An Update on Sedation and Analgesia During Flexible Bronchoscopy

Safety and discomfort during bronchoscopy performed under sedation with fentanyl and midazolam: a prospective study

OBJECTIVE

Although sedation with fentanyl and midazolam during bronchoscopic examination is widely accepted in the USA and Europe, it is not routine practice in Japan. The objective of the present study was to evaluate sedation with fentanyl and midazolam during bronchoscopy.

METHODS

Thirty-seven patients were enrolled prospectively between November 2014 and July 2015 at Okayama University Hospital. Fentanyl (20 μg) was administered to the patients just before the examination, and fentanyl (10 μg) and midazolam (1 mg) were added as needed during the procedure. A questionnaire was administered 2 hours after the examination. In the questionnaire, patient satisfaction was scored using a visual analog scale as follows: great (1 point), good (2 points), normal (3 points), uncomfortable (4 points) and very uncomfortable (5 points). An additional question ('Do you remember the bronchoscopic examination?') was also used. Predefined matters for investigation (e.g. blood pressure, heart rate, oxygen saturation and complications) were recorded.

RESULTS

The enrolled patients included 13 males and 24 females; the median age was 67 (range: 31-87) years. The patients received a median dose of fentanyl of 45.4 μg (range: 30-100 μg) and midazolam of 2.56 mg (range: 1-10 mg). Twenty-six patients (70.2%) agreed to undergo a second bronchoscopic examination, and the average levels of discomfort and re-examination were 2.02 points for each. Only 37.8% of the patients remembered the bronchoscopic examination. No severe complications were reported.

CONCLUSIONS

Sedation with fentanyl and midazolam during bronchoscopic examination should be recommended for use in Japan.

Anesthesia for bronchoscopy and interventional pulmonology: from moderate sedation to jet ventilation

PURPOSE OF REVIEW

The field of interventional bronchoscopy has seen an evolving need for different types of anesthesia for various procedures. This review describes recent advances in the field of anesthesiology that have increased the suitability of conscious sedation under monitored anesthesia care or general anesthesia for prolonged and complex interventional bronchoscopic procedures, especially those performed on severely ill patients. Additionally, the pros and cons of performing bronchoscopic procedures in the bronchoscopy suite versus the operating room are analyzed.

RECENT FINDINGS

Although conscious sedation is the most commonly used form of anesthesia for simple bronchoscopic procedures, general anesthesia is emerging as a more appropriate technique for newer, more complex interventional bronchoscopic procedures. Large interventional pulmonology departments have state-of-the-art bronchoscopy suites in which both conscious sedation and general anesthesia are used. New advances in the field of anesthesiology such as the laryngeal mask airway, short-acting anesthetics with minimal effect on respiratory function, and mechanical jet ventilators are well suited for interventional bronchoscopic procedures.

SUMMARY

Interventional bronchoscopists are encouraged to examine the pros and cons of different types of anesthesia for various bronchoscopic procedures.