PURPOSE: Many patients undergoing flexible bronchoscopy (FB), which is usually performed with mild sedation only, may experience anxiety and discomfort during the procedure. This prospective study was designed for the assessment whether lorazepam premedication would improve patient satisfaction for diagnostic FB.
METHODS: Patients planning to undergo diagnostic FB were randomly assigned to the lorazepam (treatment) and placebo (control) groups. The treatment group received 0.5mg of oral lorazepam the night before the FB and 1mg 1 hour before the FB procedure. The baseline anxiety, depression level and sleep disturbance of the patients were assessed by a verified questionnaire: the Hospital Anxiety and Depression Scale and Insomnia Severity Index. To evaluate patient satisfaction, general patient ability to tolerate the FB and willingness to return for another FB were measured by a questionnaire with a subjective 10-point scale.
RESULTS: A total of 172 patients were randomized and 159 (82 in the treatment group and 77 in control group) completed the questionnaire. There were no differences between the two groups in demographics, smoking history, previous experience with FB, insight into their disease and procedure-related factors, such as duration of FB, amount of lidocaine and saline used, and skill of the operator. The general patient ability to tolerate the FB was calculated as 6.25 points in treatment group and 6.72 in control group (p=0.289). There was no significant difference about the willingness to return for another FB between the two groups (5.42 point in lorazepam vs. 4.63 in placebo group, p=0.194). The patients with significant anxiety, depression and interference of sleep were 16%, 32% and 20% of all study patients, respectively. In the subgroup analysis of patients with anxiety, depression or sleep disturbance, the general ability to tolerate the procedure and the willingness to return for another FB did not differ between the groups.
CONCLUSIONS: The use of lorazepam premedication before FB did not improve patient satisfaction for diagnostic FB procedure.
CLINICAL IMPLICATIONS: Further clinical trial will be needed to reduce patients’ discomfort for FB.
DISCLOSURE: The following authors have nothing to disclose: Jinwoo Lee, Young Sik Park, Jong Sun Park, Sang-Min Lee, Jae-Jun Yim, Chul-Gyu Yoo, Hee Soon Chung, Young Whan Kim, Sung Koo Han, Seok-Chul Yang
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