Endoscopic narrow-band imaging-quantitative assessment of airway vascularity of sarcoidosis

printing supported by . Visit Chiesi at Stand B2.10 TUESDAY, SEPTEMBER 4TH 2012 improve tolerance & patient satisfaction. Propofol, a short acting intravenous hypnotic, offers advantages over benzodiazepines/opiates. Objectives: We analyzed the feasibility, efficacy & safety profile of propofol administered by a trained nurse for outpatient bronchoscopy. Methods: A total of 276 flexible bronchoscopies performed between 2009 & 2011 using propofol sedation only without premedication were retrospectively reviewed. Patient demographics, indications, type of procedure, procedure time, medication doses, comfort level on 10cm verbal analogue scale (VAS, 0-10, 0=excellent, 10=unbearable) & adverse events were analyzed from procedure records. Results: Of the 276, two-thirds (182, 66%) patients were male with an average age of 56 years (range 18−82) & an average weight of 73 kg. Indications included diagnostic BAL (127, 46%), TBLB (68,25%), TBNA (41,15%) & EBB (22,8%). Average procedure time was 36 minutes (range 12−145). Average propofol dose was 1.86 mg.kg-1 (range 0.12−20 mg.kg-1). Minor adverse events (21, 7.6%) included hypotension (19, 7%), transient hypoxia (8, 3%) & tachycardia (5, 2%). Major adverse events (death,intubation, ICU stay, or hospitalization) occurred in 7 (2.5%), of which 3 (1%) were attributed to sedation, 2 (0.7%) to hemoptysis, & 1 each to hypoxia & bronchospasm. There were no procedure-related deaths. A majority (196, 71%) reported VAS of 4-6 with good amnesia, while 56 (20%) had VAS > 6 & 24 (8.6%) had VAS <3. Conclusions: Propofol is an easy to administer, safe, & effective procedural sedative for outpatient bronchoscopies providing acceptable comfort. P3575 Lidocaine administration to the laryngopharynx for inducing anesthesia before bronchoscopy: A comparative study of Jackson’s spray method and ultrasonic nebulization Ken-ichi Takahashi1, Emiko Yamakawa2, Kouki Tsuji2, Yukiko Kaneko2, Yoko Uraguchi2, Kaori Okubo2, Toshie Chiyomori2, Emiko Murakami2, Taeko Kameyama2, Kazuki Shima1, Yoko Hamakawa1, Shohei Kaneda1, Susumu Noguchi1, Akari Moriyama1, Yojiro Yutaka1, Hiromichi Katakura1, Naoki Sakai1, Akira Yamanaka1. 1Respiratry Diseases and Chest Surgery, Otsu Red Cross Hospital, Otsu, Japan; 2Endoscopy Center, Otsu Red Cross Hospital, Otsu, Japan Objective: To compare the degrees of pain experienced by patients and additional intraoperative amounts of lidocaine required when lidocaine is administered using Jackson’s spray and an ultrasonic nebulization. Methods: Forty patients who were given laryngopharyngeal anesthesia before bronchoscopy were divided into 2 groups of 20 patients each: group A, which was given 4% lidocaine 5 mL by using Jackson’s spray, and group B, which was given 2% lidocaine 10 mL by using an ultrasonic nebulizer. The degrees of pain in patients evaluated on the basis of examination times, amounts of lidocaine administered during bronchoscopy, rates of lidocaine use (obtained by dividing amounts of lidocaine administered during bronchoscopy by examination times), and results of a questionnaire survey consisting of a 5-point evaluation scale for 7 items were compared between the 2 groups. Results: There were no significant differences in examination times, amounts of lidocaine administered during bronchoscopy, and degrees of pain between the groups. However, the rates of lidocaine use in group B were significantly lower than those in group A (0.55±0.3 mL/min versus 0.38±0.2 mL/min; p = 0.03). An analysis based on patient age and smoking history showed that the rate of lidocaine use in group A was not significantly high in elderly persons (less than 70 years of age) and smokers (p = 0.05). Conclusion: In laryngopharyngeal anesthesia before bronchoscopy, the Jackson spray required a large amount of lidocaine at the time of bronchoscopic examination for bronchoscopy time, compared with the ultrasonic nebulizer. P3576 Incremental midazolam versus midazolame/rentanyl sedation during flexible bronchoscopy. Safety and tolerance in relation to the complexity of intervention Grigoris Stratakos, Ioannis Kokkonouzis, Penny Moraitaki, Philip Emmanouil, Nikos Koufos, Evangelia Stoubi, Dimitra Tsiboura, Filomila Zikopoulou, Fotis Sampsonas, Manos Alchanatis, Nikolaos Koulouris. 1st Department of Pulmonary Medicine, University of Athens, Sotiria Chest Hospital, Athens, Greece Background: Sedation during flexible bronchoscopy (FB) is undisputed. Although suggested, benzodiazepines and opiates combination is underused due to fear of complications. Aim: To prospectively compare safety and tolerance of FB sedation using incremental midazolam (M) versus combined midazolam/fentanyl (MF) administration. Methods: Consecutive patients referred for FB were enrolled. After administration of 2% lidocaine aerosol, sedation with midazolam (1-5 mg) alone or combined with fentanyl (0.025-.005mg) was given. Decision relied on clinical parameters (fear,anxiety,cough and restlessness) and on staff judgment regarding performed interventions.Nurses took active role estimating sedation need. Patients completed verbal analogue scales (VAS) and overall tolerance questionnaires.Bronchoscopists completed tolerance VAS and complications questionnaires. Results: 68 patients (53 males, aged 65±12) enrolled.31 received only M (mean 2.23 mg) while 37 received combined sedation (mean 2.74mg M and 0.033 mg F).No sedation related complications were reported.Increased duration of FB and interventional procedures (EBUS, TBNA, Electro-Cryotherapy) were associated with combined MF sedation and increased M dosage (p < 0.05). Patients & bronchoscopists reached high VAS scores (>8/10).Discomfort and adverse effect scores were equally minimal. Conclusion: Both regimens are safe and effective in reducing anxiety and cough while increasing FB tolerance. Selection can be based on prolonged duration and need for interventional modalities. Trained endoscopy nurses are effective in incrementing sedation during bronchoscopy in an “as needed” basis. P3577 Propofol sedation for flexible bronchoscopy: A large randomized, controlled, non-inferiority trial Peter Grendelmeier, Eric Pflimlin, Michael Tamm, Daiana Stolz. Clinic of Pulmonary Medicine, University Hospital, Basel, Switzerland Background: Propofol is a feasible and safe method for sedation in patients undergoing flexible bronchoscopy. However, there are no data comparing bolus administration versus continuous infusion of propofol for flexible bronchoscopy. Methods: 702 consecutive patients undergoing flexible bronchoscopy were randomly allocated to receive intravenous propofol using either a continuous infusion or an intermittent bolus technique. The primary endpoint was the number of any adverse event (SaO2 ≤ 90%; need for oroor nasopharyngeal airway insertion; systolic BP < 90 mmHg, minor or major bleeding, pneumothorax, need to abort bronchoscopy, ICU, intubation or death) assessed by the end of FB and at 24 hours. Results: The number of any adverse event was similar in both randomized groups (Bolus group 219 vs. 211 Infusion group, p = 0.810). There were complications in 8 (1.1%) cases (6 major bleedings, 2 intubations). There was no death. As compared to the Bolus group, the amount of propofol required was significantly higher in the infusion group (226mg ± 147 versus vs. 308 mg ± 204.8, p < 0.0001). In a linear multivariate regression model, this difference remained significant independently of duration and the interventions (e.g. TBB, EBUS) performed during flexible bronchoscopy. The duration of bronchoscopy was significantly longer in the infusion group (14 [9 24] versus 17 [12 27] minutes, p < 0.0001). Conclusion: Although propofol continuous infusion is as feasible and safe as bolus administration, it is associated with higher propofol requirements and a longer duration of the bronchoscopy. P3578 Bronchology in the Czech Republic – National surveys during last decades Vitezslav Kolek1, Miloslav Marel2, Pavel Barton3. 1Respiratory Medicine, University Hospital, Olomouc, Czech Republic; 2Respiratory Medicine, University Hospital, Motol, Praha, Czech Republic; 3Tuberculosis and Respiratory Diseases, Institute, Jevicko, Czech Republic Czech bronchology has a long tradition and its activities have been monitored for many years. Statistical analysis based on questionnaires was realised in 1977 (Hlobil), 1994 (Marel), 1996, 1999,2003 (Kolek). Increasing trends of total numbers of endoscopes, broncoscopies and especially interventional bronchological procedures were verified in this surveys. Similar questionnaire was sent electronically and via post to all Czech bronchological centres in 2009. Personal and telephone contacts were used to accelerate an adequate response,too. Questions dealt with numbers of bronchoscopists, types of bronchoscopes, diagnostic methods, interventional techniques and system of work. Results were compared with older surveys mentioned above. In 2009 there were 59 active bronchological centres, which performed 33. 282 bronchoscopies. Out of them 1.637 (4,9%) were done by rigid bronchoscope, 258 were done in children. General anaesthesia was used in 2194, fluoroscopy in 1238 procedures. Altogether 182 bronchoscopists worked with 182 flexible and 87 rigid bronchoscopes, 29 videocameras and 81 videobronchoscopes. Out of all procedures, 544 EBUS, 1724 AFO,1041 NBI and 46 EMN investigations were performed. Doctors performed 1235 laser resections, 246 electrocautheries, 121 stent insertions, 78 afterloadings, 5 plasmacoagulations, 3 cryotherapies and first endobronchial valves insertions. During last decades, the quantity of bronchological procedures (especially therapeutical and new sophisticated diagnostic methods) is increasing, vice versa the number of bronchological centres is decreasing. P3579 Bronchoscopic practice in Japan Fumihiro Asano, Motoi Aoe, Yoshinobu Ohsaki, Yoshinori Okada, Shinji Sasada, Shigeki Sato, Eiichi Suzuki, Hiroshi Senba, Shozo Fujino, Kazumitsu Ohmori. Safety Management Committee, Japan Society for Respiratory Endoscopy, Tokyo,