Safety and efficacy of using a combination of midazolam and fentanyl in comparison to midazolam only during flexible bronchoscopy

BackgroundBronchoscopy is sometimes stressful in cases where there may be anxiety related to discomfort, breathing problems, or other potential complications. Various sedatives, such as benzodiazepines, opioids, and dexmedetomidine, have been utilized. The objective of this work is to study and compare the safety and efficacy of flexible Bronchoscopy sedation using incremental midazolam versus combined midazolam/fentanyl.MethodsA prospective study was done on 60 cases from March 2023 to February 2024. Eligible patients are randomized to two groups: either sedation with midazolam or midazolam combined with fentanyl. Vital parameters like pulse rate, non-invasive blood pressure, and SpO2 levels were recorded before beginning the procedure, again at the fifth and fifteenth minute during the procedure, and 10 min after completion of the procedure. Patient-reported tolerance, satisfaction, and physician-reported feasibility of the procedure were assessed using a post-bronchoscopy questionnaire.ResultsNinety percent of cases in the midazolam group (group A) and 73% of cases in the fentanyl and midazolam group (group B) were satisfied with the procedure. In both groups, the majority of patients were not bothered by local anesthesia or by bronchoscope insertion or its passage through the vocal cords. Breathing difficulty, cough, or pain during the procedure were evenly endured. Twenty-one patients in both groups reported willing to repeat the procedure in the future. Adding Fentanyl to midazolam showed no significant improvement.ConclusionBronchoscopy is generally a safe procedure with a low risk of serious complications. The addition of conscious sedation to bronchoscopy made the procedure satisfactory. Patient satisfaction and procedural tolerability were equal in both midazolam and midazolam-fentanyl.