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Combined sedation with a benzodiazepine and an opiate has been proposed as standard sedation for bronchoscopy. Propofol is a sedative-hypnotic with a rapid onset of action and fast recovery time, but carries the potential risk of respiratory failure. Consecutive patients (n = 200) were randomly allocated to receive either the combination midazolam and hydrocodone or intravenous propofol. The primary end-points were the mean lowest arterial oxygen saturation during bronchoscopy and the readiness-for-discharge score 1 h after the procedure. The mean lowest arterial oxygen saturation during bronchoscopy did not differ across treatment groups (p = 0.422), and the number of patients recording an arterial oxygen saturation ofor =90% on at least one occasion was similar in both groups (p = 0.273). The median (interquartile range) readiness-for-discharge score 1 h after the procedure was significantly higher in the propofol group than in the combined sedation group (8 (6-9) versus 7 (5-9); p = 0.035). Patients assigned propofol exhibited less tachycardia during bronchoscopy and foror =1 h after the examination. Minor procedural complications were noted in 71 (35.5%) patients and exhibited a similar incidence in both treatment arms (p = 0.460). Propofol is as effective and safe as combined sedation in patients undergoing flexible bronchoscopy, thus representing an appealing option if timely discharge is a priority.

Background: Current British Thoracic Society guidelines do not recommend routinely the combined use of a benzodiazepine and opiate during flexible bronchoscopy (FB). A randomised, placebo controlled, double blind study was undertaken to determine whether hydrocodone in combination with midazolan improves cough suppression during FB without increasing the risk of desaturation. Methods: 120 patients were randomised to receive midazolam and 5 mg IV hydrocodone or midazolam and placebo with topical anaesthesia. Pulse oximetry was recorded continuously during FB. Bronchoscopists and nurses charted their perception of cough and the patients rated their discomfort during the procedure on a 10 cm visual analogue scale (VAS). Results: There was no significant difference between the two groups with regard to the indication for FB, duration of procedure (21 (11) min v 22 (10) min, p = 0.570), doses of supplemental lignocaine (171 (60) mg v 173 (66) mg, p = 0.766) and midazolam (4.5 (2.3) mg v 4.9 (2.7) mg, p = 0.309), lowest oxygen saturation (94.8 (2.7) v 94.9 (2.7), p = 0.433), and desaturations ⩽90%. Perception of cough by both the bronchoscopist and the nurse was significantly lower in the hydrocodone group (3 (0–10) and 3 (0–10)) than in the placebo group (6 (0–10) and 6 (0–10)), respectively (p = 0.001). According to the VAS scale, patients’ tolerance was also significantly better with hydrocodone than with placebo (2 (0–8) v 3 (0–9), p = 0.043). Conclusion: The combination of midazolam and hydrocodone markedly reduces cough during FB without causing significant desaturation, especially when invasive diagnostic procedures are performed.

Propofol and the combination of a benzodiazepine and an opiate have been established for sedation in flexible bronchoscopy. It is as yet unknown whether propofol in combination with an opiate is superior to propofol alone to suppress cough during the procedure. 300 consecutive patients undergoing flexible bronchoscopy at a tertiary care university hospital were randomly allocated to receive either the combination propofol and hydrocodone or propofol alone in a double-blind fashion. The primary end-point was the cough score during the procedure as estimated by the physician using a visual analogue scale. Demographics were similar in both groups. Compared with propofol alone, median (interquartile range) cough scores assessed by physicians, nurses and patients were significantly lower in the group randomised to the combination propofol and hydrocodone (2.5 (1.5-4.0) versus 2.0 (1.0-3.0), respectively, p=0.011). Additionally, patients receiving the combination required significantly lower doses of propofol than those receiving propofol alone (200 mg (140-280) versus 260 mg (180-350), p

The aim of the present study was to assess the feasibility of measuring combined arterial oxygen saturation measured by pulse oximetry ( S p,O 2 ) and cutaneous carbon dioxide tension ( P c,CO 2 ) to monitor ventilation and quantify change in P c,CO 2 during bronchoscopy. Combined S p,O 2 and P c,CO 2 were measured at the ear lobe in 114 patients. In four patients, the ear-clip slipped and they were excluded. In total, 11 patients had artefacts with S p,O 2 recordings, thus, S p,O 2 was analysed in 99 patients. Spirometry data were available in 77 patients. Multivariate analysis of covariance and logistic regression were used for statistical analyses. Mean baseline P c,CO 2 was 4.78±1.06 kPa (36±8 mmHg) and mean rise in the P c,CO 2 during bronchoscopy was 1.26±0.70 kPa (9.5±5.3 mmHg), while mean P c,CO 2 at the end of bronchoscopy was 5.85±1.19 kPa (44±9 mmHg) . Baseline P c,CO 2 and the lowest S p,O 2 were significantly associated with peak P c,CO 2 and the change in P c,CO 2 during bronchoscopy. Risk of significant hypoxaemia ( S p,O 2 ≤90%) was lower for a higher baseline S p,O 2 . Peak P c,CO 2 was directly associated with significant hypoxaemia. There was no significant association in the baseline P c,CO 2 , peak P c,CO 2 , baseline S p,O 2 or the lowest S p,O 2 comparing patients with and without chronic obstructive pulmonary disease. In conclusion, it is feasible to measure combined pulse oximetry and cutaneous carbon dioxide tension effectively to monitor ventilation during flexible bronchoscopy.