SEDATION FOR FIBER OPTIC BRONCHOSCOPY

Most current sedative regimens for fibre optic bronchoscopy use an opi oid, a benzodiazepine or a combination of both. This study compares mi dazolam (RI) (a benzodiazepine), alfentanil (A) (an opioid) and a comb ination of both drugs (M+A). One hundred and three patients were rando mized in double-blind manner into groups M(35), A(33) and M+A(35). The number of coughs, number of additional aliquots of lignocaine and dur ation of the procedures were recorded along with oxygen desaturation. The patient's level of discomfort was assessed by patient and bronchos copist and expressed as a visual analogue score. There were significan tly fewer coughs per minute in Group A compared with Group M (P=0.0053 ), and significantly less lignocaine was required in Group A (P=0.005) and in Groups M+A (P<0.002) compared with Group M. There was no signi ficant difference in the assessment of discomfort between the groups. There was a trend for Group M+A to desaturate more than the other two with a significant difference between desaturation in Group M+A and Gr oup A (P=0.033). Alfentanil is a more effective anti-tussive agent tha n midazolam for outpatient fibre optic bronchoscopy. The combination o f alfentanil and midazolam does not provide any better anti-tussive ef fect and may have the risk of a greater degree of desaturation seconda ry to increased sedation.