Does sedation help in fibreoptic bronchoscopy?

Hatton, M. Q. F.; Allen, Martin; Vathenen, A.S.; Mellor, E; Cooke, N. J.

doi:10.1136/bmj.309.6963.1206

Cited by 87 publications

(56 citation statements)

References 5 publications

(3 reference statements)

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“…The median number of consultants per hospital unit was three (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The median population served per consultant was 116,667 people with an interquartile (IQR) range of 90,000-150,000 people.…”

Section: Resultsmentioning

confidence: 99%

“…Some groups have suggested that unsedated bronchoscopies are as tolerable for the patient without the risk of sedation. HATTON et al [13] questioned the use of routine sedation in bronchoscopy when they failed to demonstrate a difference in patient tolerance with either opioid or anxiolytic. However, their study was criticised [14] as they did not record sedation level ("light sedation").…”

Section: Discussionmentioning

confidence: 99%

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Is preparation for bronchoscopy optimal?

Pickles¹,

Jeffrey²,

Datta³

et al. 2003

European Respiratory Journal

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The results of a questionnaire survey, of the current preparation for and practice of diagnostic bronchoscopy in England and Wales, are reported in this paper. The British Thoracic Society (BTS) has recently published guidelines on bronchoscopy and these provide a consensus statement on the current evidence base. There is no specific guidance on drugs or techniques, although it is recommended that all patients should be offered sedation, except where there are contraindications.In the present survey, there was a response rate of 76% (344 responses to 452 questionnaires) and the median number of bronchoscopies performed per session was 5 (interquartile range 4-6). Most operators use lignocaine gel to the nose (65%), spray to the throat (70%), followed by the "spray as you go" method (84%), recommended by the BTS. Atropine is routinely used by 13% contrary to the guidelines and despite concerns about its side-effects. Most operators use sedation with midazolam (85%) or a wide variety of combinations of sedative, analgesic, and anaesthetic agents (27%), and 27% perform unsedated bronchoscopies, with only 0.1% routinely performing unsedated bronchoscopies. A total 251 (77%) responders stated they assessed adequacy of sedation, with most using patient observation alone (149 (46%)). Only three operators assessed sedation using a formal sedation score. Thus, most centres routinely perform sedated bronchoscopies and the systematic level of monitoring is poor.The current controversies about sedation and safe sedation practice are discussed. There is a need for more evidence to allow more specific guidance to be produced in this difficult area. Eur Respir J 2003; 22: 203-206 The bronchoscopic technique is not standardised and the ideal preparation for diagnostic bronchoscopy is not known. The current British Thoracic Society (BTS) guidelines [1] provide a consensus statement on the current evidence base without specific guidance on drugs or techniques and without defining methods of sedation. The guidelines recommend offering sedation to all undergoing diagnostic flexible fibreoptic bronchoscopy, except where there are contraindications [1]. The aim is to achieve good patient tolerance, comfort and cooperation whilst reducing complications. The issues of sedation are controversial. If a centre has experience of performing unsedated diagnostic flexible fibreoptic bronchoscopy, it is reported that patient cooperation is not improved with sedation [2]. Furthermore there is worrying evidence that insufficient monitoring of sedated patients occurs, potentially placing patients at risk [3]. One-half of deaths reported are related to sedation [4]. It is unclear what constitutes optimum sedation. A Report by an Intercollegiate Working Party suggests safety measures for sedation undertaken by an operator who is not anaesthetics-trained (table 1) [5]. As bronchoscopy may be performed safely without sedation, when it is used there is emphasis on its safe administration.In this survey, the authors aimed to obtain a "snap sh...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is preparation for bronchoscopy optimal?

Pickles¹,

Jeffrey²,

Datta³

et al. 2003

European Respiratory Journal

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“…Operators often tend to minimise patient discomfort [3][4][5] and, although FB can be performed without sedation [6][7][8], a recent survey revealed that 80% of patients prefer to be sedated during FB [4].…”

mentioning

confidence: 99%

Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomised trial

Clark¹,

Licker²,

Ab³

et al. 2009

European Respiratory Journal

122

116

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In this study, we questioned whether propofol provided clinical benefits compared with midazolam in terms of neuropsychometric recovery, safety profile and patient tolerance.Patients, aged .18 yrs, were randomised to receive midazolam or propofol, given by nonanaesthetist physicians to achieve moderate levels of sedation as assessed by the electroencephalographic bispectral index (BIS; between 70 and 85). The primary end-point was the time delay until recovery of the BIS above 90. Other end-points included a neuropsychometric continuous performance test (CPT), serious respiratory adverse events, patient tolerance and physician satisfaction.Neuropsychometric recovery was improved in the propofol compared to the midazolam group as evidenced by faster normalisation of BIS index (5.4¡4.7 min versus 11.7¡10.2 min; p50.001) and better results at the CPT. In the midazolam group, 15% of patients presented profound sedation precluding CPT completion and one patient required mechanical ventilatory support. Patient tolerance was significantly better in the propofol group, whereas the operator's assessment was comparable in both groups.Compared with midazolam, propofol provided a higher quality of sedation in terms of neuropsychometric recovery and patient tolerance. BIS-guided propofol administration represents a safe sedation technique that can be performed by the non-anaesthesiologist.

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“…At that time, some authors suggested that routine sedation could do little for patients undergoing the procedure and that bronchoscopy could be carried out without pre-medication [1][2][3]. However, over the last few decades, several things have changed.…”

mentioning

confidence: 99%

It is time for patients to undergo bronchoscopy without discomfort

Gasparini

2011

European Respiratory Journal

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Does sedation help in fibreoptic bronchoscopy?

Cited by 87 publications

References 5 publications

Is preparation for bronchoscopy optimal?

Is preparation for bronchoscopy optimal?

Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomised trial

It is time for patients to undergo bronchoscopy without discomfort

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