RT Journal Article
SR Electronic
T1 A randomised study of comfort during bronchoscopy comparing conscious sedation and anaesthetist controlled general anaesthesia, including the utility of Bispectral Index (BIS) monitoring
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00895-2020
DO 10.1183/23120541.00895-2020
A1 Thomas R. Skinner
A1 Joseph Churton
A1 Timothy P. Edwards
A1 Farzad Bashirzadeh
A1 Christopher Zappala
A1 Justin T. Hundloe
A1 Hau Tan
A1 Andrew J. Pattison
A1 Maryann Todman
A1 Gunter F. Hartel
A1 David I. Fielding
YR 2021
UL http://openres.ersjournals.com/content/early/2021/03/26/23120541.00895-2020.abstract
AB Background The difference in patient comfort with conscious sedation (CS) versus general anaesthesia (GA) for bronchoscopy has not been adequately assessed in a randomised trial. This study aimed to assess if patient comfort during bronchoscopy with CS is non-inferior to GA.Methods 96 subjects were randomized to receive CS or GA for bronchoscopy. The primary outcome was subject comfort. Secondary outcomes included: Willingness to undergo a repeat procedure if necessary andlevel of sedation assessed clinically and by Bispectral Index (BIS) monitoring.Results There was no significant difference between subject comfort scores (difference −0.01 (95% CI −0.63, 0.61 on a 10 point scale,, p=0.97) or willingness to undergo a repeat procedure (97.7% versus 91.8%, (95% CI −4.8%, 15.5%); p=0.37). Deeper levels of sedation in the GA cohort was confirmed with both clinical and BIS. There was no significant difference in diagnostic accuracy (CS: 93.9% (95% CI 80.4%, 98.3%) versus GA: 86.5% (95% CI 72.0%, 94.1%); p=0.43). There were more complications (29.6% (95% CI 18.2%, 44.2%) versus 6.1% (95% CI 2.1%, 16.5%); p<0.01) in the GA group. There was no relationship between high BIS scores and subject discomfort. BIS levels of less than 40 during a procedure was associated with increased complications.Conclusion CS is not inferior to GA in providing patient comfort during bronchoscopy despite lighter sedation and is associated with fewer complications and comparable diagnostic accuracy. BIS monitoring may have a role in preventing complications associated with deeper sedation.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Skinner has nothing to disclose.Conflict of interest: Dr. Churton has nothing to disclose.Conflict of interest: Dr. Edwards has nothing to disclose.Conflict of interest: Dr. Bashirzadeh has nothing to disclose.Conflict of interest: Dr. Zappala has nothing to disclose.Conflict of interest: Dr. Tan has nothing to disclose.Conflict of interest: Dr. Pattison has nothing to disclose.Conflict of interest: Clinical Nurse M Todman has nothing to disclose.Conflict of interest: Dr. Hartel has nothing to disclose.Conflict of interest: Dr. Fielding has nothing to disclose.