# Validity of Bronchoscopist Assessment of Patient Discomfort During Flexible Bronchoscopy: An Observational Study

## TL;DR

This study finds that bronchoscopists often misjudge how uncomfortable patients feel during bronchoscopy, and using midazolam can significantly reduce patient discomfort.

## Contribution

The study demonstrates that bronchoscopists' predictions of patient discomfort during bronchoscopy are inaccurate and identifies midazolam as a key factor in reducing discomfort.

## Key findings

- Patients in the pethidine group reported higher discomfort than predicted by bronchoscopists.
- Midazolam use significantly reduced patient discomfort compared to predictions.
- Hypoxia during bronchoscopy increased patient discomfort.

## Abstract

Background: The distress experienced by patients during bronchoscopy is often more severe than bronchoscopists anticipate. However, the use of sedatives during bronchoscopy varies depending on the facility, which may be insufficient. We examined the accuracy of bronchoscopist evaluation of predicted patient discomfort during bronchoscopy under intravenous sedation.

Methods: This study retrospectively reviewed 186 consecutive patients who underwent bronchoscopy between December 2018 and April 2019. Ultimately, 113 patients who underwent bronchoscopy with pethidine (meperidine) and 64 patients who underwent bronchoscopy with pethidine and midazolam were assigned to the pethidine group and the pethidine with midazolam combination group, respectively. We compared the patient self-assessed discomfort scores (obtained after recovery from sedation) with the discomfort scores predicted by bronchoscopists, using a five-point rating scale in each sedation group. Any discrepancy was then evaluated.

Results: The pethidine group had significantly higher self-assessed patient discomfort scores than the predictive assessment by bronchoscopists (mean score 3.4±1.3 vs. 2.9±1.2; P< 0.001). Conversely, the pethidine with midazolam group had a significantly lower self-assessed patient discomfort score than the bronchoscopists’ predictive assessment (mean score 2.4±1.5 vs. 3.3±1.4; P < 0.001). Multivariate analysis identified the use of midazolam as a significant factor affecting patient discomfort (odds ratio: 0.176, P < 0.001) in addition to hypoxia during bronchoscopy (odds ratio: 3.331, P = 0.008).

Conclusions: Bronchoscopists may underestimate patient discomfort during bronchoscopy under intravenous sedation. The use of midazolam was an important factor affecting the patient's discomfort during bronchoscopy.