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Yang L, He T, Liu MX, Han SQ, Wu ZA, Hao W, Lu ZX. The effect of intravenous lidocaine on propofol dosage in painless bronchoscopy of patients with COPD. Front Surg 2022; 9:872916. [PMID: 36189388 PMCID: PMC9520192 DOI: 10.3389/fsurg.2022.872916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWe tested the hypothesis that intravenous (IV) lidocaine reduces propofol requirements in painless bronchoscopy in patients with chronic obstructive pulmonary disease (COPD).MethodsA total of 93 patients who underwent bronchoscopy were included in this randomized placebo-controlled study. The patients were randomly divided into two groups. After the IV doses of nalbuphine, patients were given a bolus of propofol, which was titrated if necessary until loss of consciousness. Then patients were given IV lidocaine (2 mg/kg then 4 mg/kg/h) or the same volume of saline. The primary endpoint was the propofol requirements. Secondary endpoints were the incidence of hypoxemia, the incidence of cough during glottis examination, the systolic blood pressure (SBP) and heart rate (HR) during bronchoscopy procedures, the bronchoscopist's comforts, and the time for wakefulness before recovery.ResultsLidocaine infusion resulted in a significant reduction in propofol requirements (p < .0001), and the incidence of hypoxemia (p = .001) and cough (p = .003) during examination decreased significantly in the lidocaine group. During the examination, the fluctuation of SBP and HR was significantly lower than that in the control group, and the difference was statistically significant (p < .05). Bronchoscopist's comforts were higher in the lidocaine group (p < .001), and time for wakefulness (p < .001) were significantly lower in the lidocaine group.ConclusionIn painless bronchoscopy in patients with COPD, IV infusion of lidocaine resulted in a reduction in propofol dose requirements and reduce the incidence of adverse events.
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Affiliation(s)
- Li Yang
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Tao He
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Min-Xiao Liu
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Shi-Qiang Han
- Department of Radiotherapy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Zhi-Ang Wu
- Department of Anesthesiology, Luquan Second People's Hospital, Shijiazhuang, China
| | - Wei Hao
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
- Correspondence: Zhi-Xia Lu Wei Hao
| | - Zhi-Xia Lu
- Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
- Correspondence: Zhi-Xia Lu Wei Hao
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Guedes F, Ferreira AJ, Dionísio J, Rodrigues LV, Bugalho A. Pre- and post-COVID practice of interventional pulmonology in adults in Portugal. Pulmonology 2022:S2531-0437(22)00070-8. [PMID: 35339419 DOI: 10.1016/j.pulmoe.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES There is a lack of information regarding bronchoscopy practice in adults in Portugal. Our objective was to obtain an overview of the characteristics, resources, techniques and behaviors in national interventional pulmonology (IP) units, before and after SARS-CoV-2 outbreak. MATERIALS AND METHODS An online survey was developed by an expert panel with a total of 46 questions comprising the specifications of each unit, namely physical space, equipment, staff, procedure planning, monitoring, technical differentiation, and numbers pre- and post-COVID-19. Forty-one interventional pulmonology centers were invited to participate between April and May 2021. RESULTS 37 units (90.2%) responded to the survey. The majority (64.9%) have a fully dedicated space with a weekly presence of ≥3 chest physicians (82.1%) and support of an anesthesiologist on specific days (48.6%). There is marked heterogeneity in the IP unit's equipment, and 56.8% acquired disposable bronchoscopes after COVID-19 pandemics. Pre-bronchoscopy hemogram, platelet count and coagulation tests are regularly asked by more than 90% of the units, even when deep sedation or biopsies are not planned. In 97.3% of cases, topical anesthesia and midazolam are utilized. Propofol (21.6%) and fentanyl (29.7%) are occasionally employed in some institutions. Most units use ancillary sampling techniques to diagnose central or peripheral lesions, with radial EBUS being used for guidance of distal procedures in 37.8% of centers, linear EBUS and EUS-B-FNA for mediastinal diagnosis and/or staging in 45.9% and 27.0% of units, respectively. Cryobiopsies are used by 21.6% of respondents to diagnose diffuse lung diseases. Rigid bronchoscopy is performed in 37.8% of centers. There was a decrease in the number of flexible (p < 0.001) and rigid (p = 0.005) bronchoscopies and an upscale of personal protective equipment (PPE) during the COVID-19 outbreak. CONCLUSIONS IP units have variable bronchoscopic practices, but during the COVID-19 pandemic, they complied with most international recommendations, as elective procedures were postponed and PPE levels increased.
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Affiliation(s)
- F Guedes
- Pulmonology Department, Centre Hospitalier de Luxembourg, Luxembourg; Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Porto, Portugal.
| | - A J Ferreira
- Pulmonology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Dionísio
- Pulmonology Department, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - L V Rodrigues
- Pulmonology Department, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - A Bugalho
- Pulmonology Department, CUF Tejo Hospital and CUF Descobertas Hospital, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Lisbon, Portugal
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Shoukry RA. Safety and efficacy of dexmedetomidine sedation for elective fiberoptic bronchoscopy: A comparative study with propofol. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Assessment of Bronchoscopic Dexterity and Procedural Competency in a Low-fidelity Simulation Model. J Bronchology Interv Pulmonol 2018; 25:198-203. [PMID: 29389834 DOI: 10.1097/lbr.0000000000000481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Assessment of competency in bronchoscopy has traditionally been undertaken in clinical settings, however, recent recognition of increased procedural complications and learner anxiety have led to interest in simulation-based competency assessment. The aim of this study was to determine if low-fidelity simulation-based assessment allows discrimination of competency based on prior experience between bronchoscopists. METHODS Forty-four participants were allocated to 3 groups based on prior bronchoscopic experience [novices (n=31) with no prior experience, intermediates (n=7) with prior experience of 5 to 10 bronchoscopies, and expert bronchoscopists (n=6) with minimum 200 prior bronchoscopies performed]. Participants performed bronchoscopy in a 3D-printed anatomic airway model and were assessed according to time required to navigate to a target bronchus. Bronchoscopic dexterity was measured using a modified version of the validated Bronchoscopy Skills and Tasks Assessment Tool. RESULTS Competency based on successful navigation to a target bronchus differed significantly between each group [experts, 12/12 (100%); intermediates, 9/14 (64%); novices, 19/62 (31%); P<0.001]. Bronchoscopic dexterity as measured by modified Bronchoscopy Skills and Tasks Assessment Tool also differed significantly between groups with experts achieving consistently higher scores compared with other 2 groups [median (interquartile range) scores: novices, 3.5 (2.5 to 5); intermediate, 5 (4.5 to 7); experts, 8 (7.5 to 8); P<0.0.001). CONCLUSIONS Multiple measures demonstrate that low-fidelity simulation-based assessment may reliably discriminate between different levels of skill in performing bronchoscopic navigation and airway inspection. Procedural dexterity of trainees may be assessed in a 0-risk simulation environment.
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Riachy M, Khayat G, Ibrahim I, Aoun Z, Dabar G, Bazarbachi T, Khalil N, Habr B. A randomized double-blind controlled trial comparing three sedation regimens during flexible bronchoscopy: Dexmedetomidine, alfentanil and lidocaine. CLINICAL RESPIRATORY JOURNAL 2017; 12:1407-1415. [PMID: 28779544 DOI: 10.1111/crj.12669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/09/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION No standardized sedation protocol is available for flexible bronchoscopy (FB). OBJECTIVES The aim of this study was to evaluate the efficacy and safety of three regimens used for sedation during FB. METHODS This randomized double-blind controlled trial assessed patients undergoing bronchoscopy and receiving lidocaine alone (C) or combined with dexmedetomidine (D) or alfentanil (A). Tolerance was assessed using the bronchoscopy score, and level of sedation was assessed using the Nursing Instrument for the Communication of Sedation. Safety was evaluated in terms of pulmonary function and vital signs. RESULTS A total of 162 patients were enrolled. The bronchoscopy score was identical in all groups. Group D subjects were the most sedated (P = .013), whereas group A subjects were the least agitated. Linear regression showed a negative association between bronchoscopy score and age in A (β = -0.06; P = .001). Positive predictors of bronchoscopy score were female gender (β = 1.96; P = .003) in D and obesity (β = 2.41; P = .012), longer procedures (β = 0.08; P = .009) and female gender (β = 1.15; P = .038) in C. Longer procedures (β = -0.12; P = .010) was a negative predictor of bronchoscopy score in D. Desaturation, hypoxia and heart rate changes were most prevalent in group A. Hypotension was mostly observed in D. CONCLUSIONS No consistent differences were present between the three regimens; however, each was more appropriate in certain patient profiles. We consequently proposed a protocol as a first step towards standardizing sedation practice in FB in a patient-tailored manner. A more comprehensive and detailed protocol including other sedative agents with their corresponding doses should be developed.
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Affiliation(s)
- Moussa Riachy
- Department of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
| | - Georges Khayat
- Department of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
| | - Ihab Ibrahim
- Department of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
| | - Zeina Aoun
- Department of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
| | - Georges Dabar
- Department of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
| | - Taha Bazarbachi
- Department of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
| | - Nadine Khalil
- Department of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
| | - Bassem Habr
- Department of Pulmonary and Critical Care, Hôtel Dieu de France University Hospital, Beirut, Lebanon
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Mercado-Longoría R, Armeaga-Azoños C, Tapia-Orozco J, González-Aguirre JE. Non-anesthesiologist-administered Propofol is not Related to an Increase in Transcutaneous CO 2 Pressure During Flexible Bronchoscopy Compared to Guideline-based Sedation: A Randomized Controlled Trial. Arch Bronconeumol 2017; 53:489-494. [PMID: 28410767 DOI: 10.1016/j.arbres.2016.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/30/2016] [Accepted: 12/16/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Evidence for the use of non-anesthesiologist-administered propofol for sedation during flexible bronchoscopy is scarce. The main objective of this study was to determine whether non-anesthesiologist-administered propofol balanced sedation was related to higher transcutaneous CO2 pressure compared with current guideline-based sedation (combination midazolam and opioid). Secondary outcomes were post-procedural recuperation time, patient satisfaction and frequency of adverse events. METHODS In this randomized controlled trial we included data from outpatients aged 18 years or older with an indication for flexible bronchoscopy in a university hospital in northern Mexico. RESULTS Ninety-one patients were included: 42 in the midazolam group and 49 in the propofol group. During 60min of transcutaneous capnometry monitoring, mean transcutaneous CO2 pressure values did not differ significantly between groups (43.6 [7.5] vs. 45.6 [9.6]mmHg, P=.281). Propofol was related with a high Aldrete score at 5, 10, and 15min after flexible bronchoscopy (9 [IQR 6-10] vs. 10 [9,10], P=.006; 9 [8-10] vs. 10 [IQR 10-10], P<.001 and 10 [IQR 9-10] vs. 10 [10], respectively) and with high patient satisfaction on a visual analogue scale of 1 (not satisfied) to 10 (very satisfied) (8.41 [1.25] vs. 8.97 [0.98], P=.03). Frequency of adverse events was similar among groups (30.9% vs. 22.4%, P=.47). CONCLUSION Compared with guideline-recommended sedation, non-anesthesiologist-administered propofol balanced sedation is not associated with higher transcutaneous CO2 pressure or with more frequent adverse effects. Propofol use is associated with faster sedation recovery and with high patient satisfaction. CLINICAL TRIAL REGISTRATION NCT02820051.
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Affiliation(s)
- Roberto Mercado-Longoría
- Pulmonary and Critical Care Medicine Department, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, N.L., Mexico
| | - Carolina Armeaga-Azoños
- Pulmonary and Critical Care Medicine Department, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, N.L., Mexico
| | - Jasel Tapia-Orozco
- Pulmonary and Critical Care Medicine Department, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, N.L., Mexico
| | - Julio E González-Aguirre
- Pulmonary and Critical Care Medicine Department, "Dr. José E. González" University Hospital, Nuevo León Autonomous University, Monterrey, N.L., Mexico.
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7
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Gaisl T, Bratton DJ, Heuss LT, Kohler M, Schlatzer C, Zalunardo MP, Frey M, Franzen D. Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey. BMC Pulm Med 2016; 16:113. [PMID: 27495824 PMCID: PMC4974777 DOI: 10.1186/s12890-016-0275-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/02/2016] [Indexed: 11/23/2022] Open
Abstract
Background There is limited knowledge on practice patterns in procedural sedation and analgesia (PSA), the use of propofol, and monitoring during flexible bronchoscopy (FB). The purpose of this study was to assess the current practice patterns of FBs and to focus on the use of propofol, the education of the proceduralist, and the involvement of anaesthesiologists during FB. Methods An anonymous questionnaire was sent to 299 pulmonologists. Only respondents who were active physicians in adult respiratory medicine performing FB were subsequently analysed. Results The response rate was 78 % and 27,149 FB in the previous 12 months were analysed. The overall sedation-related morbidity rate was 0.02 % and mortality was 7/100’000 FB. Sedation was used in 95 % of bronchoscopies. The main drugs used for PSA were propofol (77 %) and midazolam (46 %). In 84 % of PSAs propofol was used without the attendance of an anaesthesiologist. The use of propofol was associated with high volume bronchoscopists (p < 0.010) and career-young pulmonologists (p < 0.001). While monitoring vital parameters has become standard practice, pulmonologists reported a very low rate of systematic basic education and training in the field of PSA (50 %). Conclusions In Switzerland, PSA during FB is mostly performed with propofol without the attendance of an anaesthesiologist and the use of this drug is expected to increase in the future. While monitoring standards are very high there is need for policies to improve education, systematic training, and support for pulmonologists for PSA during FB.
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Affiliation(s)
- Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. .,Spital Zollikerberg, Zollikerberg, Switzerland.
| | - Daniel J Bratton
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | | | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.,Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - Christian Schlatzer
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Marco P Zalunardo
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel Franzen
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Schulze M, Grande B, Kolbe M, Kriech S, Nöthiger CB, Kohler M, Spahn DR, Franzen D. SafAIRway: an airway training for pulmonologists performing a flexible bronchoscopy with nonanesthesiologist administered propofol sedation: A prospective evaluation. Medicine (Baltimore) 2016; 95:e3849. [PMID: 27281093 PMCID: PMC4907671 DOI: 10.1097/md.0000000000003849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Nonanesthesiologist administered propofol (NAAP) sedation for flexible bronchoscopy is controversial, because there is no established airway management (AM) training for pulmonologists. The aim was to investigate the performance and acceptance of a proposed AM algorithm and training for pulmonologists performing NAAP sedation. The algorithm includes using 3 maneuvers including bag mask ventilation (BMV), laryngeal tube (LT), and needle cricothyrotomy (NCT). During training (consisting of 2 sessions with a break of 9 weeks in between), these maneuvers were demonstrated and exercised, followed by 4 consecutive attempts to succeed with each of these devices. The primary outcome was the improvement of completion time needed for a competent airway. Secondary outcomes were the trainees' overall reactions to the training and algorithm, and the perceptions of psychological safety (PS). The 23 staff members of the Department of Pulmonology performed a total of 552 attempts at AM procedures (4 attempts at each of the 3 maneuvers in 2 sessions), and returned a total of 42 questionnaires (4 questionnaires were not returned). Median completion times of LT and NCT improved significantly between Sessions 1 and 2 (P = 0.005 and P = 0.04, respectively), whereas BMV was only marginally improved (P = 0.05). Trainees perceived training to be useful and expressed satisfaction with this training and the algorithm. The perception of PS increased after training. An AM algorithm and training for pulmonologists leads to improved technical AM skills, and is considered useful by trainees and raised their perception of PS during training. It thus represents a promising program.
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Affiliation(s)
| | - Bastian Grande
- Institute of Anesthesiology
- Simulation Center, University Hospital Zurich
| | | | - Sarah Kriech
- Simulation Center, University Hospital Zurich
- ETH Zurich
| | | | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel Franzen
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- ∗Correspondence: Daniel Franzen, Department of Pulmonology, University Hospital Zurich, Raemistr. 100, 8091 Zurich, Switzerland (e-mail: )
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Clouzeau B, Saghi T. La fibroscopie bronchique chez le patient de réanimation hypoxémique et non intubé: modalités pratiques. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Abstract
Lidocaine is currently the most commonly used topical anesthetic during flexible bronchoscopy (FFB) in North America. Tetracaine, a longer-acting agent, might produce better airway analgesia; however, previous literature has suggested that tetracaine is more risky and can even result in cardiac arrest. The maximum recommended tetracaine dose for topical anesthesia is 20 mg. Over the past 30 years, our Pulmonary Special Procedures Unit has used topical tetracaine in considerably higher doses. In this study, we sought to review the safety of this approach. We completed a retrospective review of all FFBs performed on nonintubated patients by a single bronchoscopist from January 2005 to February 2007. The primary outcome variables included adverse reactions and tetracaine dose administered. Five hundred thirty-seven FFBs were performed on 431 patients. Patient age ranged from 20 to 94 years, with a mean age of 55 years. Eighty-one percent (n=434) of these FFBs were performed using only topical anesthesia. Tetracaine solution 0.45% was used in 99.6% of these procedures. Mean tetracaine dose was 120 mg (range: 18 to 158 mg). No adverse reactions attributable to tetracaine were noted. Specifically, no cardiac or neurologic events occurred. Bronchospasm was noted in 1.5% of patients and 1 patient required intubation after the procedure owing to severe hypoxemia. This retrospective study suggests that topical tetracaine at doses up to 8 times the "recommended" dose is safe for the use during FFB.
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Martin-Loeches I, Artigas A, Gordo F, Añón JM, Rodríguez A, Blanch L, Cuñat J. [Current status of fibreoptic bronchoscopy in intensive care medicine]. Med Intensiva 2012; 36:644-9. [PMID: 23141554 DOI: 10.1016/j.medin.2012.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/04/2012] [Accepted: 09/13/2012] [Indexed: 11/27/2022]
Abstract
Flexible bronchoscopy (FB) has been of great help in the management of critically ill patients. Its safety and usefulness in the hands of experienced professionals, with the required measures of caution, has resulted in the increasingly widespread use of the technique even in unstable critical patients subjected to mechanical ventilation and with high oxygen demands. The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), through its Acute Respiratory Failure (GT-IRA) and Infectious Diseases (GT-EI) Work Groups, aims to promote knowledge and standards of quality in the use of FB among all specialists in Intensive Care Medicine. Through an expert committee, the SEMICYUC has established the objective of accrediting such training, with the preparation of a curriculum and definition of those Units qualified for providing training in the different techniques and levels. The accreditation process seeks to stimulate good learning practice and quality in training. Both specialists in Intensive Care Medicine and other specialists, and the patients, will benefit from the commitment and control afforded by such accreditation, and from the learning and training which the mentioned process entails.
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Affiliation(s)
- I Martin-Loeches
- CIBER Enfermedades Respiratorias, Servicio de Medicina Intensiva, Corporació Sanitària i Universitària Parc Taulí, Institut Universitari Parc Taulí, Hospital de Sabadell, Universitat Autònoma de Barcelona, Barcelona, España.
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12
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FIELDING DAVID, PHILLIPS MARTIN, ROBINSON PETER, IRVING LOUIS, GARSKE LUKE, HOPKINS PETER. Advanced interventional pulmonology procedures: Training guidelines from the Thoracic Society of Australia and New Zealand. Respirology 2012; 17:1176-89. [DOI: 10.1111/j.1440-1843.2012.02253.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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13
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Liao W, Ma G, Su Q, Fang Y, Gu B, Zou X. Dexmedetomidine versus Midazolam for Conscious Sedation in Postoperative Patients Undergoing Flexible Bronchoscopy: A Randomized Study. J Int Med Res 2012; 40:1371-80. [DOI: 10.1177/147323001204000415] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE: This prospective randomized study evaluated the efficacy and patient tolerance of dexmedetomidine compared with midazolam for sedation in postoperative patients undergoing flexible bronchoscopy. METHODS: A total of 198 postoperative patients were randomized to receive dexmedetomidine ( n = 99) or midazolam ( n = 99) to produce conscious sedation for bronchoscopy. Peripheral oxygen saturation, heart rate and systolic and diastolic arterial pressures were recorded before, during and after the procedure. Patient tolerance was recorded using various visual analogue scales. RESULTS: The mean lowest peripheral oxygen saturation was significantly lower in the midazolam group than in the dexmedetomidine group. Heart rate and systolic arterial pressure were both significantly higher during bronchoscopy in the midazolam group than in the dexmedetomidine group. Bronchoscopy was well tolerated in both groups; there was no between-group difference in patient discomfort scores or in the percentage of patients who would accept repeat bronchoscopy. CONCLUSIONS: Compared with midazolam, dexmedetomidine provided better oxygen saturation and was equally well tolerated for conscious sedation in postoperative patients undergoing bronchoscopy.
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Affiliation(s)
- W Liao
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - G Ma
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Qg Su
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Y Fang
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Bc Gu
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Xm Zou
- Department of Intensive Care Medicine, Cancer Centre, Sun Yat-sen University, Guangzhou, China
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14
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Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients. Intensive Care Med 2011; 37:1969-75. [DOI: 10.1007/s00134-011-2375-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 09/12/2011] [Indexed: 10/17/2022]
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Eastwood PR, Maher TM, Wells AU, Lam B. Year in review 2009: Interstitial lung diseases, acute injury, sleep, physiology, imaging and bronchoscopic intervention. Respirology 2010; 15:172-81. [PMID: 20199638 DOI: 10.1111/j.1440-1843.2009.01696.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Peter R Eastwood
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia.
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Antoniades N, Worsnop C. Topical lidocaine through the bronchoscope reduces cough rate during bronchoscopy. Respirology 2009; 14:873-6. [PMID: 19703068 DOI: 10.1111/j.1440-1843.2009.01587.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Topical lidocaine is often administered through the flexible bronchoscope in an attempt to reduce excessive coughing and patient discomfort. With the increasing use of sedation, including opiates that possess central cough suppressant effects, and the potential for serious clinical toxicity, the need for evidence regarding the efficacy of topical lidocaine is important. This study assessed whether topical lidocaine through the bronchoscope could reduce cough and stridor rate. METHODS A randomized controlled trial of 49 patients undergoing flexible bronchoscopy was conducted. Following sedation and topical anaesthesia to the upper airway, patients were randomized to receive either lidocaine 2% or placebo (N-saline) through the bronchoscope to the vocal cords and tracheobronchial tree. Cough and stridor rates were recorded by audiotape. Bronchoscopists and nurses assessed coughing with visual analogue scales. RESULTS There were no significant differences in baseline demographics and level of sedation between the two groups. The cough rate per minute (mean (SD)) was lower (P < 0.001) in the lidocaine group, 12.20 (7.99), n = 18, than in the placebo group, 27.50 (10.74), n = 31. The stridor rate was lower with lidocaine, 0.22 (0.60) per minute than with placebo 0.80 (1.35), but the difference was non-significant at P = 0.095. Both doctors' and nurses' scores for cough were significantly lower in the lidocaine group (P < 0.001 for both). Less midazolam 2.1 mg (1.1) was used with lidocaine than with placebo 3.4 mg (1.9), P = 0.02 and less fentanyl 81.9 mg (34.1) versus 98.4 mg (20.4), P = 0.04. CONCLUSIONS Topical lidocaine through the bronchoscope significantly decreased cough frequency and the total dose of sedation required during flexible bronchoscopy.
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Affiliation(s)
- Nick Antoniades
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia
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Silvestri GA, Vincent BD, Wahidi MM, Robinette E, Hansbrough JR, Downie GH. A Phase 3, Randomized, Double-Blind Study To Assess the Efficacy and Safety of Fospropofol Disodium Injection for Moderate Sedation in Patients Undergoing Flexible Bronchoscopy. Chest 2009; 135:41-47. [DOI: 10.1378/chest.08-0623] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Stolz D, Pollak V, Chhajed PN, Gysin C, Pflimlin E, Tamm M. A randomized, placebo-controlled trial of bronchodilators for bronchoscopy in patients with COPD. Chest 2007; 131:765-772. [PMID: 17356091 DOI: 10.1378/chest.06-2308] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In contrast to asthma, the indication for bronchodilators prior to bronchoscopy in patients with COPD has not been properly investigated. We therefore performed a randomized, double-blind, placebo-controlled trial to determine whether use of a short-acting bronchodilator provides a protective effect in patients with COPD undergoing bronchoscopy. METHODS One hundred twenty patients undergoing bronchoscopy were included. Patients with COPD were randomized to receive either 200 mug of salbutamol (n = 40) or placebo (n = 40) before bronchoscopy. Control patients (n = 40) did not receive any inhaled medication. Spirometry was performed before and 2 h after bronchoscopy in all patients. Sedative drug requirements and hemodynamic parameters were recorded. RESULTS Hemodynamic findings before, during, and after bronchoscopy were similar in patients with COPD randomized to either salbutamol or placebo (p = not significant for all). Compared to prebronchoscopy values, postbronchoscopy percentage of predicted FEV(1) decreased significantly in all three groups: salbutamol (median, - 4.7%; interquartile range [IQR], - 13.3 to 6.6); placebo (median, - 4.8%; IQR, - 19.9 to 8.4); and control subjects (median, - 10.0%; IQR, - 20.2 to - 3.3) [p = 0.023]. The decrease in FEV(1) was similar in all three patient groups (p = 0.432). The relative change in FEV(1) was inversely correlated to the increasing severity of COPD as expressed by Global Initiative for Chronic Obstructive Lung Disease stages (p = 0.01). CONCLUSIONS Premedication with an inhaled short-acting beta-agonist cannot be recommended in patients with COPD undergoing bronchoscopy.
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Affiliation(s)
- Daiana Stolz
- The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland.
| | - Vincent Pollak
- The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland
| | - Prashant N Chhajed
- The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland
| | - Christian Gysin
- The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland
| | - Eric Pflimlin
- The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland
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Affiliation(s)
- William W Lunn
- Interventional Pulmonology, Baylor College of Medicine, 1709 Dryden St., Suite 950, Houston, TX 77030, USA.
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