Sedative drug requirements during flexible bronchoscopy.
BACKGROUND
There is a paucity of data comparing doses of sedative medication during bronchoscopy in immunosuppressed and non-immunosuppressed patients.


OBJECTIVE
The aim of this study was to define the sedative medication doses used in specific patient groups during bronchoscopy.


METHODS
Bronchoscopy was performed under local anesthesia, sedation with intermittent boluses of intravenous midazolam and intravenous hydrocodone 5 mg. Two hundred and thirty-nine consecutive bronchoalveolar lavage procedures were included. Procedures in non-immunosuppressed patients were classified as controls (n = 91). Procedures in immunosuppressed patients who received midazolam consisted of stem cell transplant (34), solid organ transplant (25), chemotherapy (33), HIV with drug abuse (10), HIV (5), prednisone (17) and immunosuppression for other diseases (12). Intravenous propofol was administered during 12 procedures due to inability to achieve optimal sedation with midazolam in a previous bronchoscopy (stem cell transplant recipient 1, lung transplant for cystic fibrosis 5) and during the same bronchoscopy due to inadequate sedation with a high dose of midazolam--renal transplant recipient 1, drug abuse (HIV 1, renal transplant recipient 1), bronchoscopy combined with gastroscopy (2) and a hypoxemic patient (1). The mean dose of propofol administered was 2.8 +/- 1.3 mg/kg.


RESULTS
Midazolam requirement was significantly higher in patients with stem cell transplantation (0.09 +/- 0.05 mg/kg) compared with controls (0.06 +/- 0.03 mg/kg; p = 0.0002). In the HIV patients with drug abuse (0.12 +/- 0.10 mg/kg), there was a tendency for the need of a higher dose of midazolam compared with the control group (p = 0.0754).


CONCLUSIONS
Stem cell transplant recipients and selected HIV patients with drug abuse need higher doses of midazolam for bronchoscopy.
Chhajed
Prashant N
PN
Pulmonary Medicine, University Hospital Basel, Petersgraben 4, CH-1031 Basel, Switzerland. PChhajed@uhbs.ch
Wallner
Julia
J
Stolz
Daiana
D
Baty
Florent
F
Strobel
Werner
W
Brutsche
Martin H
MH
Tamm
Michael
M
D018893:Bronchoalveolar Lavage / Q000379:methods; D001999:Bronchoscopy / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D016867:Immunocompromised Host; D008874:Midazolam / Q000008:administration & dosage*; D012189:Retrospective Studies; D019966:Substance-Related Disorders
D006993:Hypnotics and Sedatives; D008874:Midazolam