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Sedation for fibre optic bronchoscopy

J H Greig1, S M Cooper, H J Kasimbazi

  • 1Chest Clinic, Southern General Hospital, Glasgow, U.K.

Respiratory Medicine
|January 1, 1995
PubMed
Summary
This summary is machine-generated.

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For fiber optic bronchoscopy, alfentanil (an opioid) is a better cough suppressant than midazolam (a benzodiazepine). Combining both offers no added benefit and may increase sedation risks.

Area of Science:

  • Anesthesiology
  • Pulmonology
  • Pharmacology

Background:

  • Current sedative regimens for fiber optic bronchoscopy often involve opioids and benzodiazepines.
  • Midazolam (a benzodiazepine) and alfentanil (an opioid) are commonly used agents.

Purpose of the Study:

  • To compare the efficacy and safety of midazolam, alfentanil, and their combination for sedation during fiber optic bronchoscopy.
  • To evaluate anti-tussive effects, lignocaine requirements, procedure duration, patient discomfort, and oxygen desaturation.

Main Methods:

  • A double-blind, randomized study involving 103 patients undergoing fiber optic bronchoscopy.
  • Patients were allocated to receive midazolam (M), alfentanil (A), or a combination (M+A).
  • Outcomes measured included cough frequency, lignocaine use, procedure duration, discomfort (visual analogue score), and oxygen saturation.

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Main Results:

  • Group A (alfentanil) showed significantly fewer coughs per minute compared to Group M (midazolam).
  • Significantly less lignocaine was required in Group A and Group M+A compared to Group M.
  • No significant difference in patient discomfort was observed between groups. Group M+A trended towards greater desaturation than other groups.

Conclusions:

  • Alfentanil is a more effective anti-tussive agent than midazolam for outpatient fiber optic bronchoscopy.
  • Combining alfentanil and midazolam does not enhance anti-tussive effects and may increase the risk of desaturation.
  • Alfentanil appears to be a preferable agent for managing cough during this procedure.