: Os agentes sedativos têm vindo a ser cada vez mais utilizados na broncofibroscopia (BF) para melhorar o conforto do doente. Devido à sua rápida ação, propriedades ansiolíticas e amnésicas, o midazolam é um dos sedativos mais frequentemente usados. Objetivos: Avaliar o efeito da sedação com midazolam na BF, incluindo a tolerância do doente, complicações e a sua potencial aplicação na prática clínica diária. Material e métodos: Estudo multicêntrico, prospetivo, randomizado, controlado com placebo, com inclusão de 100 indivíduos submetidos a BF em 2 Serviços de Pneumologia. Doentes do Grupo 1 receberam midazolam (0,05 mg/kg) e doentes do Grupo 2 receberam placebo (0,9% NaCl), 5 minutos antes do procedimento. A escala de ansiedade «The Hospital Anxiety and Depression Scale» (HADS-A) foi aplicada para determinar o nível de ansiedade basal do doente. Questionários subjetivos acerca dos principais receios e queixas relativamente à BF foram aplicados antes e depois do exame. Resultados: Média de idades de 56,0 ± 14,1 anos; 66% do sexo masculino. A maioria (65%) dos doentes apresentava baixa pontuação (< 7) na escala HADS-A, sem diferença entre grupos. Não se observaram diferenças significativas entre os 2 grupos no que diz respeito à duração da BF, procedimentos realizados, dose total de lidocaína usada e complicações observadas. A pressão arterial sistólica foi significativamente mais elevada (p < 0,003), durante e após a BF, nos indivíduos do Grupo 2. Os doentes do Grupo 1 apresentaram menos tosse (32 vs 56%; p = 0,03) e dispneia (2% vs 34%; p < 0,001) comparativamente com o Grupo 2, não se registando diferenças significativas relativamente à náusea (6 vs 18%; p > 0,05) e à dor (4 vs 12%; p > 0,05). Foi demonstrada recetibilidade em repetir o exame por todos os doentes do Grupo 1 e em 82% dos doentes do Grupo 2 (p = 0,003).

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“…2 According to several studies, relieving the patient's anxiety during the endoscopic procedure shortens the time of the procedure and prevents adverse events. 3 There are no exact guidelines on how to perform analgosedation; however, most authors agree that using only topical anesthesia is insufficient and suggest using moderate sedation, previously known as conscious sedation.…”

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confidence: 99%

Flexible bronchoscopy under conscious sedation with midazolam and fentanyl can be safely performed by nonanesthesiologists

Szczeklik¹,

Andrychiewicz²,

Górka³

et al. 2015

Polish Archives of Internal Medicine

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RESEARCH LETTER Flexible bronchoscopy under conscious sedation with midazolam and fentanyl... 869contraindications to use midazolam or fentanyl, diminished communication capacity, and cognitive disorders. The study was approved by the Ethics Committee at Jagiellonian University, Kraków, Poland.In all patients, topical anesthesia was used according to current guidelines. 4 Most patients received a bolus of midazolam (2.5 mg) and fentanyl (0.05 mg) before the examination. If necessary, both medications were titrated in incremental doses during FB to achieve adequate analgosedation. The initial dose of fentanyl was not administered in 23 patients for one of the following reasons: exacerbation of chronic obstructive pulmonary disease, respiratory failure, or advanced age with several comorbidities. A bronchofiberoscope was introduced through a mouthpiece 3 minutes after drug administration. During the whole procedure, vital parameters were monitored including oxygen saturation, blood pressure, and electrography; adverse events were also recorded. The level of patient sedation was continuously assessed according to the Ramsey sedation scale.6 The study personnel were trained in acute life support and study nurses had specialization in anesthesia and intensive care. During the whole procedure, the patient's spontaneous ventilation was sustained with oxygen administered through a nasal cannula if needed (in 282 patients, approximately 3.5 l/min of O 2 ). Monitoring was continued following FB until complete recovery from sedation was observed. If needed, patients were administered antagonists-flumazenil and naloxone-to reverse drug reaction. Immediate anesthesiologist support was available at all time during the study in case of need.A statistical analysis was performed using the Statistica software (version 10.0; StatSoft, Inc., Introduction Flexible bronchoscopy (FB) is one of the most commonly used diagnostic and therapeutic tools in current respiratory medicine.1 It is an invasive method that is unpleasant for the patient and is preferably performed under analgosedation. 2 According to several studies, relieving the patient's anxiety during the endoscopic procedure shortens the time of the procedure and prevents adverse events. 3 There are no exact guidelines on how to perform analgosedation; however, most authors agree that using only topical anesthesia is insufficient and suggest using moderate sedation, previously known as conscious sedation. 4This approach enables the medical personnel to stay in verbal contact with the patient and, at the same time, to relieve unpleasant symptoms. In several countries, mainly in Europe, moderate sedation in endoscopic procedures is restricted only to anesthetists despite several reports on the safety and cost-effectiveness of sedation applied by nonanesthesiologists. [5][6][7] Between the years 2013 and 2014, we performed a prospective observational study that aimed to assess factors that influence anxiety and satisfaction in patients undergoing FB under analgosedation.8 In thi...

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Patient Satisfaction With Conscious Sedation for Bronchoscopy

Cited by 141 publications

References 28 publications

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

Sedation with midazolam in flexible bronchoscopy – A prospective study

Flexible bronchoscopy under conscious sedation with midazolam and fentanyl can be safely performed by nonanesthesiologists

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