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The effect of midazolam premedication on patient satisfaction during fiberoptic bronchoscopy under patient-controlled
Won Kyoung Kwon1, Eun Su Choi1, Ji Young Kim1
1Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea.
Background:
Patient-controlled sedation (PCS) with propofol is a safe and effective method of attenuating discomfort during fiberoptic bronchoscopy. The purpose was to evaluate the usefulness of midazolam in addition to PCS for fiberoptic bronchoscopy.
Methods:
We randomly assigned 155 patients undergoing diagnostic bronchoscopy to two groups. Group M (n = 79) received 0.03 mg/kg of midazolam for premedication while group P (n = 76) received a loading dose (0.05 ml/kg) of PCS solution composed of 200 mg (20 ml) of propofol and 1 mg (2 ml) of alfentanil. Both groups received the PCS solution 0.2 ml/kg/hr with a bolus of 1 ml and a lockout time of 1 min. Vital signs, pulmonologist satisfaction, patient satisfaction and amnesia were evaluated.
Results:
After the insertion of the bronchoscope, there was a slight decrease of SpO2 and an increase of blood pressure and heart rate in both groups with no significant differences between the two groups. The group P required more bolus injections (1.6 +/- 1.7 in the group M vs 2.5 +/- 2.2 in group P; P < 0.05). There was no difference in the satisfaction of pulmonologists, but the satisfaction of patients was higher in the group M (P < 0.05). More patients in the group P (93%) remembered the procedure than in the group M (70%) (P < 0.05).
Conclusions:
PCS is an effective method for sedating patients undergoing fiberoptic bronchoscopy and midazolam provides more patient satisfaction and amnesia.
Insights
Adding midazolam to patient-controlled sedation (PCS) for fiberoptic bronchoscopy improved patient satisfaction and amnesia. This combination offers a more comfortable experience for patients undergoing the procedure.
Area of Science:
- Anesthesiology
- Pulmonology
- Pharmacology
Background:
- Patient-controlled sedation (PCS) using propofol is established for managing discomfort during fiberoptic bronchoscopy.
- Evaluating adjuncts to PCS can optimize procedural sedation and patient experience.
Purpose of the Study:
- To assess the efficacy and impact of adding midazolam to propofol-based PCS for fiberoptic bronchoscopy.
Main Methods:
- A randomized controlled trial involving 155 patients undergoing diagnostic bronchoscopy.
- Patients received either midazolam premedication or propofol/alfentanil PCS, with both groups receiving standardized PCS infusions.
- Outcomes measured included vital signs, procedural satisfaction (patient and pulmonologist), and patient amnesia.
Main Results:
- No significant differences in vital signs (SpO2, blood pressure, heart rate) were observed between groups.
- Patients receiving midazolam (Group M) reported higher satisfaction and better amnesia compared to the PCS-only group (Group P).
- Group P required more supplemental bolus injections of sedation, indicating potentially less effective sedation titration.
Conclusions:
- Midazolam, when used as premedication with propofol-based PCS, enhances patient satisfaction and amnesia during fiberoptic bronchoscopy.
- PCS remains an effective sedation method, but adjuncts like midazolam can further improve patient-centered outcomes.
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