Medical thoracoscopy (MT) is a safe procedure provided by respiratory physicians across the UK. The conscious sedation is administered by staff with a variable level of training.
Aim To assess a simple patient comfort score at MT when conscious sedation (CS) was provided by an advanced nurse practitioner (ANP) compared to others (senior nurse, endoscopy nurse or junior doctor).
Methods A patient comfort score is recorded routinely as part of our thoracoscopy service immediately after the procedure once the patient is awake in recovery. The ANP is an ALS provider with senior experience in critical care. Intraoperative administration of midazolam for sedation and alfentanyl for pain control pre-biopsies was undertaken by a dosing schedule determined by the level of sedation assessed by the ANP who also monitored the patient during the procedure. When CS was given by others midazolam was administered in an initial bolus followed by boluses as indicated by the thoracoscopist in keeping with information by the monitoring nurse on the level of sedation or discomfort. Patient comfort score was evaluated using a 5 point scale within 30 minutes of return to the recovery area. The CS was administered either by the ANP or others in keeping with their availability on the day; no randomisation was performed. The analysis used SPSS programme.
Results 50 consecutive patients undergoing thoracoscopy were included. 27 had CS by ANP (group 1) and 23 by others (group 2). Overall the procedure was well tolerated. Patient comfort score was better in group 1 (mean, SD 0.59 +/- 0.8) vs. group 2 (1.63 +/- 1.3), p < 0.05. This was achieved with a larger dose of midazolam in group 1 (2.87 +/- 1.12 mg) vs. group 2 (2.30 +/- 0.70 mg), p < 0.05 and smaller dose of alfentanyl (0.245 +/- 0.14 mg) in group 1 vs. group 2 (0.527 +/- 0.25 mg), p < 0.01.
Conclusions conscious sedation for medical thoracoscopy when provided by a critical care experienced ANP resulted in an improved patient experience of the procedure and this was achieved through and adequate use of midazolam and lesser doses of alfentanyl; this was cost-saving since the ANP also monitored the patient. Retaining of trained staff is essential for this specialised service.
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