Conscious sedation reduces patient discomfort and improves satisfaction in flexible bronchoscopy

Background: Conscious sedation for patients undergoing flexible bronchoscopy (FB) is suggested to alleviate discomfort and improve satisfaction despite controversy regarding its benefits. In Taiwan, the general FB practice involves local anesthesia only. This study aimed to assess the benefits and risks of conscious sedation in diagnostic FB. Methods: This prospective case control study enrolled 44 non-sedated and 44 sedated patients who underwent diagnostic FB. All received the standard upper airway preparation, while sedated patients received clinically judged increments of midazolam and alfentanil for conscious sedation. Patient discomforts and the operator's opinions during FB were assessed using the verbal analogue score (VAS, 0-10 scale). Willingness to return was assessed as five scales to monitor patient satisfaction. Safety profiles throughout the procedures were 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 the procedures (5 [1-10] vs. 0 [0-9], p < 0.001). More sedated patients expressed willingness to return (70.5% vs. 36.4%, p = 0.001). The bronchoscopist also rated lower VAS scores on cough and dyspnea in sedated patients. Sedated patients 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 reduces discomforts, improves satisfaction, and carries slight, but manageable, hypoxemia risks in patients undergoing FB.