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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: Anesthesiology 2011

The American Society of Anesthesiologists’ annual meeting, Anesthesiology 2011, held on October 15-19 in Chicago, was a comprehensive education program in anesthesiology, focusing on transforming patient safety through science and innovation. The news items below highlight just some of the studies that emerged from the meeting. » Less Propofol Required for Obese Children » Certain Behaviors Lead to Poor Pediatric Surgical Outcomes  » Identifying Women at Risk for Cesarean Pain » Risk Factors for Labor Pain » Anesthetics & Postoperative Delirium in the Elderly  Less Propofol Required for Obese Children The Particulars: The Particulars: Information regarding the appropriate doses for many anesthetics in obese children is lacking. Anesthesiologists must decide whether a dose should be based on actual or lean body weight in a population for whom 75% of excess body weight consists of drug distribution-altering fat tissue. Propofol can cause low blood pressure, prolonged sleepiness, and decreased breathing. Data Breakdown: Researchers measured responses in 40 obese and 40 non-obese children 20 seconds after they received propofol. To bring about unconsciousness at the beginning of surgery, obese children needed 2 mg/kg of propofol. Normal weight children required 3.2 mg/kg of propofol to bring about unconsciousness. Take Home Pearl: Obese children appear to require 50% to 60% less propofol than normal weight children to initiate anesthesia at the beginning of surgical procedures. Certain Behaviors Lead to Poor Pediatric Surgical Outcomes [back to top] The Particulars: Determining the coping, distress, and anxiety behaviors of children and their parents prior to surgery can be challenging during anesthesia induction and following surgery. The Perioperative Adult Child Behavioral Interaction Scale (PACBIS) is thought to provide real-time measurements for determining...
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