Discomfort during bronchoscopy performed after endobronchial intubation with fentanyl and midazolam: a prospective study.
OBJECTIVE
Although endobronchial intubation during a bronchoscopic examination is useful for invasive procedures, it is not routine practice in Japan. The present study evaluated discomfort due to endobronchial intubation using fentanyl and midazolam sedation during bronchoscopy.


METHODS
Thirty-nine patients were enrolled prospectively from November 2014 to September 2015 at Okayama University Hospital. Fentanyl (20 µg) was administered to the patients just before endobronchial intubation, and fentanyl (10 µg) and midazolam (1 mg) were added as needed during the procedure. A questionnaire survey was administered 2 h after the examination. In the questionnaire, patient satisfaction was scored using a visual analog scale as follows: excellent (1 point), good (2 points), normal (3 points), uncomfortable (4 points) and very uncomfortable (5 points). An additional question ('Do you remember the bronchoscopic examination?') was also asked. Predefined parameters (blood pressure, heart rate, oxygen saturation and complications) were recorded.


RESULTS
The enrolled patients included 22 males and 17 females; their median age was 70 (range: 28-88) years. The patients received a mean dose of 47.9 µg of fentanyl (range: 30-90 µg) and 2.79 mg of midazolam (range: 1-7 mg). In total, 28 patients (71.7%) agreed to undergo a second bronchoscopic examination; the mean levels of discomfort and for the re-examination were 2.07 points each. About 41% of the patients remembered the bronchoscopic examination. No severe complications were reported.


CONCLUSIONS
Endobronchial intubation using fentanyl and midazolam sedation during an invasive bronchoscopic procedure might be recommended.


BACKGROUND
UMIN000015578 in the UMIN Clinical Trials Registry.
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Daisuke
D
Minami
Department of General Internal Medicine 4, Kawasaki Medical School,Okayama, Japan.
Nagio
N
Takigawa
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Hirohisa
H
Kano
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Takashi
T
Ninomiya
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Toshio
T
Kubo
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Eiki
E
Ichihara
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Kadoaki
K
Ohashi
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Akiko
A
Sato
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Katsuyuki
K
Hotta
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Masahiro
M
Tabata
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Mitsune
M
Tanimoto
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Hospital, Okayama.
Katsuyuki
K
Kiura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000009:adverse effects*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000494:pharmacology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007440:Intubation / Q000009:adverse effects*; D007564:Japan; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000494:pharmacology; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires
D008874:Midazolam; D005283:Fentanyl
clinical trials; endobronchial intubation; endoscopy-respiratory tract; interventional pulmonology; sedation