Analysis of the Utility and Safety of Bronchoscopy Performed in Combination with Sedatives and Local Anesthesia

Abstract

Background. Sedation for bronchoscopy reduces pain, although there is a risk of respiratory depression, and understanding how to clarify the aspects of pleural pain during transbronchial brushing and/or biopsy remains limited. Subjects and Methods. We retrospectively analyzed the utility and safety of local anesthesia and combination treatment with sedatives and local anesthesia among patients in whom transbronchial brushing and/or a biopsy was performed between September 2004 and September 2014 at our institution. Both groups underwent nebulizer inhalation of 4% lidocaine at a dose of 10 ml, with midazolam added in the sedative combination group. We administered 2.5 mg of midazolam and an additional 2.5 mg of midazolam in cases of insufficient sedation. Bronchoscopy was performed after confirming sedation. We analyzed the number of samples unsuitable for diagnosis and the incidence of adverse events, and the degree of pain was classified into five levels in the two groups. Results. The local anesthesia group included 192 cases, and the sedative combination group included 211 cases. The number of samples unsuitable for diagnosis was not significantly different between the two groups. The rates of adverse reactions were also similar in both groups. There were three cases of pneumothorax in the local anesthesia group (1.56%) and two cases in the sedative combination group (0.95%). There was one case of pneumonia in the local anesthesia group (0.52%) and three cases in the sedative combination group (1.42%). In the sedative combination group, there was one case of hypotension (0.47%). The amount of oxygen supplementation and decrease in percutaneous oxygen saturation were greater in the sedative combination group than in the local anesthesia group. The patient's pain was significantly diminished by using sedatives in addition to local anesthesia. Conclusions. Although bronchoscopy using sedatives in addition to local anesthesia requires monitoring of changes in the patient's respiratory condition, it is possible to obtain a suitable sample for diagnosis, taking advantage of reducing pain.