• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of thoraxThoraxVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Thorax. Sep 2004; 59(9): 773–776.
PMCID: PMC1747138

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

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 [less-than-or-eq, slant]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.

Full Text

The Full Text of this article is available as a PDF (72K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Pickles J, Jeffrey M, Datta A, Jeffrey AA. Is preparation for bronchoscopy optimal? Eur Respir J. 2003 Aug;22(2):203–206. [PubMed]
  • 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. [PubMed]
  • Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A. Patient satisfaction with conscious sedation for bronchoscopy. Chest. 1999 May;115(5):1437–1440. [PubMed]
  • Matot I, Kramer MR. Sedation in outpatient bronchoscopy. Respir Med. 2000 Dec;94(12):1145–1153. [PubMed]
  • Greig JH, Cooper SM, Kasimbazi HJ, Monie RD, Fennerty AG, Watson B. Sedation for fibre optic bronchoscopy. Respir Med. 1995 Jan;89(1):53–56. [PubMed]
  • 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. [PubMed]
  • Webb AR, Doherty JF, Chester MR, Cummin AR, Woodhead MA, Nanson EM, Flack ST, Millard FJ. Sedation for fibreoptic bronchoscopy: comparison of alfentanil with papaveretum and diazepam. Respir Med. 1989 May;83(3):213–217. [PubMed]
  • Sury MR, Cole PV. Nalbuphine combined with midazolam for outpatient sedation. An assessment in fibreoptic bronchoscopy patients. Anaesthesia. 1988 Apr;43(4):285–288. [PubMed]
  • Smyth CM, Stead RJ. Survey of flexible fibreoptic bronchoscopy in the United Kingdom. Eur Respir J. 2002 Mar;19(3):458–463. [PubMed]
  • Chhajed Prashant N, Glanville Allan R. Management of hypoxemia during flexible bronchoscopy. Clin Chest Med. 2003 Sep;24(3):511–516. [PubMed]
  • 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. [PubMed]
  • Kamei Junzo. Delta-opioid receptor antagonists as a new concept for central acting antitussive drugs. Pulm Pharmacol Ther. 2002;15(3):235–240. [PubMed]
  • Homsi J, Walsh D, Nelson KA. Important drugs for cough in advanced cancer. Support Care Cancer. 2001 Nov;9(8):565–574. [PubMed]
  • Homsi J, Walsh D, Nelson KA, LeGrand SB, Davis M. Hydrocodone for cough in advanced cancer. Am J Hosp Palliat Care. 2000 Sep-Oct;17(5):342–346. [PubMed]
  • EDDY NB, HALBACH H, BRAENDEN OJ. 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]
  • Turturro MA, Paris PM, Yealy DM, Menegazzi JJ. Hydrocodone versus codeine in acute musculoskeletal pain. Ann Emerg Med. 1991 Oct;20(10):1100–1103. [PubMed]
  • 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]
  • 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]
  • 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. [PubMed]
  • 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. [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Compound
    Compound
    PubChem Compound links
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles
  • Substance
    Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...