Sedation with fentanyl and midazolam without oropharyngeal anesthesia compared with sedation with pethidine and midazolam with oropharyngeal anesthesia in ultrathin bronchoscopy for peripheral lung lesions |
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| Authors: | Toshiyuki Sumi Koki Kamada Takeyuki Sawai Naoki Shijubou Yuichi Yamada Hisashi Nakata Yuji Mori Hirofumi Chiba |
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| Affiliation: | 1. Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan;2. Department of Pulmonary Medicine, Hakodate General Hospital, Hokkaido, Japan;3. Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan;1. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan;2. Department of Laboratory of Pathology, Nagasaki University Hospital, Nagasaki, Japan;3. Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan;1. Department of Respiratory Medicine, Ichinomiya-nishi Hospital, Ichinomiya, Japan;2. Department of Radiology, Ichinomiya-nishi Hospital, Ichinomiya, Japan;1. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan;2. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan;3. Department of Medical IT Center, Nagoya University Hospital, Nagoya, Aichi, Japan;4. Department of Respiratory Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Aichi, Japan;5. National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan;1. Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan;2. Department of Infectious Diseases, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan;3. Department of Pulmonary Medicine, Awaji Medical Center, Japan;4. Department of Pulmonary Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Japan;5. Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan;1. Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan;2. Department of Respiratory Medicine, Saitama Red Cross Hospital, Japan |
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| Abstract: | BackgroundIn advanced lung cancer, precision medicine requires repeated biopsies via bronchoscopy at therapy change. Since bronchoscopies are often stressful for patients, sedation using both fentanyl and midazolam is recommended in Europe and America. In Japan, bronchoscopies are generally orally performed under midazolam and oropharyngeal anesthesia. Nasal intubation creates a physiological route to the trachea, causing less irritation to the pharynx than intubation via the oral cavity; however, the necessity of oropharyngeal anesthesia remains unclear. We aimed to compare the safety, patient discomfort, and diagnostic rates for oropharyngeal anesthesia and sedation with pethidine and midazolam (Group A) and sedation with midazolam and fentanyl without oropharyngeal anesthesia (Group B) for ultrathin bronchoscopy of peripheral pulmonary lesions (PPLs) via nasal intubation.MethodsWe retrospectively reviewed 74 consecutive potential lung cancer patients who underwent ultrathin bronchoscopies at the Hakodate Goryoukaku Hospital between July 2019 and June 2020. We reviewed the following: diagnostic rates; cumulative doses of lidocaine, midazolam, and fentanyl; hemodynamic changes; procedural complications in both groups. Pharyngeal anesthesia in group A was administered by spraying 2% (w/v) lidocaine into the pharynx. The chi-squared test was used for statistical analyses.ResultsThere were no significant changes in hemodynamic parameters and complications. The mean level of discomfort for bronchoscopic examinations was significantly lower in Group B (2.39 vs. 1.64; P = 0.014), with no significant inter-group difference in the diagnostic yields for PPLs (63.0% vs. 71.4%; P = 0.46).ConclusionsOur findings indicate the advantages of sedation with fentanyl and midazolam without oropharyngeal anesthesia for ultrathin bronchoscopy through nasal intubation. |
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| Keywords: | Lung cancer Peripheral pulmonary lesion Ultrathin bronchoscopy Fentanyl Midazolam peripheral pulmonary lesions" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" (PPLs) radial endobronchial ultrasound" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" (rEBUS) |
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