The safety of flexible fibre‐optic bronchoscopy and proceduralist‐administered sedation: a tertiary referral centre experience

Dang, D.; Robinson, Peter; Winnicki, S.; Jersmann, H. P. A.

doi:10.1111/j.1445-5994.2010.02261.x

Cited by 25 publications

(39 citation statements)

References 19 publications

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“…Major complications (major bleeding, termination of the examination, intubation, need for ICU or death) were uncommon in both groups. The percentage of 2% was similar to the one described by DANG et al [27] (2.2%) in patients sedated with a benzodiazepine and an opiate.…”

Section: Discussionsupporting

confidence: 71%

Propofol versus propofol plus hydrocodone for flexible bronchoscopy: a randomised study

Schlatter¹,

Pflimlin²,

Fehrke³

et al. 2011

European Respiratory Journal

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Propofol and the combination of a benzodiazepine and an opiate have been established for sedation in flexible bronchoscopy. It is as yet unknown whether propofol in combination with an opiate is superior to propofol alone to suppress cough during the procedure. 300 consecutive patients undergoing flexible bronchoscopy at a tertiary care university hospital were randomly allocated to receive either the combination propofol and hydrocodone or propofol alone in a double-blind fashion. The primary end-point was the cough score during the procedure as estimated by the physician using a visual analogue scale.Demographics were similar in both groups. Compared with propofol alone, median (interquartile range) cough scores assessed by physicians, nurses and patients were significantly lower in the group randomised to the combination propofol and hydrocodone (2.5 (1.5-4.0) versus 2.0 (1.0-3.0), respectively, p50.011). Additionally, patients receiving the combination required significantly lower doses of propofol than those receiving propofol alone (200 mg (140-280) versus 260 mg (180-350), p,0.0001). Complex examinations, including bronchoalveolar lavage or transbronchial biopsy, benefited more from additional opiate. The duration of the procedure, time to discharge and complication rate were similar in both groups.The combination of propofol and hydrocodone is safe and superior to propofol alone for cough suppression in flexible bronchoscopy.

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Section: Discussionsupporting

confidence: 71%

Propofol versus propofol plus hydrocodone for flexible bronchoscopy: a randomised study

Schlatter¹,

Pflimlin²,

Fehrke³

et al. 2011

European Respiratory Journal

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“…Another noteworthy factor was the absence of complications due to GL during our study. Notably, it can be compared to major adverse events of bronchoscopy in a study by Dang et al in which it was stated that this technique is safe as they came across less major complications like pneumothorax [20]. However, the aim of this study was not to evaluate the efficacy of BAL procedure, there were no major complication of bronchoscopy except desaturation, respiratory discomfort during and throat discomfort after the procedure.…”

Section: Discussionmentioning

confidence: 92%

Comparison of GeneXpert MTB/RIF Assay in Broncho Alveolar Lavage and Gastric Lavage Samples

Mahat¹,

Rizvi²,

Saifullah³

et al. 2016

AID

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Objective: To compare the yield from Gastric lavage (GL) and Broncho alveolar lavage (BAL) samples in adult patients suspected case of Tuberculosis but not producing sputum. Methodology: 80 adults with suspected case of tuberculosis but not producing sputum were recruited. 72 patients were then subjected to one gastric lavage followed by Broncho-alveolar lavage in the same morning. The collected samples were subjected to GeneXpert MTB/RIF assay. Result: Of the 72 patients samples, the mean age was 38.6 years. 41 (56.9%) were male and 31 (43.1%) were female. History of TB contact was present in 25 (34.7%) patients. 37 (51.4%) patients had GeneXpert MTB/RIF positive on BAL and/or GL samples. The GeneXpert MTB/RIF of BAL fluid was positive on 35 (48.6%), which was not significantly greater than that for specimens from GL, which was 28 (38.9%) (p > 0.05). In 26 (36.1%) cases, GeneXpert MTB/RIF was positive in both BAL and GL samples. Conclusion: This study showed the yield of GeneXpert MTB/RIF in GL was comparable to BAL to detect Mycobacterium tuberculosis complex. Patients who can't produce sputum, GL can be a good alternative to BAL to detect Mycobacterium tuberculosis complex in resource poor areas and patients who do not tolerate Bronchoscopy.

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“…In several countries, mainly in Europe, moderate sedation in endoscopic procedures is restricted only to anesthetists despite several reports on the safety and cost-effectiveness of sedation applied by nonanesthesiologists. [5][6][7] Between the years 2013 and 2014, we performed a prospective observational study that aimed to assess factors that influence anxiety and satisfaction in patients undergoing FB under analgosedation.8 In this brief communication, we would like to present data on the safety of moderate sedation applied by nonanesthesiologists.Patients and methods After obtaining written consent to participate in the study, we enrolled 463 consecutive patients undergoing FB at the Department of Pulmonology of the University Hospital in Krakow, Poland. The exclusion criteria were as follows: respiratory failure (defined as hemoglobin oxygen saturation [SpO 2 ] below 90% despite oxygen therapy or need for more than 50% of oxygen in a respiratory mixture),…”

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confidence: 99%

“…Some researchers have also suggested that the use of propofol instead of benzodiazepines is preferable because of a more rapid patient's recovery. 9 These drugs proved to be safe in several studies used by nonanesthesiologists, [5][6][7] and are recommended by most gastroenterology and respiratory societies to use for moderate sedation in various endoscopic procedures. 4,10,11 Despite this, anesthesiology societies have raised several safety concerns, especially regarding the use of propofol 12 by nonanesthesiologists, and the use of moderate sedation has not been legally approved in many countries (including Poland), being restricted solely to anesthesiologists.…”

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confidence: 99%

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confidence: 99%

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Flexible bronchoscopy under conscious sedation with midazolam and fentanyl can be safely performed by nonanesthesiologists

Szczeklik¹,

Andrychiewicz²,

Górka³

et al. 2015

Polish Archives of Internal Medicine

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RESEARCH LETTER Flexible bronchoscopy under conscious sedation with midazolam and fentanyl... 869contraindications to use midazolam or fentanyl, diminished communication capacity, and cognitive disorders. The study was approved by the Ethics Committee at Jagiellonian University, Kraków, Poland.In all patients, topical anesthesia was used according to current guidelines. 4 Most patients received a bolus of midazolam (2.5 mg) and fentanyl (0.05 mg) before the examination. If necessary, both medications were titrated in incremental doses during FB to achieve adequate analgosedation. The initial dose of fentanyl was not administered in 23 patients for one of the following reasons: exacerbation of chronic obstructive pulmonary disease, respiratory failure, or advanced age with several comorbidities. A bronchofiberoscope was introduced through a mouthpiece 3 minutes after drug administration. During the whole procedure, vital parameters were monitored including oxygen saturation, blood pressure, and electrography; adverse events were also recorded. The level of patient sedation was continuously assessed according to the Ramsey sedation scale.6 The study personnel were trained in acute life support and study nurses had specialization in anesthesia and intensive care. During the whole procedure, the patient's spontaneous ventilation was sustained with oxygen administered through a nasal cannula if needed (in 282 patients, approximately 3.5 l/min of O 2 ). Monitoring was continued following FB until complete recovery from sedation was observed. If needed, patients were administered antagonists-flumazenil and naloxone-to reverse drug reaction. Immediate anesthesiologist support was available at all time during the study in case of need.A statistical analysis was performed using the Statistica software (version 10.0; StatSoft, Inc., Introduction Flexible bronchoscopy (FB) is one of the most commonly used diagnostic and therapeutic tools in current respiratory medicine.1 It is an invasive method that is unpleasant for the patient and is preferably performed under analgosedation. 2 According to several studies, relieving the patient's anxiety during the endoscopic procedure shortens the time of the procedure and prevents adverse events. 3 There are no exact guidelines on how to perform analgosedation; however, most authors agree that using only topical anesthesia is insufficient and suggest using moderate sedation, previously known as conscious sedation. 4This approach enables the medical personnel to stay in verbal contact with the patient and, at the same time, to relieve unpleasant symptoms. In several countries, mainly in Europe, moderate sedation in endoscopic procedures is restricted only to anesthetists despite several reports on the safety and cost-effectiveness of sedation applied by nonanesthesiologists. [5][6][7] Between the years 2013 and 2014, we performed a prospective observational study that aimed to assess factors that influence anxiety and satisfaction in patients undergoing FB under analgosedation.8 In thi...

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The safety of flexible fibre‐optic bronchoscopy and proceduralist‐administered sedation: a tertiary referral centre experience

Cited by 25 publications

References 19 publications

Propofol versus propofol plus hydrocodone for flexible bronchoscopy: a randomised study

Propofol versus propofol plus hydrocodone for flexible bronchoscopy: a randomised study

Comparison of GeneXpert MTB/RIF Assay in Broncho Alveolar Lavage and Gastric Lavage Samples

Flexible bronchoscopy under conscious sedation with midazolam and fentanyl can be safely performed by nonanesthesiologists

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