芬太尼和咪达唑仑镇静，不使用或使用口咽麻醉，与哌替啶和咪达唑仑镇静，使用或不使用口咽麻醉在超细支气管镜检查外周肺病变中的比较。

Sedation with fentanyl and midazolam without oropharyngeal anesthesia compared with sedation with pethidine and midazolam with oropharyngeal anesthesia in ultrathin bronchoscopy for peripheral lung lesions.

机构信息

Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan.

出版信息

Respir Investig. 2021 Mar;59(2):228-234. doi: 10.1016/j.resinv.2020.10.001. Epub 2020 Nov 5.

DOI:10.1016/j.resinv.2020.10.001

PMID:33160904

Abstract

BACKGROUND

In advanced lung cancer, precision medicine requires repeated biopsies via bronchoscopy at therapy change. Since bronchoscopies are often stressful for patients, sedation using both fentanyl and midazolam is recommended in Europe and America. In Japan, bronchoscopies are generally orally performed under midazolam and oropharyngeal anesthesia. Nasal intubation creates a physiological route to the trachea, causing less irritation to the pharynx than intubation via the oral cavity; however, the necessity of oropharyngeal anesthesia remains unclear. We aimed to compare the safety, patient discomfort, and diagnostic rates for oropharyngeal anesthesia and sedation with pethidine and midazolam (Group A) and sedation with midazolam and fentanyl without oropharyngeal anesthesia (Group B) for ultrathin bronchoscopy of peripheral pulmonary lesions (PPLs) via nasal intubation.

METHODS

We retrospectively reviewed 74 consecutive potential lung cancer patients who underwent ultrathin bronchoscopies at the Hakodate Goryoukaku Hospital between July 2019 and June 2020. We reviewed the following: diagnostic rates; cumulative doses of lidocaine, midazolam, and fentanyl; hemodynamic changes; procedural complications in both groups. Pharyngeal anesthesia in group A was administered by spraying 2% (w/v) lidocaine into the pharynx. The chi-squared test was used for statistical analyses.

RESULTS

There were no significant changes in hemodynamic parameters and complications. The mean level of discomfort for bronchoscopic examinations was significantly lower in Group B (2.39 vs. 1.64; P = 0.014), with no significant inter-group difference in the diagnostic yields for PPLs (63.0% vs. 71.4%; P = 0.46).

CONCLUSIONS

Our findings indicate the advantages of sedation with fentanyl and midazolam without oropharyngeal anesthesia for ultrathin bronchoscopy through nasal intubation.

摘要

背景

在晚期肺癌中，精准医疗需要在治疗改变时通过支气管镜进行反复活检。由于支气管镜检查对患者来说通常很有压力，因此在欧美建议使用芬太尼和咪达唑仑进行镇静。在日本，支气管镜检查通常在咪达唑仑和口咽麻醉下经口进行。经鼻插管可建立通向气管的生理通道，比经口腔插管对咽部的刺激小；然而，口咽麻醉的必要性仍不清楚。我们旨在比较经鼻插管行外周肺病变（PPL）超细支气管镜检查时，使用哌替啶和咪达唑仑（A 组）行口咽麻醉和镇静与使用咪达唑仑和芬太尼（B 组）行无口咽麻醉镇静的安全性、患者不适和诊断率。

方法

我们回顾性分析了 2019 年 7 月至 2020 年 6 月在函馆五棱郭医院接受超细支气管镜检查的 74 例连续潜在肺癌患者。我们回顾了以下内容：诊断率；利多卡因、咪达唑仑和芬太尼的累积剂量；血流动力学变化；两组的程序并发症。A 组的咽部麻醉通过向咽部喷洒 2%（w/v）利多卡因来进行。采用卡方检验进行统计学分析。