Different sedation practices in a bronchoscopy unit : does it really matter?

In our bronchoscopy unit there is wide variation among respiratory teams regarding use of topical anaesthesia (LA) and sedatives during flexible bronchoscopy (FB). Our aim was to assess if there is a disparity in patient comfort between different sedation practices. We included all patients undergoing FB, with their consent. Endoscopy nurses completed a survey at the end of each FB. Likert9s scale (0-10); rating ease and comfort of FB, and Ramsay scale assessing depth of sedation were used. Patient phone surveys were conducted on the same day using Likert9s scale. Bronchoscopy notes were reviewed. Kruskall Wallis and Chi square tests were used. Of 135 patients, 74.8% were males. The mean age was 64 (22-87). 14.8%, 61.5%, and 23.7% were given alfentanyl (group A), midazolam (group B), and both alfentanyl and midazolam (group C) accordingly. The nurses9 mean rating score (MRS) for comfort during procedure was 8.5, 6.92 and 8.16 for A, B and C (p=0.002). Ramsay scale of 2 was obtained in 75% of A, 62.7% of B and 68.8% of C (p=0.450). 5% in A, 19.3% in B and 9.4% in C were undersedated. Oversedation was comparable among the 3 groups. Doctors9 ease of execution favored group C with MRS 8.25 vs 8.2 in group A and 7.7 in group B (p=0.272). 5%, 3.6%, 3.1% had a prolonged recovery in A, B and C accordingly (p = 0.939). MRS for patient anxiety, comfort during LA, comfort during tube insertion and comfort during procedure were similar in all groups. There is conformity in patient-reported comfort between all 3 sedation practices. Nurse-reported patient comfort however favoured alfentanyl. The majority of undersedated patients were in the midazolam group.