Chest
Clinical InvestigationsFiberoptic Bronchoscopy without Premedication: A Retrospective Study
Section snippets
Materials and Methods
All diagnostic FOB performed by pulmonary fellows and staff members at the Portland VA Medical Center during a 12-month period between December 1988 and November 1989 were reviewed. Laser procedures or FOB brachytherapy were not included because these currently are not performed at this institution. Patient data recorded were age, indication for FOB, procedures performed (endobronchial biopsy, transbronchial biopsy, bronchoalveolar lavage, needle aspiration) and related complications. Major
Results
During the study period, 304 diagnostic FOB procedures were performed. Twenty-three FOB procedures done on intubated inpatients were excluded. A total of 281 FOB procedures were reviewed. The mean age of patients was 63.2 years (range, 31 to 91 years), and all were male. Group 1 consists of 91 consecutive FOB procedures performed without premedication. Group 2 includes 190 FOB procedures performed with premedication.
Demographic, spirometric (PET) and ABG level data are found in Table 1.
Discussion
Standard practice of bronchoscopy in the United States usually includes parenteral administration of premedication and use of day surgery or recovery rooms for patient observation. Because no single medication provides amnesia, anxiolysis and analgesia, premedication regimens often include atropine, a sedative or analgesic, and often, intravenous administration of a benzodiazepine such as diazepam or midazolam as needed. Many current recommendations stem from studies performed in the 1970s, yet
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Cited by (91)
Sedation in Bronchoscopy: A Review
2018, Clinics in Chest MedicineCitation Excerpt :Studies comparing bronchoscopy with and without sedation found no difference in rates of complication, and, as such, bronchoscopy without sedation was thought to be safe. These studies, however, did not assess patient tolerance, comfort, or willingness to undergo a repeat procedure.5 The procedure itself is uncomfortable, with patients often experiencing difficulty breathing, cough, pain, fear, anxiety, and airway irritation.
Diagnostic Bronchoscopy
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionAirway anatomy for the bronchoscopist: An anesthesia approach
2014, Revista Colombiana de AnestesiologiaAmerican College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients
2011, ChestCitation Excerpt :In the early days of flexible bronchoscopy, there was a concern about the adverse events of sedation, so it was rarely used. Earlier studies showed no difference in complications rate when comparing the two approaches and concluded that performing diagnostic bronchoscopy without sedation is safe and acceptable; however, these studies did not take into consideration patient's preferences.4,5 Subsequent randomized studies have shown that sedation led to better tolerance of the procedure by patients6–9 and higher physician satisfaction.10
Manuscript received March 12; revision accepted June 4.