A Prospective Analysis of the Efficacy and Complications Associated With Deep Sedation With Midazolam During Fiberoptic Bronchoscopy.

Background: Moderate sedation has been commonly used for fiberoptic bronchoscopy (FB). However, patients may find FB under moderate sedation to be unpleasant. We therefore examined whether deep sedation was a useful premedication for FB. Methods: We designed a prospective, randomized study using a patient questionnaire to address the perceptions of the procedures and complications of patients who underwent FB with deep sedation (deep sedation group) with midazolam in comparison with those who underwent FB with moderate sedation (moderate sedation group) with the same drug. Patients were asked to grade FB as being easy or difficult to tolerate. The primary endpoint was tolerability and the secondary endpoints included complications associated with the procedure. Results: A total of 80 patients were included in the study. A significantly lower number of patients in the deep sedation group reported that the technique was difficult to tolerate (5.0% vs. 40.0%, moderate sedation group; P < 0.001). However, the dose of oxygen required to maintain an oxygen saturation of >= 90% was higher in the deep sedation group (7.3 +/- 4.7 vs. 2.7 +/- 1.6 L/ min; P < 0.0001). There were no cases of prolonged oxygen desaturation or deaths related to FB in either group. Conclusion: In the present study, deep sedation had a beneficial effect on patient tolerance to FB. Although oxygen desaturation during FB represents a potentially serious complication, deep sedation may be considered to be a useful premedication for FB.