Chest
Volume 115, Issue 5, May 1999, Pages 1437-1440
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Bronchoscopy
Patient Satisfaction With Conscious Sedation for Bronchoscopy

https://doi.org/10.1378/chest.115.5.1437Get rights and content

Study objective

Bronchoscopic technique is not standardized. Controversies exist with regard to premedication with sedatives before the test. To evaluate safety and efficacy of conscious sedation, we studied 100 randomized patients undergoing diagnostic bronchoscopy; patients received premedication with lidocaine spray and atropine sulfate IM (nonsedation group; 50 patients) or lidocaine spray, atropine IM and diazepam IV (sedation group; 50 patients).

Methods and results

Monitoring during flexible fiberoptic bronchoscopy included continuous ECG and pulse oximetry. The procedure could not be completed in six patients. None received premedication with diazepam; among the patients who ended the examination, tolerance to the examination (visual analogue scale, 0 to 100; 0 = excellent; 100 = unbearable) was better in the sedation group. Low anxiety, male sex, but not age were also associated with improved patient tolerance to the test. Oxygen desaturation occurred in 17% of patients, and it was not more frequent after diazepam treatment.

Conclusions

In our study, sedation had a beneficial effect on patient tolerance and rarely induced significant alterations in cardiorespiratory monitoring parameters.

Section snippets

Patients

One hundred patients, undergoing a routine diagnostic FFB for the first time, were evaluated. Patients undergoing BAL and transbronchial biopsy, as well as intubated patients, were excluded from the study. Fifty-four bronchoscopies were performed on an outpatient basis; the other 46 patients underwent bronchoscopy during hospitalization. Each patient provided informed and written consent to bronchoscopy and was randomly allocated to either the group examined with sedation or without sedation.

Procedure

Results

There were no significant differences between the two groups in terms of age, sex, smoking status, indications for bronchoscopy, FEV1 (percent of the predicted one), and FVC values (percent of the predicted one) (Table 1). Bronchoscopic procedures carried out were similar in both groups, including endobronchial biopsies and/or brushings in 28% and 32% in the sedation and nonsedation groups, respectively. Anxiety score before FFB, as judged on VAS, was 40.57 ± 30.16 in the sedation group and

Discussion

FFB is mostly performed with the patient under conscious sedation.13 However, little is known about the relationship between sedation and patient satisfaction with the procedure.1013141516 Various IV sedative drugs have been tested previously because of their ability to improve patient tolerance, and currently benzodiazepines are more frequently preferred for sedation during FFB.23 The use of benzodiazepines seems justified by its powerful anxiolytic and amnesiac effects, but the evidence

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