Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review

Abstract

Background Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and gas exchange. The restitution of normal respiration takes place in the recovery room. Nonetheless, there is no evidence on the necessary observation time. We systematically reviewed current guidelines on bronchoscopy regarding sedation, monitoring and recovery. Methods This review was registered at the PROSPERO database (CRD42020197476). MEDLINE and awmf.org were double-searched for official guidelines, recommendation or consensus statements on bronchoscopy from 2010 to 2020. The PICO-process focussed on adults (Patients), bronchoscopy with maintained spontaneous breathing (Interventions), and recommendations regarding the intra- and postprocedural monitoring and sedation (O). The guideline quality was graded. A catalogue of 54 questions was answered. Strength of recommendation and evidence levels were recorded for each recommendation. Results Six guidelines on general bronchoscopy and three expert statements on special bronchoscopic procedures were identified. Four guidelines were evidence-based. Most guidelines recommend sedation to improve the patient’s tolerance. Midazolam combined with an opioid is preferred. The standard monitoring consists of non-invasive blood pressure, and pulse oximetry, furthermore electrocardiogram in cardiac patients. Only one guideline discusses hypercapnia and capnometry, but without consensus. Two guidelines discuss a recovery time of two hours, but a recommendation was not given because of lack of evidence. Conclusion Evidence for most issues is low to moderate. Lung-diseased patients are not represented by current guidelines. Capnometry and recovery time lack evidence. More primary research in these fields is needed so that future guidelines may address these issues, too.

Efficacy and safety of ciprofol-remifentanil versus propofol-remifentanil during fiberoptic bronchoscopy: A prospective, randomized, double-blind, non-inferiority trial

“…We only recruited patients with ASA I-II and those who had a procedure time <30 min (eg, endobronchial inspection, bronchoscopic biopsy, and bronchoalveolar lavage). However, with the development of respiratory endoscopy technology, more complex endoscopic therapy is required under anesthesia, when there is no contraindication according to guidelines ( Wahidi et al, 2011 ; Strohleit et al, 2021 ; Long et al, 2022 ). A previous study reported that ciprofol produces similar levels of sedation compared with propofol in the intensive care unit setting to achieve required sedation times of 6–24 h ( Liu et al, 2022 ).…”

Research Bronchoscopies in Critically Ill Research Participants: An Official American Thoracic Society Workshop Report

“…In clinical bronchoscopies, more than half of severe complications, including death, are believed to be related to administration of analgesia and sedation ( 50 , 51 ). The critically ill patient with a protected airway has substantially reduced risk for sedation-induced respiratory depression given presence of mechanical ventilation.…”

Anesthesia for interventional pulmonology

“…Common complications as pneumothorax, hemorrhage, hypoxia, hypoventilation, laryngo-, and bronchospasm can occur in almost all patients undergoing bronchoscopic procedures. Other problems may occur due to the specific procedure and underlying pathophysiology [5 ▪▪ ].…”