134 / 242
134
Chapter 10
were restored with administration of intravenous ephedrine. No other adverse events were
encountered.
Table 4.
Observer Assessment of Alertness/Sedation score
5
Responds readily to name spoken in normal tone
1 (3%)
4
Lethargic response to name spoken in normal tone
15 (48%)
3
Responds only after name is spoken loudly or rapidly, or both
13 (42%)
2
Responds only after mild prodding or shaking
1 (3%)
1
Does not respond to mild prodding or shaking
1 (3%)
0
Does not respond to noxious stimulus
1 (3%)
Table 5.
Adverse events (n=32)
Serious adverse events
0
Adverse events
6
Desaturation (SpO
2
< 90% for at least 30 s)
a
4
Hypotension (need for ephedrine)
2
Hypertension
0
Other
0
Values are numbers. SpO
2
, oxygen saturation.
a
One case of desaturation required conversion to general anaesthesia.
DISCUSSION
In this studywe showed thatmoderate sedationwith propofol and remifentanil TCI provided
by specialised sedation anaesthesia nurses for BT in high-risk severe asthma patients is safe
and feasible with high satisfaction rates for both, patients and bronchoscopists. Therefore,
this sedation strategy might qualify as an optimal strategy for BT since it has a fine balance
between under- and oversedation that obviates the need for an anaesthesiologist to be
present in the endoscopy suite. To our knowledge, we are the first to report on this specific
sedation strategy successfully applied during BT procedures.
Propofol and remifentanil sedation has been known to be safe and feasible for standard
flexible bronchoscopies, thoracoscopies, and other bronchoscopic procedures, including
endobronchial ultrasound bronchoscopy.
11–14
Several factors contribute to the importance
of optimal sedation for BT treatment in particular. First, BT procedures require high precision
and last longer (43–58 min in total in this study) than diagnostic bronchoscopies. Second,
they are performed in patients with highly reactive airways, which involve an increased
risk of developing laryngospasm and bronchospasm during bronchoscopy.
20,21
Every
single activation during a BT represents a strong mechanical manipulation of the bronchial
mucosal wall that contributes to an increased risk of adverse events. Finally, the complete