Comparison of midazolam and midazolam-fentanyl combination for sedation in convex probe endobronchial ultrasound

Background: This study aims to investigate the sedative effects, possible side-effects, and impact on patient and bronchoscopist satisfaction of midazolam and midazolam-fentanyl combination in patients undergoing convex probe endobronchial ultrasound (CP-EBUS). Methods: Between May 1, 2011 and June 18, 2011, 50 consecutive patients (35 males, 15 females; mean age 51.6 +/- 14.6 years; range 17 to 79 years) admitted to our clinic for CP-EBUS for mediastinal or hilar staging or histological diagnosis were included in this prospective study. All patients underwent topical anesthesia with lidocaine. The patients were divided into two groups in the order of admittance. 2 mg of midazolam + 0.5 mu/kg with increasing doses of fentanyl was applied to the first 25 of the patients (group F) and 2 mg starting dose with increasing doses of midazolam was applied to the second 25 of the patients (group M). Before and after the procedure and during the procedure, oxygen saturation and hemodynamic variables of the patients, total duration of the procedure, and duration of procedure per aspirated lymph node and per aspiration were recorded. At the end of the procedure, amnesia level, satisfaction levels of the patients and bronchoscopist, repeatability of the procedure, cough, pain, and dyspnea were evaluated. The satisfaction level of the bronchoscopist during the procedure and sedation or procedure-related complications were also noted. Results: During the procedure, cough symptoms were significantly lower in group F than the group M (p<0.05). The patient and bronchoscopist satisfaction levels were significantly higher in the group F (p=0.007, p<0.001). The duration of the procedure per aspirated lymph node was significantly lower in F group (p<0.05). Minimum and maximum heart rate during and at the end of the procedure were significantly lower in group F compared to the group M (p<0.05). No significant difference in the level of amnesia was found between the two groups. Conclusion: The combination of fentanyl and midazolam shortens the duration of procedure and increases the patient and physician satisfaction compared to the use of midazolam alone without any significant difference in the rate of complications.