title: Evaluation of discomfort and tolerability to bronchoscopy according to different sedation procedures with midazolam.
abstract: Patients frequently experience great discomfort during a bronchoscopy for the diagnosis of lung neoplasms. Sedation is generally recommended during bronchoscopy; however, few studies have evaluated the discomfort and tolerability of patients to a bronchoscopy with regard to the administration procedures. The aim of the present study was to evaluate the discomfort and tolerability of patients undergoing a bronchoscopy using different sedation procedures with midazolam. The retrospective survey of sedation during bronchoscopy involved the comparison of two periods: January-March 2012 (first period) and July-September 2012 (second period). A numerical rating score, which ranged between 1 (best) and 5 (worst) according to the subjective view of the patients, was used to rate patient discomfort, pain, sensation, time and tolerability to the bronchoscopy. In the first period, 2.5 mg midazolam was administered prior to the initiation of surgery, and additional doses of midazolam was added in 2.5-mg increments whenever the patient deviated from the target sedation level. In the second period, 2.0 or 3.0 mg midazolam was administered prior to the initiation of surgery, and additional midazolam doses were administered in 1.0-mg increments until the patients were sedated to the target sedation level. In total, 60 and 68 valid responses were obtained in the first and second periods, respectively. The patients in the second period exhibited significantly improved discomfort and pain scores during the bronchoscopy and higher rates of consent to re-examination, as compared with the patients in the first period (1.89±1.40 vs. 2.78±1.52, P<0.001; 1.48±1.13 vs. 2.00±1.37, P=0.005; 2.45±1.62 vs. 3.13±1.47, P=0.013, respectively). The amount of midazolam administered was significantly higher in the second period. There were no fatal complications during the bronchoscopy in either period. In conclusion, the present study observed that the administration of additional midazolam in small doses, until the target sedation level is achieved, is a safe procedure that is associated with significantly less discomfort and pain during bronchoscopy and a greater consent to re-examination when compared with the administration of a fixed dose of midazolam.
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kato
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Shimizu
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Otoshi
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Daichi
authors.initials: D
authors.lastname: Fujimoto
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tamai
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
keywords: bronchoscopy; discomfort; midazolam; sedation; tolerability