title: Midazolam in flexible bronchoscopy premedication: effects on patient-related and procedure-related outcomes.
abstract: BACKGROUND
  The role of midazolam in flexible bronchoscopy premedication has been debated. The aim of the present study was to evaluate whether midazolam premedication increases the patient-reported tolerance and the physician-reported or nurse-reported feasibility of bronchoscopy.
  
  
  METHODS
  Randomized, double-blinded, placebo-controlled, 3-arm study. The study population included patients undergoing bronchoscopy for appropriate clinical indications. Patients were randomly assigned to receive 0.035 mg/kg intravenous midazolam (low dose), 0.07 mg/kg (high dose), or placebo. Vital parameters were monitored in continuum during the procedure. At the end of the procedure, the operating physician and assisting nurse filled out a questionnaire to score the procedure-related outcomes (satisfaction, feasibility, completeness, and unexpected events). Patients were asked to fill out a specific questionnaire to assess the patient-reported tolerance and satisfaction 2 hours after the bronchoscopy.
  
  
  RESULTS
  A total of 100 patients (mean age 58.6±1.0; 57% male) were included in the study (33 in the low-dose midazolam group, 34 in the high-dose midazolam group, and 33 in the placebo group). The patient-reported tolerance score was significantly higher in the high-dose midazolam group than in the placebo group (P<0.01). No differences were found in the 3 groups in terms of the physician-reported feasibility and completeness of the procedure. In the groups of patients premedicated with midazolam, significant oxygen desaturation was recorded (at 10 and 8 min after the introduction of the bronchoscope) compared with the baseline value (P<0.01).
  
  
  CONCLUSIONS
  In our study, premedication with midazolam increased the patient-reported tolerance of the bronchoscopy. However, the absence of premedication did not affect the diagnostic yield of the procedure.
authors.affiliation: Respiratory Medicine, Intensive Care Unit, University Hospital, Ferrara, Italy. ctm@unife.it
authors.forename: Marco
authors.initials: M
authors.lastname: Contoli
authors.forename: Giulia
authors.initials: G
authors.lastname: Gnesini
authors.forename: Denise
authors.initials: D
authors.lastname: Artioli
authors.forename: Caterina
authors.initials: C
authors.lastname: Ravenna
authors.forename: Stella
authors.initials: S
authors.lastname: Sferra
authors.forename: Cristina
authors.initials: C
authors.lastname: Romanazzi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Marangoni
authors.forename: Ippolito
authors.initials: I
authors.lastname: Guzzinati
authors.forename: Claudio
authors.initials: C
authors.lastname: Pasquini
authors.forename: Alberto
authors.initials: A
authors.lastname: Papi
authors.forename: Franco
authors.initials: F
authors.lastname: Ravenna
mesh_terms: D001999:Bronchoscopy; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology*; D008875:Middle Aged; D017060:Patient Satisfaction; D010361:Patients; D011292:Premedication; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D008874:Midazolam