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Is preparation for bronchoscopy optimal?

J Pickles1, M Jeffrey, A Datta

  • 1Chest Clinic, Northampton General Hospital, Northampton, UK. jpickles@doctors.org.uk

The European Respiratory Journal
|September 4, 2003
PubMed
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A survey of diagnostic bronchoscopy practices in England and Wales reveals most patients receive sedation, but monitoring is inconsistent. Further evidence is needed for clearer sedation guidelines.

Area of Science:

  • Pulmonology
  • Anesthesiology
  • Medical Practice Survey

Background:

  • The British Thoracic Society (BTS) has issued guidelines for diagnostic bronchoscopy.
  • Current BTS guidelines recommend offering sedation to all patients unless contraindicated.
  • There is a lack of specific guidance on drugs and techniques for bronchoscopy sedation.

Purpose of the Study:

  • To assess current preparation and practice of diagnostic bronchoscopy in England and Wales.
  • To evaluate adherence to British Thoracic Society guidelines regarding sedation.
  • To identify areas for improvement in sedation practices and monitoring during bronchoscopy.

Main Methods:

  • A questionnaire survey was distributed to practitioners in England and Wales.
  • The survey achieved a 76% response rate (344 out of 452 questionnaires).

Related Experiment Videos

  • Data collected included sedation methods, drug use, and monitoring techniques.

    • Main Results:

    • Most operators use local anesthetics (lignocaine) and the "spray as you go" method.
    • Midazolam is the most common sedative (85%), with many using combined agents.
    • Sedation adequacy assessment is often informal, with poor use of formal sedation scores.

    Conclusions:

    • Most diagnostic bronchoscopies are performed with sedation, but systematic monitoring is inadequate.
    • Routine use of atropine contradicts guidelines and raises safety concerns.
    • More evidence is required to develop specific, evidence-based sedation guidelines for bronchoscopy.