Susanne Eberl

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PROPOFOL AND REMIFENTANIL SEDATION FOR BRONCHIAL THERMOPLASTY

on the vocal cords and the tracheal mucosa for local anaesthesia. This local anaesthesia

administration was repeated every 10–15 min, or when the patient started coughing with

a maximum of 8.2 mg/kg.

During bronchoscopy, close communication between the

bronchoscopist and the anaesthesia nurse was secured. In case of a desaturation, measures

were taken, such as chin lift/jaw thrust, stimulating the patient to take a deep breath,

temporary mask ventilation, or intubation. After the procedure, patients were transferred

to the recovery room as soon as they reached a stable respiratory and haemodynamic state

with oxygen saturation (SpO

) of > 92% without oxygen.

BT procedure and monitoring

Thirty minutes before the procedure, patients were nebulised with 0.5 mg/2.5 mg

ipratropium/salbutamol, respectively. BT procedures were performed with flexible

bronchoscopes (Olympus Tokyo, Japan) and with the ALAIR system (Boston Scientific,

Natick, MA, USA), which automatically measures the number of successful activations per

BT procedure. During the procedure, 2 l/min of oxygen was administered by the Smart

Capnoline (Medtronic Trading NL B.V., Eindhoven, the Netherlands), which enables exhaled

carbon dioxide monitoring and nasal delivery of oxygen simultaneously. Patients were

constantly monitored by specialised sedation anaesthesia nurses for heart rate, respiratory

rate, SpO

, electrocardiogram, non-invasive blood pressure, and exhaled carbon dioxide

measured continuously and recorded at 5-min intervals.

Primary endpoint

The primary endpoint was satisfaction of patients and bronchoscopists. Patients were

asked to rate their overall satisfaction by using a 10-cm visual analogue scale (VAS) (0 =

“unbearable”, 10 = “excellent”) as well as degree of dyspnea, pain, cough, and anxiety (0

= “no complaints at all”, 10 = “enormously”) after they were fully awake. After the third BT

procedure, patients were asked, if they would be willing to undergo the entire procedure

again under the same conditions, and if they would recommend this form of sedation to

their best friend. Similarly, directly after every BT procedure, the bronchoscopists were asked

to score their satisfaction with sedation by rating the following aspects via a 10-cm VAS:

patient overall cooperation (0 = “unmanageable”, 10 = “excellent”) and estimated degree

of dyspnea, pain, cough, and discomfort for the patient (0 = “no complaints at all”, 10 =

“enormously”).