CHEST Guidelines-American-College-of-Chest-Physicians-Consensus-Sta

American-College-of-Chest-Physicians-Consensus-Sta

Pdf Summary

The CHEST Consensus Statement provides guidelines on the use of anesthesia, analgesia, and sedation during flexible bronchoscopy, emphasizing the need for patient comfort, physician ease, and risk minimization. It highlights that bronchoscopy can be performed with or without sedation but suggests using sedation to improve patient satisfaction and procedure tolerance unless contraindicated. Sedation levels can vary depending on the procedure setting and complexity.<br /><br />The document emphasizes topical anesthesia's efficacy in reducing cough during bronchoscopy and recommends lidocaine as the preferred agent due to its safety profile. Although other anesthetics like cocaine, benzocaine, and tetracaine are effective, their side effects and safety concerns limit their use. Techniques for administering anesthesia include "spray-as-you-go," nebulization, and nerve blocks, though the latter are discouraged as first-line methods due to their invasive nature.<br /><br />Benzodiazepines are recommended for sedation, with midazolam being preferred for its quick onset and short duration. Combining benzodiazepines with opioids, specifically fentanyl, is suggested for their synergistic effects on patient tolerance and cough suppression. Propofol is considered an effective alternative, offering benefits like shorter recovery times compared to benzodiazepine-opioid combinations.<br /><br />The consensus discourages the use of anticholinergic agents like atropine and glycopyrrolate for bronchoscopy, as they have not shown significant clinical benefits. Non-pharmacologic methods like music and imagery have not proven effective in reducing patient anxiety during the procedure.<br /><br />Overall, the statement provides a comprehensive guide for clinicians, encouraging the use of anesthesia and sedation to enhance the bronchoscopy experience while balancing safety and effectiveness. Further research is encouraged to continue improving bronchoscopy practices.

Keywords

CHEST Consensus Statement

anesthesia

analgesia

sedation

flexible bronchoscopy

patient comfort

lidocaine

benzodiazepines

midazolam

fentanyl