A Comparison of Pethidine Hydrochloride Alone and Midazolam Plus Pethidine Hydrochloride for Bronchoscopic Sedation - a Post Hoc Analysis with a Questionnaire

• Published in: The Journal of the Japan Society for Respiratory Endoscopy Vol. 43; no. 2; pp. 103 - 111
• Main Authors: Terada, Jiro, Shikano, Kohei, Hino, Aoi, Maeda, Takashi, Kasai, Hajime, Shionoya, Yu, Tatsumi, Koichiro, Saito, Go, Fujimoto, Kazushi, Ishiwata, Tsukasa
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Respiratory Endoscopy 25.03.2021; 特定非営利活動法人 日本呼吸器内視鏡学会
• Subjects: Bronchoscopy; Midazolam; Pethidine; Sedation; ペチジン; ミダゾラム; 気管支鏡; 鎮静
• ISSN: 0287-2137; 2186-0149
• DOI: 10.18907/jjsre.43.2_103

Background. The difference in the efficacy and safety of pethidine hydrochloride alone (P group) and pethidine combined with midazolam (M+P group) for bronchoscopic sedation is unclear. Methods. We used a questionnaire to investigate the tolerability of reexamination with bronchoscopy for 209 patients undergoing inpatient bronchoscopy at our hospital between September 2015 and March 2017. In this study, the patients were divided into two groups: P and M+P groups. The patients' background characteristics, diagnosis rate, complications, and questionnaire responses were reanalyzed as a post hoc analysis. Results. Of the total 209 cases, the P group comprised 81 (39%) cases, and the M+P group comprised 128 (61%) cases. Significant differences were not noted in the diagnosis rate (65% vs 73%, p=0.21) or incidence of complications (14% vs 12%, p=0.67) between the P and M+P groups. The questionnaire responses indicated that the M+P group had significantly lower levels of distress than the P group (2.2±1.1 vs 2.9±1.2, p<0.001), the procedure was less painful than expected (2.0±1.0 vs 2.6±1.3, p<0.001) and the re-examination was better tolerated (2.5±1.3 vs 3.0±1.3, p=0.010). With respect to experiencing distress during the test, a greater number of respondents in the M+P group than in the P group stated that they were not distressed (35% vs 51%, p=0.02). Cough was cited as the most common cause of distress experienced by subjects in the P group (23%), while many subjects in the M+P group listed the pre-examination pharyngeal anesthesia as a cause of distress (29%). Conclusion. The tolerability and safety of sedation using a combination of midazolam and pethidine in bronchoscopy are similar to those of midazolam and fentanyl sedation reported previously in a prospective intervention study in Japan; thus, the use of a combination of midazolam and pethidine is considered a powerful sedation method.