American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients
| Autor: | Michael A. Jantz, Pyng Lee, Prasoon Jain, G. Burkhard Mackensen, Gerard A. Silvestri, Momen M. Wahidi, Carla Lamb, Sally Y. Barbour |
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| Rok vydání: | 2011 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult medicine.medical_specialty Lidocaine medicine.drug_class Sedation Conscious Sedation Anticholinergic agents Critical Care and Intensive Care Medicine Topical anesthetic law.invention Randomized controlled trial Bronchoscopy law medicine Humans Hypnotics and Sedatives Anesthetics Local Intensive care medicine Analgesics medicine.diagnostic_test business.industry Sedative Anesthesia medicine.symptom Analgesia Cardiology and Cardiovascular Medicine Propofol business medicine.drug Anesthesia Local |
| Zdroj: | Chest. 140(5) |
| ISSN: | 1931-3543 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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