Myocardial ischemia in sedated patients undergoing fiberoptic bronchoscopy

To study the incidence of myocardial ischemia and related hemodynamic alterations in sedated patients undergoing fiberoptic bronchoscopy (FOB).

Prospective study.

Tertiary care, university hospital.

Twenty-nine patients, age 50 years or older, undergoing elective FOB.

Myocardial ischemia was assessed by continuous ECG monitoring beginning 30 min before, and until 2 h after FOB.

During FOB, there was a significant rise in heart rate (89+/-3 [mean+/-SE] to 120+/-4 beats/min) and fall in oxygen saturation (95+/-1 to 90+/-1%). There was no significant rise in systolic or diastolic BP. Five patients (17%) had myocardial ischemia during FOB that lasted 20+/-8 min. Their demographic and pre-FOB characteristics were not different from the other patients. Compared to baseline values, a significant rise in heart rate, a fall in oxygen saturation, and no significant change in BP were observed during FOB in patients, both with or without ischemia. Although not statistically significant, ischemia was associated with more protracted procedures.

Myocardial ischemia may develop in elderly patients undergoing FOB. This observation encourages the routine use of ECG and oximetry during FOB, allowing for early intervention to prevent the dangerous combination of hypoxia, tachycardia, and myocardial ischemia. Moreover, this study suggests that methods to ensure oxygenation during FOB should be adhered to, and that the routine administration of atropine should be reconsidered.