Abstract
Since 1996, we have used intravenous midazolam sedation for bronchoscopy and abandoned atropine premedication. We reviewed our experience and assessed the efficacy and safety of our methods. We studied 905 consecutive patients who underwent beonchoscopy from April 1999 to December 2002. Patients were given no premedication. The procedure consisted of; 1) indwelling intravenous catheter and 4% lidocaine spray. 2) Oxygen was supplied at 2l/min by nasal cannula. Oxygen saturation, pulse wave and possible arrhythmia were monitored with pulse oxymeter. 3) Administration of midazolam by slow injection; 0.07 mg/kg (≦59 years), 0.06 mg/kg (60-69), 0.05 mg/kg (70-79), 0.04 mg/kg (80≦). No reverse with flumazenil was done in principle. All bronchoscopies except 3 patients were completed. Those 3 patients were not sedated adequately. There was no termination of procedure due to respiratory depression and without atropine premedication. Awake from sedation was smooth and no problem with outpatients. In Germany rigid bronchoscopy and occasional flexible fiberscopy were performed under general anesthesia with propofol and fentanyl by management of anesthesiologist. Although bronchoscopy under general anesthesia is ideal, we recommend intravenous midazolam sedation for bronchoscopy through our experiences concerning with Japanese medical circumstances.
