In the study group, induction was started using alfentanil 4~5μg/kg bolus following repeated propofol boluses (0.5~1.5 mg/kg) until the BIS level reached 70. During maintenance, propofol infusion (3~12 mg/kg/hour) was given using a syringe pump (Injectomat Agilia, Fresenius Kabi, France), which was titrated to keep the BIS level between 65 and 75.

In the control group, induction was started using alfentanil 4~5μg/kg bolus following 2 mg midazolam bolus. After 2 minutes, if the patient was not well sedated, midazolam boluses were repeat by increments of 2 mg/2min until conscious sedation was achieved

BIS-guided Propofol Infusion

In the control group, induction was started using alfentanil 4~5μg/kg bolus following 2 mg midazolam bolus. After 2 minutes, if the patient was not well sedated, midazolam boluses were repeat by increments of 2 mg/min until conscious sedation was achieved

Clinical-judged Midazolam Administration

Total

Sex: Female, Male

Region of Enrollment

The hypoxemia event is defined as that when the oxyhemoglobin (SpO2) was less than 90% with any duration during the flexible bronchoscopy.

The Number of Participants With Any Hypoxemia Event During Flexible Bronchoscopy

The event of hypotension: when the systolic blood pressure (SBP) was less than 90mmHg with any duration.

The Number of Participants With Any Hypotension Event During Flexible Bronchoscopy

"Procedure interference by patients' movement" was when the bronchoscopist had to stop the procedure temporarily and our assistant had to hold down the irritant patient

The Number of Participants Causing Any Procedure Interference by the Patients' Movement During Flexible Bronchoscocopy

"Procedure interference by cough" was when the bronchoscopist had to stop the procedure temporarily and additional xylocaine spray and/or alfentanil had to be given to stop the cough.

The Number of Participants Causing Any Procedure Interference by Cough

The time to orientation defined as the time between finishing flexible bronchoscopy to the moment when patients could open their eyes spontaneously, could recall their date of birth, and perform a finger-nose test correctly

The Recovery Time to Orientation

The global tolerance of the entire procedure was evaluated on a 10-point verbal analogous scale (VAS, 0: no bother, 10: worst intolerable).

The Global Tolerance for Flexible Bronchoscopy by Verbal Analogus Scale

The recovery time to ambulation defined as the time between finishing flexible bronchoscopy to the moment when patients could walk without assistance.

The Recovery Time to Ambulation

Patients were asked their willingness to return for another FB if needed by means of a five-point scale (definitely not, probably not, unsure, probably would, and definitely would return). Both "probably would", and "definitely would return" were defined as patients agreed to return.

Patients Willing Return if Repeated Bronchoscopy is Indicated.

Overall Study

Ting-Yu Lin

Flexible Bronchoscopy

Induction:
Alfentanil: 5μg/kg slowly push. Propofol: 0.5-1.5mg/kg slowly push till BIS value 70.
Maintenance:
Propofol infusion (3~12 mg/kg/hour) to maintain BIS around 65~75. Alfentanil: 5μg/kg slowly push Q15min prn if severe cough.

Bispectral index guide propofol infusion

Induction:
Alfentanil: 5μg/kg slowly push. Midazolam: 2 mg slowly push followed by increments of 2 mg/ 2min till OAA/S* 2~3.
Maintenance:
Midazolam: 2 mg/ 2min prn to keep OAA/S* 2~3 or if intolerance of procedure. Alfentanil as study arm.
*Observer's assessment of alertness/sedation (OAA/S):
Class 5: Responds readily to name spoken in normal tone.
Class 4: Lethargic response to name called in normal tone.
Class 3: Responds only to name called loudly.
Class 2: Responds only to shaking.
Class 1: No response to shaking.

Clinical-judged midazolam administration

Division of Thoracic Medicine, Chang Gung Memorial Hospital

Bispectral Index-guided Sedation for Flexible Bronchoscopy

Sedation for Flexible Bronchoscopy and Real Time Endobronchial Ultrasound -A Comparison Between Bispectral Index-guided Sedation and Conventional Sedation

butyric acid/hypoxia

Bispectral Index-guided Sedation for Flexible Bronchoscopy

Piracetam for Treatment Tardive Dyskinesia

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