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Chapter 10
ABSTRACT
Background
: Bronchial thermoplasty (BT) is a rapidly emerging bronchoscopic treatment for
patients with moderate-to-severe asthma. Different sedation strategies are currently used,
ranging frommildmidazolam sedation to general anaesthesia requiring tracheal intubation.
Objectives
: The aim of this study was to assess the feasibility, safety, and both, patients’ and
bronchoscopists’ satisfaction with propofol and remifentanil sedation administered by
specialised sedation anaesthesiology nurses during BT in severe asthma patients.
Methods
: A prospective observational cohort study in BT-treated severe asthma patients
of the TASMA trial was designed. Patients were asked to rate their overall BT procedure
satisfaction and tolerance with propofol/remifentanil sedation using a visual analogue scale
(VAS) ranging from0 to 10. Similarly, bronchoscopists were asked to rate patient cooperation
and tolerance. Sedation-associated adverse events and the number of BT activations were
recorded.
Results
: Thirty-two BT procedures in 13 severe asthma patients were performed under
moderate target-controlled infusion (TCI) propofol/remifentanil sedation. Patients’ median
VAS scores (median (interquartile range (IQR)) were as follows: overall satisfaction 9.6 (IQR
8.5–10.0), dyspnea 0.0 (IQR 0.0–0.6), pain 0.1 (IQR 0.0–1.0), cough 0.5 (IQR 0.0–2.1), and
anxiety 0.1 (IQR 0.0–0.7). Bronchoscopists’ median VAS scores (median (interquartile range
(IQR)) were as follows: overall patient cooperation 9.1 (IQR 8.5–9.6), dyspnea 0.3 (IQR 0.0-0.9),
pain 0.2 (IQR 0.0–1.3), cough 1.2 (IQR 0.7–2.0), and discomfort 0.6 (IQR 0.3–1.5). All patients
were willing to undergo the procedure again and would recommend this form of sedation
to their best friend. One case of conversion to general anaesthesia occurred. No serious
adverse events were reported.
Conclusions
: Moderate sedation with propofol and remifentanil TCI provided by specialised
sedation anaesthesia nurses is feasible and safe and results in high satisfaction rates of both,
patients and bronchoscopists.