Bronchoscopist-Directed Continuous Flow Propofol Based Analgosedation during Flexible Interventional Bronchoscopy and...

Area of Science:

• Pulmonology
• Anesthesiology
• Interventional Pulmonology

Background:

• Sedation techniques for interventional flexible bronchoscopy and endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) lack standardization.
• Evidence supporting general anesthesia for these procedures with full anesthesiologic involvement is limited.
• Providing bronchoscopic care with reduced personnel presents a significant challenge.

Purpose of the Study:

• To evaluate the safety and feasibility of a deep analgosedation approach.
• To assess the bronchoscopist-directed continuous flow propofol based analgosedation (BDcfP) in a two-personnel setting.
• To identify risk factors for periprocedural hypotension during these procedures.

Main Methods:

• Retrospective analysis of 513 patients undergoing flexible interventional bronchoscopy and/or EBUS-TBNA between January 2020 and August 2022.
• Implementation of BDcfP, utilizing pethidine/meperidine bolus plus continuous flow adjusted propofol.
• Monitoring for periprocedural hypotension and identifying associated risk factors.

Main Results:

• 502 out of 513 patients received BDcfP for analgosedation.
• Cardiovascular comorbidities, COPD, and arterial hypertension were identified as risk factors for periprocedural hypotension.
• Propofol flow rate did not correlate with hypotension; theodrenaline, cafedrine, and midazolam were noted as potential treatments/adjuncts.

Conclusions:

• Bronchoscopist-directed continuous flow propofol based analgosedation (BDcfP) is a safe and feasible sedation strategy for interventional flexible bronchoscopy and EBUS-TBNA.
• This approach allows for the safe performance of EBUS-TBNA and interventional flexible bronchoscopy even with limited personnel, following the implementation of safety measures.