PURPOSE: Recent advances in bronchoscopy have allowed us to use more advanced techniques for the diagnosis of various pulmonary diseases. On the other hand, more complicated techniques require longer period of examination. Thus, appropriate sedation should be offered to all patients undergoing bronchoscopy. However, standard protocol for sedation on bronchoscopy is not yet defined. Especially, ideal dose or timing for additional administration of sedative agent is still undetermined. We designed a prospective non-randomized, single arm study to evaluate the efficacy and safety of simple and individualized protocol for midazolam administration for sedation during bronchoscopy (trial number UMIN000003971).
METHODS: Consecutive patients (n=204) who underwent diagnostic bronchoscopy in our institute were enrolled between June 2010 and March 2011. Patients received midazolam intravenously immediately before the bronchoscopy. The loading dose was as follows: 0.075mg/kg (male ≤ 65 years old, female ≤ 70 years old) or 0.05mg/kg (male > 66 years old, female > 71 years old). Additional midazolam was administrated at a half of the loading dose in every twenty minutes. Patients’ tolerability was assessed by questionnaires. Blood pressure, ECG, oxygen saturation and CO2 content in expiration were monitored during the procedure.
RESULTS: There was no serious complication related to the midazolam sedation. 163 patients (79.9%) answered they felt no discomfort during the bronchoscopy. In addition, 185 patients (90.6%) felt no anxiety and 175 patients (85.8%) were acceptable for repeated bronchoscopy if needed. The mean minimum oxygen saturation was 90.3% and the mean maximum expiratory CO2 was 37 mmHg. Two cases developed pneumothorax requiring tube drainage and seven cases developed fever after bronchoscopy.
CONCLUSIONS: A simple individualized protocol of midazolam administration in this study is highly safe and fairly effective in the sedation during bronchoscopy.
CLINICAL IMPLICATIONS: This protocol could be one of the standard methods for the sedation during bronchoscopy in daily clinical settings.
DISCLOSURE: The following authors have nothing to disclose: Kazuyoshi Imaizumi, Izumi Hashimoto, Yuichiro Shindo, Naoyuki Imai, Tomomi Ogawa, Masahiro Morise, Satoru Ito, Naozumi Hashimoto, Mitsuo Sato, Masashi Kondo, Yoshinori Hasegawa
No Product/Research Disclosure Information