Chest
Volume 98, Issue 6, December 1990, Pages 1327-1330
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Clinical Investigations
Fiberoptic Bronchoscopy without Premedication: A Retrospective Study

https://doi.org/10.1378/chest.98.6.1327Get rights and content

The objective of this study was to determine if flexible FOB could be performed safely without premedication other than topical anesthesia. A total of 281 procedures performed during a 12-month period at a VA medical center were reviewed. Ninety-one procedures performed without premedication were compared with 190 procedures performed with premedication. Complications occurred in 5 percent of patients in each group. Statistical analysis revealed no significant differences in age, spirometry, P(A-a)O2 or SaO2 between both groups. Despite the proven safety of outpatient FOB without sedation, many bronchoscopists administer complicated premedication regimens and employ ambulatory surgery beds or recovery rooms to monitor patients before and after procedures. These results support a simplified approach to routine FOB which would include no premedications and greater use of outpatient facilities resulting in decreased expenditures without compromising patient care, safety or comfort.

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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    Manuscript received March 12; revision accepted June 4.

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