Analogosedation during flexible bronchoscopy using a combination of midazolam, propofol and fentanyl – A retrospective analysis

<div><p>Background</p><p>According to current guidelines flexible bronchoscopy is usually performed under sedation. Previously it has been demonstrated that combined sedation with e. g. the combination of midazolam and propofol or an opioid might have several advantages over sedation with just one sedative drug. However, little is known about the efficacy and safety of combined sedation with midazolam, fentanyl and propofol (MFP) compared to sedation with midazolam and fentanyl (MF) or midazolam and propofol (MP).</p><p>Methods</p><p>We carried out a retrospective analysis of bronchoscopies performed under triple (MFP) or double sedation (MF and MP) in an academic hospital. 1392 procedures were analyzed (MFP: n = 824; MF: n = 272; MP: n = 296). In particular, we compared the occurrence of complications and the dosage of administered sedative drugs between the groups.</p><p>Results</p><p>The occurrence of adverse events (MFP vs. MF: odds ratio (OR) 1.116 [95% CI 0.7741 to 1.604]; MFP vs. MP: OR 0.8296 [95% CI 0.5939 to 1.16] and severe adverse events (MFP vs. MF: OR 1.581 [95% CI 0.5594 to 4.336]; MFP vs. MP: OR 3.47 [95% CI 0.908 to 15.15]; all p>0.05) was similar in all groups. The dosage of midazolam was lower in the MFP compared to the MF or MP group (MFP vs. MF: Cohen’s d 0.075; MFP vs. MP: Cohen’s d 0.225; all p<0.001). In addition patients in the MFP group received significantly less propofol compared to the MP group (Cohen’s d 1.22; p<0.001).</p><p>Conclusions</p><p>In summary we were able to demonstrate that triple sedation can safely be administered during flexible bronchoscopy and is associated with a reduced dosage of midazolam and propofol.</p></div

Patient flow chart.

<p>Patient flow chart.</p

Indications for bronchoscopy.

<p>Indications for bronchoscopy.</p

Complications.

<p>Complications.</p

Patient characteristics.

<p>Patient characteristics.</p

Consumption of sedative drugs.

<p>(A) The median midazolam dosage in the MFP, the MF, the MP and the combined MF/MP group is given. Boxes represent the interquartile range, whiskers report maximum and minimum. (B) Mean ± SD of administered fentanyl in the MFP and MF group is given. (C) The median propofol dosage in the MFP and the MP group is given. Boxes represent the interquartile range, whiskers report maximum and minimum. Means are indicated by +.</p

Diagnostic interventions.

<p>Diagnostic interventions.</p

O sistema tradicional de exploração de ovinos em Bragança

Este número da série Estudos reproduz parte significativa de uma tese de Mestrado apresentada na UTAD - Universidade de Trás-os-Montes e Alto Douro, em 1993, com o título Pastores, rebanhos de ovinos e pastoreio. Que futuro para o sistema tradicional de exploração. Da tese original, retirámos um capítulo, referente ao estudo da produção ovina numa aldeia do concelho de Bragança e ao estudo económico das explorações de ovinos dessa aldeia; e alguns anexos, cuja ausência não prejudicam a leitura e compreensão deste texto. Passados estes anos, o texto perdeu alguma actualidade, pois algumas das condições então analisadas sofreram alterações. Porque conhecemos a evolução entretanto verificada (o nosso trabalho de investigação, realizado entretanto, permitiu acompanhar a actividade) podemos afirmar que o texto não perdeu, nos seus aspectos fundamentais, actualidade. Podemos referir que as alterações mais importantes que se verificaram se relacionam com aspectos de legislação (por exemplo, regulamentação da actividade, posturas autárquicas); com as modificações verificadas nalguns organismos ou instituições (por exemplo, serviços ligados ao Ministério da Agricultura); alterações nas normas e regulamentos de apoio e subsídios concedidos aos criadores de ovinos. Será interessante, no futuro, fazer a comparação, relativamente a este estudo, e analisar a evolução do sistema tradicional de exploração de ovinos, e procurar encontrar as razões das alterações verificadas

COPD: Providing the right treatment for the right patient at the right time.

Chronic Obstructive Pulmonary Disease (COPD) is a common disease associated with significant morbidity and mortality that is both preventable and treatable. However, a major challenge in recognizing, preventing, and treating COPD is understanding its complexity. While COPD has historically been characterized as a disease defined by airflow limitation, we now understand it as a multi-component disease with many clinical phenotypes, systemic manifestations, and associated co-morbidities. Evidence is rapidly emerging in our understanding of the many factors that contribute to the pathogenesis of COPD and the identification of "early" or "pre-COPD" which should provide exciting opportunities for early treatment and disease modification. In addition to breakthroughs in our understanding of the origins of COPD, we are optimizing treatment strategies and delivery of care that are showing impressive benefits in patient-centered outcomes and healthcare utilization. This special issue of Respiratory Medicine, "COPD: Providing the Right Treatment for the Right Patient at the Right Time" is a summary of the proceedings of a conference held in Stresa, Italy in April 2022 that brought together international experts to discuss emerging evidence in COPD and Pulmonary Rehabilitation in honor of a distinguished friend and colleague, Claudio Ferdinando Donor (1948-2021). Claudio was a true pioneer in the field of pulmonary rehabilitation and the comprehensive care of individuals with COPD. He held numerous leadership roles in in the field, provide editorial stewardship of several respiratory journals, authored numerous papers, statement and guidelines in COPD and Pulmonary Rehabilitation, and provided mentorship to many in our field. Claudio's most impressive talent was his ability to organize spectacular conferences and symposia that highlighted cutting edge science and clinical medicine. It is in this spirit that this conference was conceived and planned. These proceedings are divided into 4 sections which highlight crucial areas in the field of COPD: (1) New concepts in COPD pathogenesis; (2) Enhancing outcomes in COPD; (3) Non-pharmacologic management of COPD; and (4) Optimizing delivery of care for COPD. These presentations summarize the newest evidence in the field and capture lively discussion on the exciting future of treating this prevalent and impactful disease. We thank each of the authors for their participation and applaud their efforts toward pushing the envelope in our understanding of COPD and optimizing care for these patients. We believe that this edition is a most fitting tribute to a dear colleague and friend and will prove useful to students, clinicians, and researchers as they continually strive to provide the right treatment for the right patient at the right time. It has been our pleasure and a distinct honor to serve as editors and oversee such wonderful scholarly work