| Sedation during flexible bronchoscopy in patients with pre-existing respiratory failure: Midazolam versus Midazolam plus Alfentanil. | |
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MedLine Citation:
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PMID: 20016132 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The use of sedation during flexible bronchoscopy (FB) is undisputed; however, the combination of benzodiazepines and opiates, although reasonable, is suggested to cause hypoventilation, particularly in patients with pre-existing respiratory failure. OBJECTIVES: To assess respiratory function during FB. METHODS: Transcutaneous PCO(2 )(PtcCO(2)), oxygen saturation, patients' tolerance, time after FB until recovery and application of drug dosage were assessed in patients receiving either midazolam with alfentanil (n = 15) or midazolam alone (n = 15) for sedation for FB. RESULTS: There were no differences in PtcCO(2) values during FB between the two groups (all p > 0.05). However, PtcCO(2 )significantly increased over time in both groups (both p < 0.001; RM-ANOVA on ranks). Minimum oxygen saturation (SaO(2)) [89 (interquartile range 79.8/92.8) vs. 86 (interquartile range 82.3/87.8)%; p = 0.46] and the duration until recovery, i.e., achieving an ALDRETE score of > or =9 [30 (interquartile range 10/90) vs. 10 (interquartile range 10/105) min; p = 0.68] were comparable for monosedation and combined sedation, respectively. The total amount of midazolam [4.0 (interquartile range 4.0/4.0) vs. 2.0 (interquartile range 2.0/2.0) mg; p < 0.001] was lower in patients receiving combined sedation. Significantly lower scores for pain and asphyxia, and a clear tendency to less nausea and cough were reported by patients receiving combined sedation. CONCLUSIONS: Combined sedation during FB produced a comparable degree of desaturation and hypoventilation, and is associated with a comparable time to full recovery compared to monosedation in patients with pre-existing respiratory failure. Importantly, FB using combined sedation is better tolerated by patients despite only 50% midazolam consumption. |
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Authors:
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Michael Dreher; Emelie Ekkernkamp; Jan Hendrik Storre; Hans-Joachim Kabitz; Wolfram Windisch |
Publication Detail:
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Type: Comparative Study; Journal Article Date: 2009-12-14 |
Journal Detail:
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Title: Respiration; international review of thoracic diseases Volume: 79 ISSN: 1423-0356 ISO Abbreviation: Respiration Publication Date: 2010 |
Date Detail:
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Created Date: 2010-03-05 Completed Date: 2010-05-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0137356 Medline TA: Respiration Country: Switzerland |
Other Details:
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Languages: eng Pagination: 307-14 Citation Subset: IM |
Copyright Information:
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Copyright 2009 S. Karger AG, Basel. |
Affiliation:
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Department of Pneumology, University Hospital, Freiburg, Germany. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Alfentanil / administration & dosage*, adverse effects Anesthesia Recovery Period Anesthetics, Intravenous / administration & dosage*, adverse effects Blood Gas Monitoring, Transcutaneous Bronchoscopy* Carbon Dioxide / blood Female Heart Rate Humans Male Midazolam / administration & dosage*, adverse effects Middle Aged Oxygen / blood Respiratory Insufficiency / blood* |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Intravenous; 124-38-9/Carbon Dioxide; 59467-70-8/Midazolam; 71195-58-9/Alfentanil; 7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
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Respiration. 2010;79(4):276
[PMID:
20090285
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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