Conscious Sedation Reduces Patient Discomfort and Improves Satisfaction in Flexible Bronchoscopy

Background: Conscious sedation for patients undergoing flexible bronchoscopy (FB) issuggested to alleviate discomfort and improve satisfaction despite controversyregarding its benefits. In Taiwan, the general FB practice involves localanesthesia only. This study aimed to assess the benefits and risks of conscioussedation in diagnostic FB.Methods: This prospective case control study enrolled 44 non-sedated and 44 sedatedpatients who underwent diagnostic FB. All received the standard upper airwaypreparation, while sedated patients received clinically judged incrementsof midazolam and alfentanil for conscious sedation. Patient discomfortsand the operator’s opinions during FB were assessed using the verbalanalogue score (VAS, 0-10 scale). Willingness to return was assessed as fivescales to monitor patient satisfaction. Safety profiles throughout the procedureswere also assessed.Results: Compared to non-sedated patients, sedated ones expressed less discomfort,with lower VAS scores regarding scope insertion (3.5 [0-10] vs. 0 [0-5], p <0.001), cough (5 [0-10] vs. 0 [0-5], p < 0.001), dyspnea (3 [0-10] vs. 0 [0-8],p < 0.001), pain (3 [0-10] vs. 0 [0-5], p < 0.001), and global tolerance of theprocedures (5 [1-10] vs. 0 [0-9], p < 0.001). More sedated patients expressedwillingness to return (70.5% vs. 36.4%, p = 0.001). The bronchoscopist alsorated lower VAS scores on cough and dyspnea in sedated patients. Sedatedpatients had less hypertension but more hypoxemic episodes during the procedure,which were all transient and not life-threatening.Conclusions: Conscious sedation with clinically judged midazolam and alfentanil reducesdiscomforts, improves satisfaction, and carries slight, but manageable,hypoxemia risks in patients undergoing FB.