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Effective Strategies for Sedation During Bronchoscopy

Studies indicate that sedation during bronchoscopy makes the procedure more comfortable for patients and provides better working conditions for physicians when compared with no sedation. Sedation can be used during most bronchoscopies with minimal risk. However, research suggests that use varies widely between geographic areas of the country and within institutions. Survey results from 1991 showed that sedation was administered to more than half (51%) of bronchoscopy patients, but data from more than a decade later revealed that this figure jumped to nearly three-fourths of patients (73%). It’s not known if the use of sedation during bronchoscopy is continuing to rise. Optimizing Use of Sedation During Bronchoscopy In the November 2011 issue of Chest, my colleagues at the American College of Chest Physicians and I had a consensus statement published on the optimal use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adults. The statement recommends that every bronchoscopy be performed with sedation if feasible because it improves patient satisfaction and procedural tolerance significantly. It should be noted, however, that patient circumstances and access to resources may prevent use of sedation during these procedures. Patients with numerous comorbidities or severe, restricting respiratory or cardiac issues may not be appropriate because of potential complications. Although it’s acceptable to fulfill the wishes of patients who don’t want to be sedated, research suggests that topical anesthetics should be used for everyone receiving bronchoscopy. If patients have allergies to lidocaine—the preferred topical anesthetic for bronchoscopy—use of other topical anesthetics may be explored. Anticholinergic agents, however, are discouraged for pre-bronchoscopy use because data have shown that they fail to produce a clinically...

Conference Highlights: CHEST 2011

New research presented at CHEST 2011, the 77th annual meeting of the American College of Chest Physicians, from October 22-26 in Honolulu addressed many important topics in pulmonary, critical care, and sleep medicine. The features below highlight just some of the studies that emerged from the meeting. » Pain Common for Pulmonologists Performing Bronchoscopy » Guideline Effects on CRBSI  » An Effective Computer Model for Smoking Cessation  Pain Common for Pulmonologists Performing Bronchoscopy The Particulars: Much attention has been paid to ergonomics and overuse injury in gastroenterology and surgery settings. However, little attention has been paid on other medical specialties, such as bronchoscopy. Data Breakdown: Researchers in New York gave an online questionnaire to 132 pulmonologists to assess pain and injury while performing bronchoscopy. Nearly 40% reported experiencing pain while operating a bronchoscope. Among this group, 22% reported recurring pain, which mostly occurred in the shoulder, back, wrist, neck, and thumb. This pain appeared to be associated with overuse and height less than 5’7″. Only 38% of pulmonologists who felt pain attempted to modify their workspace. Take Home Pearl: Interventions may be needed to prevent musculoskeletal injuries among pulmonologists who perform bronchoscopies. Guideline Effects on CRBSI [back to top] The Particulars: The Institute of Health Improvement Bundle was created in 2006 as a guideline to help hospitals reduce catheter-related bloodstream infection (CRBSI) rates. Whether this goal has been achieved remains uncertain. Data Breakdown: An investigation from researchers in Tampa retrospectively reviewed 895 patient charts for people admitted to two hospitals who required a central venous catheter (CVC) between 2007, when the guidelines were first released, and 2010. The rate of CRBSIs decreased from 4.38 per...
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