Tolerance and Safety of 5 Models of Sedation During Endobronchial Ultrasound

• Published in: Archivos de bronconeumología (English ed.) 2016-01, Vol.52 (1), p.5-11
• Main Authors: Cases Viedma, Enrique, Andreo García, Felipe, Flandes Aldeyturriaga, Javier, Reig Mezquida, Juan Pablo, Briones Gómez, Andrés, Vila Caral, Pere, Fernández-Navamuel Basozabal, Iker, Centeno Clemente, Carmen Ángela, Campo Campo, Felipe, Sánchez Martínez, Estefanía, Sanchis Moret, Francisca, Manjón Pérez, Josefina, Sánchez Yepes, Marina
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bronchoscopy - adverse effects; Conscious Sedation - adverse effects; Deep Sedation - adverse effects; Ecobroncoscopia; Endobronchial ultrasound; Endosonography; Female; Fentanilo; Fentanyl; Humans; Hypnotics and Sedatives - therapeutic use; Internal Medicine; Male; Midazolam; Middle Aged; Models, Theoretical; Patient Satisfaction; Propofol; Prospective Studies; Pulmonary/Respiratory; Remifentanil; Remifentanilo; Sedación; Sedation
• ISSN: 1579-2129; 1579-2129
• DOI: 10.1016/j.arbr.2015.11.004

Abstract Introduction Sedation during endobronchial ultrasound (EBUS) is essential due to the long duration of this procedure. We evaluated different models of sedation and their complications. Method A multicenter, prospective, observational study of 307 patients undergoing EBUS was conducted. Patients were sedated with: (a) midazolam bolus; (b) propofol infusion; (c) midazolam bolus and propofol infusion; (d) propofol infusion and remifentanil infusion, or (e) midazolam bolus and fentanyl bolus, and clinical variables were collected. Patients were asked to complete a satisfaction survey following the test. Results Patients per sedation model were: A 24, B 37, C 107, D 62 and E 77. Scores for perceived sensations of recall, pain, cough, dyspnea and prolonged examination (0.65±1.11, 0.3±0.73, 0.46±0.9, 0.29±0.73, and 0.59±0.96, respectively) were lower compared to fear and nervousness before the examination (1.26±1.37 and 1.5±1.41, respectively). High levels of indifference to repeating the procedure (1.49±1.3) and a reported pleasant feeling during the test (1.23±1.17), with low levels of anxiety (0.49±0.85) and discomfort (0.62±1.1), show that different models of sedation were well tolerated. Almost half the patients (46.6%) did not report any “worst moment” during the procedure, and 89.6% were willing to undergo a repeat test. The E and C models presented fewest complications (12.9% and 31.7%, respectively), and all were resolved with simple therapeutic measures. Conclusions The models of sedation evaluated were well tolerated and most patients were willing to undergo repeat EBUS. Complications were few and easily resolved.