Myocardial Ischemia in Sedated Patients Undergoing Fiberoptic Bronchoscopy

Matot, Idit; Kramer, Mordechai R.; Glantz, Lucio; Drenger, Benjamin; Cotev, Shamay

doi:10.1378/chest.112.6.1454

Cited by 58 publications

(25 citation statements)

References 18 publications

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“…Rather old studies suggested that sedation was implicated as the cause of major averse events resulting from FOB [3,30]. More recent studies did not confirm these findings [31,32].…”

Section: Discussionmentioning

confidence: 98%

“…Serious cardiac adverse events, such as atrial and ventricular arrhythmias, myocardial ischemia, angina, and cardiac arrest are uncommon [3,5,30,[34][35][36]. They have been linked to sedation, hypoxemia [37], passage of the bronchoscope through the vocal cords [34], and pre-treatment with lidocaine anaesthetic.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the fact that this exceeded the recommended highest dose [1], it has been demonstrated not to be toxic [30,40] even in the very elderly [41], despite a prolonged half-time elimination [42]. Moreover it might exert a protective effect against the development of major arrhythmias during the procedure [43].…”

Section: Discussionmentioning

confidence: 99%

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Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

D’Ippolito

Foresi²,

Castagnetti

et al. 2016

Monaldi Arch Chest Dis

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Aim. To evaluate the indications and the safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL), protected specimen brushing (PSB), endobronchial biopsy (EBB), and transbronchial biopsy (TBB) in a population of very elderly patients. Methods. We performed a retrospective study of all adult patients, aged 50 years or older, who underwent FOB in the Bronchology Unit of the University of Parma Hospital between 1 January, 2003 and 31 April, 2005. Bronchoscopy records of 436 consecutive patients, including 191 patients, 75 yrs of age and older (“very elderly”; =>75 yrs), were reviewed. Results. Patients aged 75 years were no different with regard to gender, BMI, baseline FEV1/FVC ratio, baseline SaO2, and blood pressure. The primary indication in patients aged <75 years, was to assist in the diagnosis of a pulmonary mass of unknown aetiology (33%) and to remove secretions in the very elderly patients (31%). Indications for FOB and sampling procedures in the two groups were similar. Approximately 30% of patients in each group required supplemental oxygen during the procedure and fever occurred in 9.2% and 10.3% of patients, respectively.Hypertension and bleeding were relatively rare and did not occur more often in the very elderly. Conclusions. Indication for FOB did not vary with age and adverse events in both groups were uncommon and generally not severe.

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“…Rather old studies suggested that sedation was implicated as the cause of major averse events resulting from FOB [3,30]. More recent studies did not confirm these findings [31,32].…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

D’Ippolito

Foresi²,

Castagnetti

et al. 2016

Monaldi Arch Chest Dis

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“…Both tachycardia and myocardial ischaemia are also frequently present in elderly patients who undergo MS during bronchoscopy. (10) Given these concerns, we compared the MS (set as the control group) and GA groups.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of target-controlled infusion of propofol and remifentanil with high frequency jet ventilation in fibre-optic bronchoscopy

Wang¹,

Yang²,

Zhang³

et al. 2013

smedj

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O r i g i n a l A r tic le 689 I NTRO D U C TIO NOf all endoscopic procedures, bronchoscopy without sedation might be one of the most painful and uncomfortable experiences. Therefore, unless absolute contraindications exist, sedation or anaesthesia is recommended for patients undergoing bronchoscopy.( Recently, propofol has proven effective during bronchoscopy, achieving similar results as the combined administration of midazolam and opiates in aspects such as sedation, amnesia and patient tolerance. (6) Moreover, propofol has the advantage of a shorter recovery time.(7-8)The widely used combination of either midazolam or propofol and opiates to achieve MS for bronchoscopy has been known to result in a high incidence (~30%-50%) of hypoxaemia (i.e. SpO 2 < 90%) and a relatively high cough score. (9 -11) However, the use of high frequency jet ventilation (HFJV) can provide adequate gas exchange, thus avoiding hypoxaemia without interfering with the manoeuvre of the bronchoscopist.HFJV has been successfully applied in rigid bronchoscopy and difficult airway intubation. (12)(13)(14) In light of this, the combination of general anaesthesia (GA) with HFJV might be a more acceptable regimen than conventional MS in bronchoscopy, especially with the former's lower incidence of hypoxaemia and lower cough score. To the best of our knowledge, there has been no published randomised controlled study comparing MS with GA achieved via target-controlled infusion (TCI) of propofol and remifentanil with HFJV, with respect to the incidence of oxygen desaturation, haemodynamic parameters, cough score, duration of bronchoscopy and patient satisfaction.

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“…For patients who will receive a moderate level of sedation (able to maintain spontaneous ventilation and respond to verbal or tactile stimuli), continuous hemodynamic monitoring should be used at five minute intervals (ASA, 2002 (Matot et al, 1997).…”

Section: Intraprocedural Monitoringmentioning

confidence: 99%