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Comparison between bronchoscopy under general anesthesia using laryngeal mask airway and local anesthesia with conscious sedation: a patient-centered and operator-centered outcome

Egyptian Journal of Bronchology volume 8, pages 128–137 (2014)Cite this article

Abstract

Background and objectives

With the evolution of complex bronchoscopic procedures, search for procedures that were less painful to patients and easier for the operators to perform commenced. Conscious sedation partially achieved this target. We aimed to compare conscious sedation with general anesthesia (GA) in achieving a safer and more painless procedure.

Patients and methods

Eighty patients were included: 36 (45%) were subjected to local anesthesia (LA) with midazolam and 44 (55%) to GA through laryngeal mask airway. Patients responded to a visual analogue scale (VAS) for cough, choking, dyspnea, nausea, vomiting, nasal symptoms, chest pain, and anxiety during bronchoscopy. Postbronchoscopy VAS included cough, fever, dyspnea, nausea, vomiting, nasal symptoms, and hemoptysis. Lastly, VAS for the tolerability of bronchoscopy and acceptance to repeat the procedure were answered. Operator VAS included cough, desaturations, easiness of the procedure, and success. Bronchoscopy, recovery times, the number of biopsies, and cost were recorded.

Results

GA was significantly less symptomatic during bronchoscopy than LA (P = 0.0001). Nasal symptoms were more in LA after bronchoscopy (P = 0.003). Anxiety was more in LA (P = 0.014). The GA group found bronchoscopy to be more tolerable (P = 0.0001), and accepted to repeat the procedure (P = 0.001). The operator found that GA was associated with significantly less cough and desaturations, and was easier to perform (P = 0.0001). The duration of the procedure, the recovery time, the number of biopsies, and the cost were significantly higher in GA (P = 0.0001). Safety was equal in both groups.

Conclusion

GA serves as a more peaceful procedure for the patient and the operator than LA, but at the expense of recovery time and cost. Egypt J Broncho 2014 8:128–137

References

  1. Diette GB, White P Jr, Terry P, Jenckes M, Wise RA, Rubin HR. Quality assessment through patient self-report of symptoms prefiberoptic and postfiberoptic bronchoscopy. Chest 1998; 114:1446–1453.

    CAS  PubMed  Google Scholar 

  2. Mori K, Saito Y, Suga Y, Takahashi T, Yokoi K, Miyazawa N, et al. A study of pharyngeal symptoms caused by bronchofiberscopy. Jpn J Clin Oncol 1993; 23:162–165.

    CAS  PubMed  Google Scholar 

  3. Poi PJ, Chuah SY, Srinivas P, Liam CK. Common fears of patients undergoing bronchoscopy. Eur Respir J 1998; 11:1147–1149.

    CAS  PubMed  Google Scholar 

  4. Facciolongo N, Patelli M, Gasparini S, Lazzari Agli L, Salio M, Simonassi C, et al. Incidence of complications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies. Monaldi Arch Chest Dis 2009; 71:8–14.

    CAS  PubMed  Google Scholar 

  5. Gasparini S. It is time for patients to undergo bronchoscopy without discomfort. Eur Respir J 2011; 38:507–509.

    CAS  PubMed  Google Scholar 

  6. Lechtzin N, Rubin HR, Peter W, Jenckes M, Diette GB. Patient satisfaction with bronchoscopy. Am J Respir Crit Care Med 2002; 166:1326–1331.

    PubMed  Google Scholar 

  7. Hadzri HM, Azarisman SMS, Fauzi ARM, Roslan H, Roslina AM, Adina ATN, et al. Can a bronchoscopist reliably assess a patient’s experience of bronchoscopy? JRSM Short Rep 2010; 1:35–42.

    PubMed  PubMed Central  Google Scholar 

  8. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42:487–490.

    CAS  PubMed  Google Scholar 

  9. Chung F, Vincent WS, Ghan VWS, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth 1995; 7:500–506.

    CAS  PubMed  Google Scholar 

  10. Pearce SJ. Fibreoptic bronchoscopy: is sedation necessary? BMJ 1980; 281:779–780.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Hatton MQF, Allen MB, Vathenen AS. Does sedation help in fibreoptic bronchoscopy? BMJ 1994; 309:1206–1207.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Maltais F, Laberge F, Laviolette M. A randomized, double-blind, placebo controlled study of lorazepam as premedication for bronchoscopy. Chest 1996; 109:1195–1198.

    CAS  PubMed  Google Scholar 

  13. Maguire G, Rubinfeld AR. Patients prefer sedation for fibreoptic bronchoscopy. Respirology 1998; 3:81–85.

    CAS  PubMed  Google Scholar 

  14. Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A. Patient satisfaction with conscious sedation for bronchoscopy. Chest 1999; 115:1437–1440.

    CAS  PubMed  Google Scholar 

  15. Ni YL, Lo YL, Lin TY, Fang YF, Kuo HP. Conscious sedation reduces patient discomfort and improves satisfaction in flexible bronchoscopy. Chang Gung Med J 2010; 33:443–452.

    PubMed  Google Scholar 

  16. Schlatter L, Pflimlin E, Fehrke B, Meyer A, Tamm M, Stolz D. Propofol versus propofol plus hydrocodone for flexible bronchoscopy: a randomized study. Eur Respir J 2011; 38:529–537.

    CAS  PubMed  Google Scholar 

  17. Lim HJ, Cho YJ, Park JS, Yoon H, Lee J-H, Lee CT, et al. Predictors of hypoxemia developed during fiberoptic bronchoscopy under monitored anesthesia care. Chest 2012; 142:915A.

    Google Scholar 

  18. Wahidi MM, Jain P, Jantz M, Lee P, Mackensen GB, Barbour SY, et al. American college of chest physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest 2011; 140:1342–1350.

    CAS  PubMed  Google Scholar 

  19. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96:1004–1017.

    Google Scholar 

  20. Clarkson K, Power CK, Oconnell F, Pathmakanthan S, Burke CM. A comparative evaluation of propofol and midazolam as sedative agents in fiberoptic bronchoscopy. Chest 1993; 104:1029–1031.

    CAS  PubMed  Google Scholar 

  21. Crawford M, Pollock J, Anderson K, Glavin RJ, Macintyre D, Vernon D. Comparison of midazolam with propofol for sedation in outpatient bronchoscopy. Br J Anaesth 1993; 70:419–422.

    CAS  PubMed  Google Scholar 

  22. Stolz D, Kurer G, Meyer A, Chhajed PN, Pflimlin E, Strobel W, et al. Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial. Eur Respir J 2009; 34:1024–1030.

    CAS  PubMed  Google Scholar 

  23. Clark G, Licker M, Younossian AB, Soccal PM, Frey JG, Rochat T, et al. Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomized trial. Eur Respir J 2009; 34:1277–1283.

    CAS  PubMed  Google Scholar 

  24. Carmi U, Kramer MR, Zemtzov D, Rosengarten D, Fruchter O. Propofol safety in bronchoscopy: prospective randomized trial using transcutaneous carbon dioxide tension monitoring. Respiration 2011; 82:515–521.

    CAS  PubMed  Google Scholar 

  25. Sun GC, Hsu MC, Chia YY, Chen PY, Shaw FZ. Effects of age and gender on intravenous midazolam premedication: a randomized double-blind study. Br J Anaesth 2008; 101:632–639.

    CAS  PubMed  Google Scholar 

  26. Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Conscious sedation with propofol in elderly patients: a prospective evaluation. Aliment Pharmacol Ther 2003; 17:1493–1501.

    CAS  PubMed  Google Scholar 

  27. Grendelmeier P, Tamm M, Pflimlin E, Stolz D. Propofol sedation for flexible bronchoscopy: a randomised, noninferiority trial. Eur Respir J 2014; 43:591–601.

    PubMed  Google Scholar 

  28. Ernst A, Simoff M, Ost D, Michaud G, Chandra D, Herth FJF. A multicenter, prospective, advanced diagnostic bronchoscopy outcomes registry. Chest 2010; 138:165–170.

    PubMed  PubMed Central  Google Scholar 

  29. Perrin G, Colt HG, Martin C, Mak MA, Dumon JF, Gouin F. Safety of interventional rigid bronchoscopy using intravenous anesthesia and spontaneous assisted ventilation a prospective study. Chest 1992; 102:1526–1530.

    CAS  PubMed  Google Scholar 

  30. Lukomsky GI, Ovchinnikov AA, Bilal A. Complications of bronchoscopy. Comparison of rigid bronchoscopy under general anesthesia and flexible fiberoptic bronchoscopy under topical anesthesia. Chest 1981; 79:316–321.

    CAS  PubMed  Google Scholar 

  31. Keane D, McNicholas WT. Comparison of nebulized and sprayed topical anaesthesia for fibreoptic bronchoscopy. Eur Respir J 1992; 5:1123–1125.

    CAS  PubMed  Google Scholar 

  32. Berger R, McConnell JW, Phillips B, Overman TL. Safety and efficacy of using high-dose topical and nebulized anesthesia to obtain endobronchial cultures. Chest 1989; 95:299–303.

    CAS  PubMed  Google Scholar 

  33. Nielson DW, Ku PL, Egger M. Topical lidocaine exaggerates laryngomalacia during flexible bronchoscopy. Am J Respir Crit Care Med 2000; 161:147–151.

    CAS  PubMed  Google Scholar 

  34. McAlpine LG, Thomson NC. Lidocaine-induced bronchoconstriction in asthmatic patients. Chest 1989; 96:1012–1015.

    CAS  PubMed  Google Scholar 

  35. Chen WY, Chai H. Effects of inhaled lidocaine on exercise induced asthma. Respiration 1987; 51:91–97.

    CAS  PubMed  Google Scholar 

  36. Groeben H, Silvanus MS, Beste M, Peters J. Combined lidocaine and salbutamol inhalation for airway anesthesia markedly protects against reflex bronchoconstriction. Chest 2000; 18:509–515.

    Google Scholar 

  37. Sucena M, Cachapuz I, Lombardia E, Magalhães A, Tiago Guimarães J. Plasma concentration of lidocaine during bronchoscopy. Rev Port Pneumol 2004; 10:287–296.

    PubMed  Google Scholar 

  38. Jose RJ, Shaefi S, Navani N. Sedation for flexible bronchoscopy: current and emerging evidence. Eur Respir Rev 2013; 22:106–116.

    PubMed  Google Scholar 

  39. Dang D, Robinson PC, Winnicki S, Jersmann HPA. The safety of flexible fibreoptic bronchoscopy and proceduralist-administered sedation: a tertiary referral centre experience. Int Med J 2012; 42:300–305.

    CAS  Google Scholar 

  40. Hassan C, Rex DK, Cooper GS, Benamouzig R. Endoscopist-directed propofol administration versus anesthesiologist assistance for colorectal cancer screening: a cost-effectiveness analysis. Endoscopy 2012; 44:456–464.

    CAS  PubMed  Google Scholar 

  41. Brain AIJ, McGhee ID, Miatier EJ, Thomas A, Abu-Saael MAW, Bushman JA. The laryngeal mask airway. Anaesthesia 1985; 40:356–361.

    CAS  PubMed  Google Scholar 

  42. McNamee CJ, Meyns B, Pagliero KM. Flexible bronchoscopy via the laryngeal mask: a new technique. Thorax 1991; 46:141–142.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Wang T, Zhang J, Wang J, Dang BW, Xu M, Pei YH, et al. Interventional bronchoscopy with the use of mechanical ventilation by larynx mask or tracheal intubation under general anesthesia. Zhonghua Jie He He Hu Xi Za Zhi 2011; 34:739–742.

    PubMed  Google Scholar 

  44. Naguib ML, Streetman DS, Clifton S, Nasr SZ. Use of laryngeal mask airway in flexible bronchoscopy in infants and children. Pediatr Pulmonol 2005; 39:56–63.

    PubMed  Google Scholar 

  45. Tunkel DE, Fisher QA. Pediatric flexible fiberoptic bronchoscopy through the laryngeal mask airway. Arch Otolaryngol Head Neck Surg 1996; 122:1364–1367.

    CAS  PubMed  Google Scholar 

  46. Douadi Y, Bentayeb H, Malinowski S, Hoguet E, Lecuyer E, Boutemy M, et al. Anaesthesia for bronchial echoendoscopy: experience with the laryngeal mask. Rev Mal Respir 2010; 27:37–41.

    CAS  PubMed  Google Scholar 

  47. Stolz D, Chhajed PN, Leuppi JD, Brutsche M, Pflimlin E, Tamm M. Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: a randomised, double blind, placebo controlled trial. Thorax 2004; 59:773–776.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Atassi K, Mangiapan G, Fuhrman C, Lasry S, Onody P, Housset B. Prefixed equimolar nitrous oxide and oxygen mixture reduces discomfort during flexible bronchoscopy in adult patients. A randomized, controlled, double-blind trial. Chest 2005; 128:863–868.

    CAS  PubMed  Google Scholar 

  49. Ferrando J, Fernández-Navamuel I, Clemente CC, Vila P, Flandes J, Andreo F, et al. Tolerance of the endobronchial ultrasound (EBUS) using five different sedation models. Chest 2014; 145:492A.

    Google Scholar 

  50. Colt HG, Powers A, Shanks TG. Effect of music on state anxiety scores in patients undergoing fiberoptic bronchoscopy. Chest 1999; 116:819–824.

    CAS  PubMed  Google Scholar 

  51. Diette GB, Lechtzin N, Haponik E, Devrotes A, Rubin HR. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy. A complementary approach to routine analgesia. Chest 2003; 123:941–948.

    PubMed  Google Scholar 

  52. Cole P, Turton C, Lanyon H, Collins J. Bronchoalveolar lavage for the preparation of free lung cells: technique and complications. Br J Dis Chest 1980; 74:273–278.

    CAS  PubMed  Google Scholar 

  53. Williams TJ, Bowie PE. Midazolam sedation to produce complete amnesia for bronchoscopy: 2 years’ experience at a district general hospital. Respir Med 1999; 93:361–365.

    CAS  PubMed  Google Scholar 

  54. Matot I, Kramer MR, Glantz L, Drenger B, Cotev S. Myocardial ischemia in sedated patients undergoing fiberoptic bronchoscopy. Chest 1997; 112:1454–1458.

    CAS  PubMed  Google Scholar 

  55. Maître B, Jaber S, Maggiore SM, Bergot E, Richard JC, Bakthiari H, et al. Continuous positive airway pressure during fiberoptic bronchoscopy in hypoxemic patients. A randomized double-blind study using a new device. Am J Respir Crit Care Med 2000; 162:1063–1067.

    PubMed  Google Scholar 

  56. Veres J, Slavei K, Errhalt P, Seyr M, Ihra G. The Veres adapter: clinical experience with a new device for jet ventilation via a laryngeal mask airway during flexible bronchoscopy. Anesth Analg 2011; 112:597–600.

    PubMed  Google Scholar 

  57. Grendelmeier P, Kurer G, Pflimlin E, Tamm M, Stolz D. Feasibility and safety of propofol sedation in flexible bronchoscopy. Swiss Med Wkly 2011; 141:w13248.

    PubMed  Google Scholar 

  58. Yarmus LB, Akulian JA, Gilbert C, Mathai SC, Sathiyamoorthy S, Sahetya S, et al. Comparison of moderate versus deep sedation for endobronchial ultrasound transbronchial needle aspiration. Ann Am Thorac Soc 2013; 10:121–126.

    PubMed  PubMed Central  Google Scholar 

  59. Lin TY, Lo YL, Hsieh CH, Ni YL, Wang TY, Lin HC, et al. The potential regimen of target-controlled infusion of propofol in flexible bronchoscopy sedation: a randomized controlled trial. PLoS One 2013; 8:e62744.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol 2006; 101:2209–2217.

    Google Scholar 

  61. Rudner R, Jalowiecki P, Kawecki P, Gonciarz M, Mularczyk A, Petelenz M. Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy. Gastrointest Endosc 2003; 57:657–663.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Chest Medicine, Ain Shams University, Cairo, Egypt

    Hesham Raafat MD

  2. Department of Anesthesia, Ain Shams University, Cairo, Egypt

    Sameh Salem

  3. Department of Anesthesia, Mostafa Kamel Military Hospital, Alexandria, Egypt

    Mahmoud Abbas

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  1. Hesham Raafat MD
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  2. Mahmoud Abbas
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  3. Sameh Salem
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Correspondence to Hesham Raafat MD.

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Raafat, H., Abbas, M. & Salem, S. Comparison between bronchoscopy under general anesthesia using laryngeal mask airway and local anesthesia with conscious sedation: a patient-centered and operator-centered outcome. Egypt J Bronchol 8, 128–137 (2014). https://doi.org/10.4103/1687-8426.145707

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