Prevalence and characteristics of disinhibition during bronchoscopy with midazolam |
| |
| Affiliation: | 1. Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan;2. Department of Pulmonary Immunotherapeutics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan;3. Internal Medicine, Kudanzaka Hospital, 1-6-12 Kudan-minami, Chiyoda-ku, Tokyo, 102-0074, Japan;1. Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan;2. Department of Respiratory Medicine, Juntendo University, School of Medicine, Tokyo, Japan;1. Department of Medicine, ABVIMS and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India;2. Department of Respiratory Medicine, ABVIMS and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India;3. Department of Radiology, ABVIMS and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India;1. Department of Endoscopy, Respiratory Endoscopy Division. National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan;2. Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan;3. Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan;1. Department of Medical Oncology, Kishiwada City Hospital, Japan;2. Department of Medical Oncology, Kindai University Faculty of Medicine, Japan;3. Department of Respiratory Medicine, Kishiwada City Hospital, Japan;4. Department of Radiation of Oncology, Kishiwada City Hospital, Kishiwada City Hospital, Japan;1. Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan;2. Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan;3. Clinical Research Center, Kyoto Central Clinic, Kyoto, Japan;4. Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan;5. Department of Radiology, Tenri Hospital, Tenri, Japan;6. Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan;7. Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan |
| |
| Abstract: | BackgroundDisinhibition is sometimes experienced during bronchoscopy with sedation. However, data on disinhibition during bronchoscopy are scarce. We examined the prevalence and characteristics of disinhibition during bronchoscopy with midazolam.MethodsThis retrospective study analyzed consecutive patients who underwent bronchoscopy between November 2019 and December 2020. The severity of disinhibition was defined as follows: mild, disinhibition sometimes requiring restraints by assistants; moderate, disinhibition always requiring restraints by assistants; and severe, disinhibition requiring antagonization of sedation by flumazenil to continue bronchoscopy.ResultsAmong 251 eligible patients who were sedated using midazolam, 36 (14.3%; 95% confidence interval [CI], 10.5%–19.2%), 42 (16.7%; 95% CI, 12.6%–21.8%), and 7 (2.8%; 95% CI, 1.4%–5.6%) experienced mild, moderate, and severe disinhibition, respectively. Depression (odds ratio [OR] 2.77; 95% CI, 1.20–6.41), endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) (OR 10.23; 95% CI, 1.02–103.01, referred to brushing/bronchial washing/observation), and increased administration of midazolam (OR 1.20; 95% CI, 1.02–1.42, per 1-mg increase) were independently associated with moderate-to-severe disinhibition. Patients experiencing moderate disinhibition reported significantly better scores for discomfort during bronchoscopy. Besides the maximum systolic and diastolic blood pressures during bronchoscopy, the changes in hemodynamic and respiratory statuses during bronchoscopy or complications did not significantly differ between patients experiencing moderate-to-severe disinhibition and those experiencing none-to-mild disinhibition.ConclusionsModerate-to-severe disinhibition occurred in 19.5% of patients during bronchoscopy with midazolam. We should focus on disinhibition when patients have depression or are planning to undergo EBUS-TBNA, and sparing the administration of midazolam might reduce the occurrence of disinhibition.Clinical trial registrationUMIN000038571 |
| |
| Keywords: | Paradoxical reaction Disinhibitory reaction Sedation Complication |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
