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. 2004 Sep;59(9):773–776. doi: 10.1136/thx.2003.019836

Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: a randomised, double blind, placebo controlled trial

D Stolz 1, P Chhajed 1, J Leuppi 1, M Brutsche 1, E Pflimlin 1, M Tamm 1
PMCID: PMC1747138  PMID: 15333854

Abstract

Background: Current British Thoracic Society guidelines do not recommend routinely the combined use of a benzodiazepine and opiate during flexible bronchoscopy (FB). A randomised, placebo controlled, double blind study was undertaken to determine whether hydrocodone in combination with midazolan improves cough suppression during FB without increasing the risk of desaturation.

Methods: 120 patients were randomised to receive midazolam and 5 mg IV hydrocodone or midazolam and placebo with topical anaesthesia. Pulse oximetry was recorded continuously during FB. Bronchoscopists and nurses charted their perception of cough and the patients rated their discomfort during the procedure on a 10 cm visual analogue scale (VAS).

Results: There was no significant difference between the two groups with regard to the indication for FB, duration of procedure (21 (11) min v 22 (10) min, p = 0.570), doses of supplemental lignocaine (171 (60) mg v 173 (66) mg, p = 0.766) and midazolam (4.5 (2.3) mg v 4.9 (2.7) mg, p = 0.309), lowest oxygen saturation (94.8 (2.7) v 94.9 (2.7), p = 0.433), and desaturations ⩽90%. Perception of cough by both the bronchoscopist and the nurse was significantly lower in the hydrocodone group (3 (0–10) and 3 (0–10)) than in the placebo group (6 (0–10) and 6 (0–10)), respectively (p = 0.001). According to the VAS scale, patients' tolerance was also significantly better with hydrocodone than with placebo (2 (0–8) v 3 (0–9), p = 0.043).

Conclusion: The combination of midazolam and hydrocodone markedly reduces cough during FB without causing significant desaturation, especially when invasive diagnostic procedures are performed.

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Selected References

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  1. Bright E., Roseveare C., Dalgleish D., Kimble J., Elliott J., Shepherd H. Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine. Endoscopy. 2003 Aug;35(8):683–687. doi: 10.1055/s-2003-41519. [DOI] [PubMed] [Google Scholar]
  2. Chhajed Prashant N., Aboyoun Christina, Malouf Monique A., Hopkins Peter M., Plit Marshall, Grunstein Ronald R., Glanville Allan R. Management of acute hypoxemia during flexible bronchoscopy with insertion of a nasopharyngeal tube in lung transplant recipients. Chest. 2002 Apr;121(4):1350–1354. doi: 10.1378/chest.121.4.1350. [DOI] [PubMed] [Google Scholar]
  3. Chhajed Prashant N., Glanville Allan R. Management of hypoxemia during flexible bronchoscopy. Clin Chest Med. 2003 Sep;24(3):511–516. doi: 10.1016/s0272-5231(03)00050-9. [DOI] [PubMed] [Google Scholar]
  4. EDDY N. B., HALBACH H., BRAENDEN O. J. Synthetic substances with morphine-like effect: clinical experience; potency, side-effects, addiction liability. Bull World Health Organ. 1957;17(4-5):569–863. [PMC free article] [PubMed] [Google Scholar]
  5. Gonzalez R., De-La-Rosa-Ramirez I., Maldonado-Hernandez A., Dominguez-Cherit G. Should patients undergoing a bronchoscopy be sedated? Acta Anaesthesiol Scand. 2003 Apr;47(4):411–415. doi: 10.1034/j.1399-6576.2003.00061.x. [DOI] [PubMed] [Google Scholar]
  6. Greig J. H., Cooper S. M., Kasimbazi H. J., Monie R. D., Fennerty A. G., Watson B. Sedation for fibre optic bronchoscopy. Respir Med. 1995 Jan;89(1):53–56. doi: 10.1016/0954-6111(95)90071-3. [DOI] [PubMed] [Google Scholar]
  7. Hattotuwa Keith, Gamble Elizabeth A., O'Shaughnessy Terence, Jeffery Peter K., Barnes Neil C. Safety of bronchoscopy, biopsy, and BAL in research patients with COPD. Chest. 2002 Dec;122(6):1909–1912. doi: 10.1378/chest.122.6.1909. [DOI] [PubMed] [Google Scholar]
  8. Homsi J., Walsh D., Nelson K. A. Important drugs for cough in advanced cancer. Support Care Cancer. 2001 Nov;9(8):565–574. doi: 10.1007/s005200100252. [DOI] [PubMed] [Google Scholar]
  9. Homsi J., Walsh D., Nelson K. A., LeGrand S. B., Davis M. Hydrocodone for cough in advanced cancer. Am J Hosp Palliat Care. 2000 Sep-Oct;17(5):342–346. doi: 10.1177/104990910001700512. [DOI] [PubMed] [Google Scholar]
  10. Kamei Junzo. Delta-opioid receptor antagonists as a new concept for central acting antitussive drugs. Pulm Pharmacol Ther. 2002;15(3):235–240. doi: 10.1006/pupt.2002.0350. [DOI] [PubMed] [Google Scholar]
  11. Matot I., Kramer M. R. Sedation in outpatient bronchoscopy. Respir Med. 2000 Dec;94(12):1145–1153. doi: 10.1053/rmed.2000.0926. [DOI] [PubMed] [Google Scholar]
  12. Mendes de Leon C., Bezel R., Karrer W., Brändli O. Die Prämedikation bei der Fiberbronchoskopie aus der Sicht von Patient und Arzt--eine randomisierte Studie zum Vergleich von Midazolam und Hydrocodonum. Schweiz Med Wochenschr. 1986 Sep 13;116(37):1267–1272. [PubMed] [Google Scholar]
  13. Pickles J., Jeffrey M., Datta A., Jeffrey A. A. Is preparation for bronchoscopy optimal? Eur Respir J. 2003 Aug;22(2):203–206. doi: 10.1183/09031936.03.00118302. [DOI] [PubMed] [Google Scholar]
  14. Putinati S., Ballerin L., Corbetta L., Trevisani L., Potena A. Patient satisfaction with conscious sedation for bronchoscopy. Chest. 1999 May;115(5):1437–1440. doi: 10.1378/chest.115.5.1437. [DOI] [PubMed] [Google Scholar]
  15. Smyth C. M., Stead R. J. Survey of flexible fibreoptic bronchoscopy in the United Kingdom. Eur Respir J. 2002 Mar;19(3):458–463. doi: 10.1183/09031936.02.00103702. [DOI] [PubMed] [Google Scholar]
  16. Sury M. R., Cole P. V. Nalbuphine combined with midazolam for outpatient sedation. An assessment in fibreoptic bronchoscopy patients. Anaesthesia. 1988 Apr;43(4):285–288. doi: 10.1111/j.1365-2044.1988.tb08974.x. [DOI] [PubMed] [Google Scholar]
  17. Tsunezuka Y., Sato H., Tsukioka T., Nakamura Y., Watanabe Y. The role of codeine phosphate premedication in fibre-optic bronchoscopy under insufficient local anaesthesia and midazolam sedation. Respir Med. 1999 Jun;93(6):413–415. doi: 10.1053/rmed.1999.0585. [DOI] [PubMed] [Google Scholar]
  18. Turturro M. A., Paris P. M., Yealy D. M., Menegazzi J. J. Hydrocodone versus codeine in acute musculoskeletal pain. Ann Emerg Med. 1991 Oct;20(10):1100–1103. doi: 10.1016/s0196-0644(05)81383-6. [DOI] [PubMed] [Google Scholar]
  19. Walsh D., Doona M., Molnar M., Lipnickey V. Symptom control in advanced cancer: important drugs and routes of administration. Semin Oncol. 2000 Feb;27(1):69–83. [PubMed] [Google Scholar]
  20. Webb A. R., Doherty J. F., Chester M. R., Cummin A. R., Woodhead M. A., Nanson E. M., Flack S. T., Millard F. J. Sedation for fibreoptic bronchoscopy: comparison of alfentanil with papaveretum and diazepam. Respir Med. 1989 May;83(3):213–217. doi: 10.1016/s0954-6111(89)80034-4. [DOI] [PubMed] [Google Scholar]

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