Background: The use of sedation during flexible bronchoscopy (FB) is undisputed; however, the combination of benzodiazepines and opiates, although reasonable, is suggested to cause hypoventilation, particularly in patients with pre-existing respiratory failure. Objectives: To assess respiratory function during FB. Methods: Transcutaneous PCO2 (PtcCO2), oxygen saturation, patients’ tolerance, time after FB until recovery and application of drug dosage were assessed in patients receiving either midazolam with alfentanil (n = 15) or midazolam alone (n = 15) for sedation for FB. Results: There were no differences in PtcCO2 values during FB between the two groups (all p > 0.05). However, PtcCO2 significantly increased over time in both groups (both p < 0.001; RM-ANOVA on ranks). Minimum oxygen saturation (SaO2) [89 (interquartile range 79.8/92.8) vs. 86 (interquartile range 82.3/87.8)%; p = 0.46] and the duration until recovery, i.e., achieving an ALDRETE score of ≧9 [30 (interquartile range 10/90) vs. 10 (interquartile range 10/105) min; p = 0.68] were comparable for monosedation and combined sedation, respectively. The total amount of midazolam [4.0 (interquartile range 4.0/4.0) vs. 2.0 (interquartile range 2.0/2.0) mg; p < 0.001] was lower in patients receiving combined sedation. Significantly lower scores for pain and asphyxia, and a clear tendency to less nausea and cough were reported by patients receiving combined sedation. Conclusions: Combined sedation during FB produced a comparable degree of desaturation and hypoventilation, and is associated with a comparable time to full recovery compared to monosedation in patients with pre-existing respiratory failure. Importantly, FB using combined sedation is better tolerated by patients despite only 50% midazolam consumption.

British Thoracic Society Bronchoscopy Guidelines Committee: British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax 2001;56(suppl 1):i1–i21.
Prakash UB, Offord KP, Stubbs SE: Bronchoscopy in North America: the ACCP survey. Chest 1991;100:1668–1675.
Maguire GP, Rubinfeld AR, Trembath PW, Pain MC: Patients prefer sedation for fibreoptic bronchoscopy. Respirology 1998;3:81–85.
Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A: Patient satisfaction with conscious sedation for bronchoscopy. Chest 1999;115:1437–1440.
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.
Hatton MQ, Allen MB, Vathenen AS, Mellor E, Cooke NJ: Does sedation help in fibreoptic bronchoscopy? BMJ 1994;309:1206–1207.
Shelley MP, Wilson P, Norman J: Sedation for fibreoptic bronchoscopy. Thorax 1989;44:769–775.
Sury MR, Cole PV: Nalbuphine combined with midazolam for outpatient sedation. An assessment of safety in volunteers. Anaesthesia 1988;43:281–284.
Jantz MA: The old and the new of sedation for bronchoscopy. Chest 2009;135:4–6.
Silvestri GA, Vincent BD, Wahidi MM, Robinette E, Hansbrough JR, Downie GH: A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy. Chest 2009;135:41–47.
Mak PHK, Campbell RCH, Irwin MG: The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensive Care 2002;30:633–640.
Aldrete JA: The post-anesthesia recovery score revisited. J Clin Anesth 1995;7:89–91.
Nishiyama T, Nakamura S, Yamashita K: Comparison of the transcutaneous oxygen and carbon dioxide tension in different electrode locations during general anaesthesia. Eur J Anaesthesiol 2006;23:1049–1054.
Chhajed PN, Rajasekaran R, Kaegi B, Chhajed TP, Pflimlin E, Leuppi J, Tamm M: Measurement of combined oximetry and cutaneous capnography during flexible bronchoscopy. Eur Respir J 2006;28:386–390.
Evans EN, Ganeshalingam K, Ebden P: Changes in oxygen saturation and transcutaneous carbon dioxide and oxygen levels in patients undergoing fibreoptic bronchoscopy. Respir Med 1998;92:739–742.
Greig JH, Cooper SM, Kasimbazi HJ, Monie RD, Fennerty AG, Watson B: Sedation for fibre optic bronchoscopy. Respir Med 1995;89:53–56.
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