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Sedation for flexible bronchoscopy: current and emerging evidence

Ricardo J. José, Shahzad Shaefi, Neal Navani
European Respiratory Review 2013 22: 106-116; DOI: 10.1183/09059180.00006412
Ricardo J. José
*Dept of Thoracic Medicine, University College Hospital, London, #Centre for Inflammation and Tissue Repair, University College London, London, +Lungs for the Living Research Centre, University College London, London, UK. ¶Dept of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
*Dept of Thoracic Medicine, University College Hospital, London, #Centre for Inflammation and Tissue Repair, University College London, London, +Lungs for the Living Research Centre, University College London, London, UK. ¶Dept of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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  • For correspondence: r.jose@ucl.ac.uk
Shahzad Shaefi
*Dept of Thoracic Medicine, University College Hospital, London, #Centre for Inflammation and Tissue Repair, University College London, London, +Lungs for the Living Research Centre, University College London, London, UK. ¶Dept of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Neal Navani
*Dept of Thoracic Medicine, University College Hospital, London, #Centre for Inflammation and Tissue Repair, University College London, London, +Lungs for the Living Research Centre, University College London, London, UK. ¶Dept of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
*Dept of Thoracic Medicine, University College Hospital, London, #Centre for Inflammation and Tissue Repair, University College London, London, +Lungs for the Living Research Centre, University College London, London, UK. ¶Dept of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Abstract

Flexible bronchoscopy is commonly performed by respiratory physicians and is the gold standard for directly visualising the airways, allowing for numerous diagnostic and therapeutic interventions. With the widespread use of flexible bronchoscopy and the evolution of interventional bronchoscopy with more complex and longer procedures, physicians are placing increasing importance on the use of sedation as a necessary adjunct to topical anaesthesia. There is no standardised practice for the use of sedation in bronchoscopy with a good deal of variation among physicians regarding the use of pre-procedure medication and pharmacological sedatives. In addition, there is ongoing debate and controversy about proceduralist-administered versus anaesthetist-administered sedation whilst at the same time there is a growing body of evidence that nonanaesthetist administered sedation is safe and cost-effective. In this review we summarise the evidence for the use of sedation as an adjunct to topical anaesthesia in bronchoscopy and provide the clinician with up-to-date concise guidance for the use of pharmacological sedatives in bronchoscopy and future directions for sedation in the bronchoscopy suite.

  • Anaesthesia
  • bronchoscopy
  • midazolam
  • proceduralist administered
  • propofol
  • sedation

Footnotes

  • Provenance

    Submitted article, peer reviewed.

  • Statement of Interest

    None declared.

  • Received October 23, 2012.
  • Accepted December 11, 2012.
  • ©ERS 2013
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Sedation for flexible bronchoscopy: current and emerging evidence
Ricardo J. José, Shahzad Shaefi, Neal Navani
European Respiratory Review Jun 2013, 22 (128) 106-116; DOI: 10.1183/09059180.00006412

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Sedation for flexible bronchoscopy: current and emerging evidence
Ricardo J. José, Shahzad Shaefi, Neal Navani
European Respiratory Review Jun 2013, 22 (128) 106-116; DOI: 10.1183/09059180.00006412
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  • Article
    • Abstract
    • MODERATE SEDATION
    • SAFE DELIVERY OF MODERATE SEDATION
    • PRE-MEDICATION DRUGS IN BRONCHOSCOPY
    • PHARMACOLOGICAL SEDATIVES USED FOR SEDATION DURING BRONCHOSCOPY
    • EMERGING PHARMACOLOGICAL SEDATIVES IN BRONCHOSCOPY
    • DRUG INTERACTIONS
    • CONCLUSION
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