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PROPOFOL AND REMIFENTANIL SEDATION FOR BRONCHIAL THERMOPLASTY
10
INTRODUCTION
Bronchial thermoplasty (BT) is a novel bronchoscopic treatment for moderate-to-severe
asthma patients that has been shown to improve quality of life and to reduce asthma
symptoms and exacerbation rates.
1–3
Although the mechanism of action of BT is largely
unknown, there is evidence that BT reduces airway smooth muscle mass.
4,5
A complete
BT treatment consists of 3 consecutive bronchoscopic procedures during which airways
of the left lower lobe, right lower lobe, and finally both upper lobes are treated. During BT
treatment, radiofrequent energy is delivered to the larger airways by a 4-strut expandable
basket catheter that heats the surrounding tissue during 10 s to 65°C, a so-called activation.
6
On average, between ~50 and ~75 activations are delivered to treat all reachable airways
with a diameter of 3–10 mm.
Because BT treatment is performed in severe asthma patients with highly reactive
airways, and because BT procedures are time-consuming and require high precision,
these treatments were initially performed under general anaesthesia.
3
To date, there is
a large variety of sedation forms used during BT procedures. Martin et al.
7
reported mild
sedation with midazolam and fentanyl. Lee et al.
8
described monitored anaesthesia care
with dexmedetomidine. Other strategies included deep propofol sedation or general
anaesthesia requiring tracheal intubation or laryngeal mask insertion.
9
The drawbacks
of mild midazolam sedation are cough and patient discomfort
10
for an interventional
procedure which needs to be performed 3 times. On the other end of the spectrum,
general anaesthesia with intubation could be seen as overtreatment, since this is more
invasive, is associated with higher complication risks, including haemodynamic instability,
and requires a more complex infrastructure with higher costs. Propofol and remifentanil
sedation have been known to be safe and feasible for standard flexible bronchoscopies,
thoracoscopies, and other bronchoscopic procedures, including endobronchial ultrasound
bronchoscopy.
11–14
Considering the above, with the current implementation of BT, there
is an unmet need for a feasible, safe, and cost-effective sedation method for BT with high
patient and bronchoscopist satisfaction. In this study, we evaluatedwhether for BTmoderate
sedation with target-controlled infusion (TCI) of propofol combined with remifentanil
provided by specialised sedation anaesthesiology nurses is feasible, safe, and satisfying –
for both, patients and bronchoscopists.
METHODS
Study design
The current sedation study is an observational cohort study within the Unravelling Targets
of Therapy in Bronchial Thermoplasty in Severe Asthma (TASMA) trial (ClinicalTrials.gov, No.