Midazolam in flexible bronchoscopy premedication: effects on patient-related and
procedure-related outcomes.
Author(s): Contoli M(1), Gnesini G, Artioli D, Ravenna C, Sferra S, Romanazzi C, Marangoni
E, Guzzinati I, Pasquini C, Papi A, Ravenna F.
Affiliation(s): Author information:
(1)Respiratory Medicine, Intensive Care Unit, University Hospital, Ferrara, Italy.
ctm@unife.it
Publication date & source: 2013, J Bronchology Interv Pulmonol. , 20(3):232-40
BACKGROUND: The role of midazolam in flexible bronchoscopy premedication has been
debated. The aim of the present study was to evaluate whether midazolam
premedication increases the patient-reported tolerance and the physician-reported
or nurse-reported feasibility of bronchoscopy.
METHODS: Randomized, double-blinded, placebo-controlled, 3-arm study. The study
population included patients undergoing bronchoscopy for appropriate clinical
indications. Patients were randomly assigned to receive 0.035 mg/kg intravenous
midazolam (low dose), 0.07 mg/kg (high dose), or placebo. Vital parameters were
monitored in continuum during the procedure. At the end of the procedure, the
operating physician and assisting nurse filled out a questionnaire to score the
procedure-related outcomes (satisfaction, feasibility, completeness, and
unexpected events). Patients were asked to fill out a specific questionnaire to
assess the patient-reported tolerance and satisfaction 2 hours after the
bronchoscopy.
RESULTS: A total of 100 patients (mean age 58.6±1.0; 57% male) were included in
the study (33 in the low-dose midazolam group, 34 in the high-dose midazolam
group, and 33 in the placebo group). The patient-reported tolerance score was
significantly higher in the high-dose midazolam group than in the placebo group
(P<0.01). No differences were found in the 3 groups in terms of the
physician-reported feasibility and completeness of the procedure. In the groups
of patients premedicated with midazolam, significant oxygen desaturation was
recorded (at 10 and 8 min after the introduction of the bronchoscope) compared
with the baseline value (P<0.01).
CONCLUSIONS: In our study, premedication with midazolam increased the
patient-reported tolerance of the bronchoscopy. However, the absence of
premedication did not affect the diagnostic yield of the procedure.
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