Conscious sedation reduces patient discomfort and improves satisfaction in flexible bronchoscopy

Yung Lun Ni, Yu Lun Lo, Ting Yu Lin, Yueh Fu Fang, Han Pin Kuo

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Conscious sedation for patients undergoing flexible bronchoscopy (FB) is suggested to alleviate discomfort and improve satisfaction despite controversy regarding its benefits. In Taiwan, the general FB practice involves local anesthesia only. This study aimed to assess the benefits and risks of conscious sedation in diagnostic FB. Methods: This prospective case control study enrolled 44 non-sedated and 44 sedated patients who underwent diagnostic FB. All received the standard upper airway preparation, while sedated patients received clinically judged increments of midazolam and alfentanil for conscious sedation. Patient discomforts and the operator's opinions during FB were assessed using the verbal analogue score (VAS, 0-10 scale). Willingness to return was assessed as five scales to monitor patient satisfaction. Safety profiles throughout the procedures were also assessed. Results: Compared to non-sedated patients, sedated ones expressed less discomfort, with lower VAS scores regarding scope insertion (3.5 [0-10] vs. 0 [0-5], p <0.001), cough (5 [0-10] vs. 0 [0-5], p < 0.001), dyspnea (3 [0-10] vs. 0 [0-8], p < 0.001), pain (3 [0-10] vs. 0 [0-5], p < 0.001), and global tolerance of the procedures (5 [1-10] vs. 0 [0-9], p < 0.001). More sedated patients expressed willingness to return (70.5% vs. 36.4%, p = 0.001). The bronchoscopist also rated lower VAS scores on cough and dyspnea in sedated patients. Sedated patients had less hypertension but more hypoxemic episodes during the procedure, which were all transient and not life-threatening. Conclusions: Conscious sedation with clinically judged midazolam and alfentanil reduces discomforts, improves satisfaction, and carries slight, but manageable, hypoxemia risks in patients undergoing FB.

Original languageEnglish
Pages (from-to)443-452
Number of pages10
JournalChang Gung Medical Journal
Volume33
Issue number4
Publication statusPublished - Jul 1 2010
Externally publishedYes

Fingerprint

Conscious Sedation
Bronchoscopy
Alfentanil
Midazolam
Cough
Dyspnea
Local Anesthesia
Patient Satisfaction
Taiwan
Case-Control Studies
Hypertension
Safety
Pain

Keywords

  • Alfentanil
  • Bronchoscopy
  • Midazolam
  • Satisfaction
  • Sedation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Conscious sedation reduces patient discomfort and improves satisfaction in flexible bronchoscopy. / Ni, Yung Lun; Lo, Yu Lun; Lin, Ting Yu; Fang, Yueh Fu; Kuo, Han Pin.

In: Chang Gung Medical Journal, Vol. 33, No. 4, 01.07.2010, p. 443-452.

Research output: Contribution to journalArticle

Ni, Yung Lun ; Lo, Yu Lun ; Lin, Ting Yu ; Fang, Yueh Fu ; Kuo, Han Pin. / Conscious sedation reduces patient discomfort and improves satisfaction in flexible bronchoscopy. In: Chang Gung Medical Journal. 2010 ; Vol. 33, No. 4. pp. 443-452.
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AB - Background: Conscious sedation for patients undergoing flexible bronchoscopy (FB) is suggested to alleviate discomfort and improve satisfaction despite controversy regarding its benefits. In Taiwan, the general FB practice involves local anesthesia only. This study aimed to assess the benefits and risks of conscious sedation in diagnostic FB. Methods: This prospective case control study enrolled 44 non-sedated and 44 sedated patients who underwent diagnostic FB. All received the standard upper airway preparation, while sedated patients received clinically judged increments of midazolam and alfentanil for conscious sedation. Patient discomforts and the operator's opinions during FB were assessed using the verbal analogue score (VAS, 0-10 scale). Willingness to return was assessed as five scales to monitor patient satisfaction. Safety profiles throughout the procedures were also assessed. Results: Compared to non-sedated patients, sedated ones expressed less discomfort, with lower VAS scores regarding scope insertion (3.5 [0-10] vs. 0 [0-5], p <0.001), cough (5 [0-10] vs. 0 [0-5], p < 0.001), dyspnea (3 [0-10] vs. 0 [0-8], p < 0.001), pain (3 [0-10] vs. 0 [0-5], p < 0.001), and global tolerance of the procedures (5 [1-10] vs. 0 [0-9], p < 0.001). More sedated patients expressed willingness to return (70.5% vs. 36.4%, p = 0.001). The bronchoscopist also rated lower VAS scores on cough and dyspnea in sedated patients. Sedated patients had less hypertension but more hypoxemic episodes during the procedure, which were all transient and not life-threatening. Conclusions: Conscious sedation with clinically judged midazolam and alfentanil reduces discomforts, improves satisfaction, and carries slight, but manageable, hypoxemia risks in patients undergoing FB.

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