Prabhudev Amithash Marulaiah, Chogtu Bharti, Magazine Rahul
Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
Indian J Pharmacol. 2017 Jul-Aug;49(4):304-311. doi: 10.4103/ijp.IJP_683_16.
Sedation during flexible bronchoscopy is desirable, but the drugs and the dosage protocols that are used vary.
To study and compare the effects of midazolam with fentanyl-midazolam combination during flexible bronchoscopy.
The study was conducted on 144 patients, from October 2013 to July 2015. They answered Hospital Anxiety and Depression Scale-Anxiety subscale and a prebronchoscopy questionnaire to assess their expectation toward flexible bronchoscopy. The patients were randomized into three groups: placebo, midazolam, and fentanyl-midazolam. Vitals signs including heart rate, respiratory rate, blood pressure, and oxygen saturation (SpO) were recorded. Furthermore, Ramsay Sedation Scale was assessed during the procedure. Primary outcome measure was the composite score of patient-reported tolerance and satisfaction (assessed after the procedure). Secondary outcome measures were composite score of physician-reported feasibility of the procedure, hemodynamic changes during bronchoscopy, and side effects.
Patient-reported tolerance and satisfaction composite scores (median, interquartile range) for placebo, midazolam, and fentanyl-midazolam groups were 54 (52, 57), 59 (57, 61.5), 62 (58.5, 66), respectively; < 0.001. Physician-reported feasibility composite scores (median, interquartile range) for the respective groups were 24.5 (20.5, 28), 25 (21, 27), 26 (25, 29); = 0.004. There was no significant difference between the groups so far as mean heart rate ( = 0.305), mean systolic blood pressure ( = 0.532), mean diastolic blood pressure ( = 0.516), mean respiratory rate ( = 0.131), and mean SpO ( = 0.968) were concerned.
Conscious sedation with fentanyl and midazolam combination can result in better patient and operator satisfaction when compared with midazolam alone.
在可弯曲支气管镜检查期间进行镇静是可取的，但所使用的药物和剂量方案各不相同。
研究并比较咪达唑仑与芬太尼 - 咪达唑仑联合用药在可弯曲支气管镜检查期间的效果。
该研究于2013年10月至2015年7月对144例患者进行。他们回答了医院焦虑和抑郁量表 - 焦虑分量表以及支气管镜检查前问卷，以评估他们对可弯曲支气管镜检查的期望。患者被随机分为三组：安慰剂组、咪达唑仑组和芬太尼 - 咪达唑仑组。记录包括心率、呼吸频率、血压和血氧饱和度（SpO）在内的生命体征。此外，在操作过程中评估Ramsay镇静量表。主要结局指标是患者报告的耐受性和满意度综合评分（操作后评估）。次要结局指标是医生报告的操作可行性综合评分、支气管镜检查期间的血流动力学变化以及副作用。
安慰剂组、咪达唑仑组和芬太尼 - 咪达唑仑组患者报告的耐受性和满意度综合评分（中位数，四分位间距）分别为54（52，57）、59（57，61.5）、62（58.5，66）；<0.001。各组医生报告的可行性综合评分（中位数，四分位间距）分别为24.5（20.5，28）、25（21，27）、26（25，29）；=0.004。就平均心率（=0.305）、平均收缩压（=0.532）、平均舒张压（=0.516）、平均呼吸频率（=0.1十三条）和平均SpO（=0.968）而言，各组之间无显著差异。
与单独使用咪达唑仑相比，芬太尼和咪达唑仑联合进行清醒镇静可使患者和操作者的满意度更高。
