Cardiovascular consequences of fibreoptic bronchoscopy

Area of Science:

• Cardiology
• Pulmonology
• Anesthesiology

Background:

• Fibreoptic bronchoscopy (FOB) is a common procedure, increasingly performed in elderly patients.
• While oxygenation issues during FOB are known, cardiovascular effects are less understood.
• The cardiovascular impact of FOB, particularly in older populations, requires further investigation.

Purpose of the Study:

• To prospectively evaluate the cardiovascular effects of fibreoptic bronchoscopy.
• To identify potential risk factors and patient subgroups experiencing adverse cardiovascular events during FOB.
• To assess the relationship between cardiovascular changes, oxygenation, and patient demographics during FOB.

Main Methods:

• Prospective study of 45 patients undergoing elective FOB (median age 65).
• Continuous monitoring using 12-lead ECG, finger plethysmographic blood pressure (FPBP), and pulse oximetry.
• Sedation with fentanyl and droperidol, with intratracheal cocaine and pharyngeal xylocaine spray.

Main Results:

• Significant increases in blood pressure and heart rate were observed during FOB.
• Seven patients (15.5%) experienced significant ECG changes (ST depression or bundle branch block).
• These seven patients were older, had higher tachycardia and blood pressure, and a history of heavier smoking.
• Oxygen desaturation occurred in 19 patients, associated with poorer lung function but independent of cardiovascular changes.

Conclusions:

• Fibreoptic bronchoscopy is associated with significant cardiovascular changes.
• Evidence of cardiac strain was observed in 21% of patients over 60 years old.
• Cardiovascular monitoring is crucial during FOB, especially in elderly patients and those with a history of smoking.