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      Factors affecting patients’ comfort during fiberoptic bronchoscopy and endobronchial ultrasound

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          Abstract

          Objective

          This study investigated the factors that can affect the comfort of patients who underwent diagnostic fiberoptic bronchoscopy (FOB) and diagnostic endobronchial ultrasonography (EBUS) for the first time and the effect of the patients’ anxiety level on their comfort during the procedure.

          Materials and methods

          We recorded the demographics of the patients, the medications they used previously, the anesthesia applied during the procedure, the experience of the operator, the insertion technique of the bronchoscope, the types of the bronchoscopic interventions during the procedure, the duration of the procedure, and the anxiety levels of the patients before the session. Patients’ discomfort level before and after the procedure and anxiety levels before the procedure were evaluated using a visual analog scale (VAS), and willingness for repeating FOB and EBUS was assessed using a questionnaire.

          Results

          We found that longer examination time, higher anxiety level before the procedure, the nasal insertion of bronchoscope, and higher number of interventions are related to the increased discomfort during FOB and EBUS. Patients’ willingness for repeating FOB and EBUS increased as the level of discomfort decreased during the procedure.

          Conclusion

          The patient’s anxiety level should be determined using a questionnaire before the FOB and EBUS procedures, and the operator should adjust their procedure according to the patients’ anxiety level.

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          Most cited references 14

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

          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. 120 patients were randomised to receive midazolam and 5 mg i.v. 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). 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 < or =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). 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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            Patient satisfaction with conscious sedation for bronchoscopy.

            Bronchoscopic technique is not standardized. Controversies exist with regard to premedication with sedatives before the test. To evaluate safety and efficacy of conscious sedation, we studied 100 randomized patients undergoing diagnostic bronchoscopy; patients received premedication with lidocaine spray and atropine sulfate i.m. (nonsedation group; 50 patients) or lidocaine spray, atropine i.m. and diazepam i.v. (sedation group; 50 patients). Monitoring during flexible fiberoptic bronchoscopy included continuous ECG and pulse oximetry. The procedure could not be completed in six patients. None received premedication with diazepam; among the patients who ended the examination, tolerance to the examination (visual analogue scale, 0 to 100; 0 = excellent; 100 = unbearable) was better in the sedation group. Low anxiety, male sex, but not age were also associated with improved patient tolerance to the test. Oxygen desaturation occurred in 17% of patients, and it was not more frequent after diazepam treatment. In our study, sedation had a beneficial effect on patient tolerance and rarely induced significant alterations in cardiorespiratory monitoring parameters.
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              Common fears of patients undergoing bronchoscopy.

              In the world of medical literature, little has been reported about the fears of patients undergoing bronchoscopy. The aim of this study was to identify the common fears of patients undergoing fibreoptic bronchoscopy and to determine whether any factors might contribute to reducing these fears. One hundred and four consecutive patients undergoing bronchoscopy were interviewed. Sixty one patients expressed fear about the procedure, as follows: afraid of pain (33); afraid of breathing difficulties (11); afraid of oropharyngeal irritation (5); afraid of the bronchoscopy findings (2); afraid of sedation, cross-infection and nasal lignocaine spray, respectively (3); and unable to be specific (7). There was no difference between the "no fear" and "fearful" groups in ethnicity, source of referral, education, previous endoscopy, doctors' explanation and the patients' understanding of the procedure and its indication. "Fearful" patients were significantly younger (t=2.082, p=0.037) and female (chi2=4.180, p=0.038). Doctors were more likely to explain the indication for bronchoscopy than how it would be performed (chi2=6.403; p=0.011), and patients were more likely to understand why they needed a bronchoscopy than how it would be performed (chi2=21.505; p<0.001). Fear preceding bronchoscopy is independent of patients' demographic features except for age and gender. Doctors tend to explain "why" but not "how" the procedure is performed. Provision of detailed information about sensations that are likely to be experienced in bronchoscopy could be used to allay some of these common fears.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                29 March 2017
                : 10
                : 775-781
                Affiliations
                [1 ]Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
                [2 ]Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
                Author notes
                Correspondence: Fatma Yıldırım, Department of Pulmonary Medicine, Faculty of Medicine, Gazi University 06500, Beşevler/Çankaya, Ankara, Turkey, Tel +90 535 952 82 30, Fax +90 312 202 19 90, Email fatma_bodur2000@ 123456yahoo.com
                Article
                jpr-10-775
                10.2147/JPR.S118047
                5386605
                © 2017 Yıldırım et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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