Document Detail


American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients.
MedLine Citation:
PMID:  22045879     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Optimal performance of bronchoscopy requires patient's comfort, physician's ease of execution, and minimal risk. There is currently a wide variation in the use of topical anesthesia, analgesia, and sedation during bronchoscopy.
METHODS: A panel of experts was convened by the American College of Chest Physicians Interventional/Chest Diagnostic Network. A literature search was conducted on MEDLINE from 1969 to 2009, and consensus was reached by the panel members after a comprehensive review of the data. Randomized controlled trials and prospective studies were given highest priority in building the consensus.
RESULTS: In the absence of contraindications, topical anesthesia, analgesia, and sedation are suggested in all patients undergoing bronchoscopy because of enhanced patient tolerance and satisfaction. Robust data suggest that anticholinergic agents, when administered prebronchoscopy, do not produce a clinically meaningful effect, and their use is discouraged. Lidocaine is the preferred topical anesthetic for bronchoscopy, given its short half life and wide margin of safety. The use of a combination of benzodiazepines and opiates is suggested because of their synergistic effects on patient tolerance during the procedure and the added antitussive properties of opioids. Propofol is an effective agent for sedation in bronchoscopy and can achieve similar sedation, amnesia, and patient tolerance when compared with the combined administration of benzodiazepines and opiates.
CONCLUSIONS: We suggest that all physicians performing bronchoscopy consider using topical anesthesia, analgesic and sedative agents, when feasible. The existing body of literature supports the safety and effectiveness of this approach when the proper agents are used in an appropriately selected patient population.
Authors:
Momen M Wahidi; Prasoon Jain; Michael Jantz; Pyng Lee; G Burkhard Mackensen; Sally Y Barbour; Carla Lamb; Gerard A Silvestri
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Publication Detail:
Type:  Consensus Development Conference; Journal Article    
Journal Detail:
Title:  Chest     Volume:  140     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-02     Completed Date:  2011-12-29     Revised Date:  2012-08-22    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1342-50     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. momen.wahidi@duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Analgesia / methods*
Analgesics / therapeutic use*
Anesthesia, Local / methods*
Anesthetics, Local / therapeutic use*
Bronchoscopy / methods*
Conscious Sedation / methods*
Humans
Hypnotics and Sedatives / therapeutic use*
Chemical
Reg. No./Substance:
0/Analgesics; 0/Anesthetics, Local; 0/Hypnotics and Sedatives
Comments/Corrections
Comment In:
Chest. 2012 Jun;141(6):1640-1; author reply 1641   [PMID:  22670032 ]
Chest. 2012 Apr;141(4):1125; author reply 1125-6   [PMID:  22474162 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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