CHEST Guidelines-Use of Topical Anesthesia, Analgesia, and Sedation During Flexible Bronchoscopy in Adult Patients

Use of Topical Anesthesia, Analgesia, and Sedation During Flexible Bronchoscopy in Adult Patients

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The CHEST consensus statement discusses the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy, emphasizing the importance of patient comfort, safety, and physician satisfaction. While bronchoscopy can be safely performed with or without sedation, patient satisfaction and tolerance are significantly better with sedation.<br /><br />The consensus recommends sedation for all patients undergoing bronchoscopy without contraindications. The choice of sedation—ranging from minimal to general anesthesia—depends on the bronchoscopy setting and complexity. Topical anesthesia effectively reduces cough and sedation dose during the procedure. Lidocaine is preferred due to its safety profile, though caution is advised in certain patients like the elderly or those with liver impairment.<br /><br />Regarding sedatives, benzodiazepines, particularly midazolam, are recommended for their effective sedation, anterograde amnesia, and quick onset. Opioids, especially fentanyl, are suggested for their cough-suppressing abilities when combined with benzodiazepines. Propofol is another effective option, offering rapid recovery time similar to combined benzodiazepine and opioid sedation, but requires careful monitoring due to potential for deeper sedation levels.<br /><br />Anticholinergic agents like atropine and glycopyrrolate are not recommended as they have minimal clinical impact and can cause adverse cardiovascular effects. Non-pharmaceutical interventions (e.g., visual or sound effects) have not proven effective in reducing anxiety during bronchoscopy.<br /><br />This consensus aims to guide bronchoscopy sedation practices based on a comprehensive literature review, balancing efficacy and patient safety. Ongoing research is necessary to refine these guidelines and explore new sedation methods or combinations for optimal bronchoscopy outcomes.

Keywords

bronchoscopy

sedation

topical anesthesia

patient comfort

lidocaine

benzodiazepines

midazolam

fentanyl

propofol

anticholinergic agents