Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey

Abstract

Background: There is limited knowledge on practice patterns in procedural sedation and analgesia (PSA), the use of propofol, and monitoring during flexible bronchoscopy (FB). The purpose of this study was to assess the current practice patterns of FBs and to focus on the use of propofol, the education of the proceduralist, and the involvement of anaesthesiologists during FB.

Methods: An anonymous questionnaire was sent to 299 pulmonologists. Only respondents who were active physicians in adult respiratory medicine performing FB were subsequently analysed.

Results: The response rate was 78 % and 27,149 FB in the previous 12 months were analysed. The overall sedation-related morbidity rate was 0.02 % and mortality was 7/100'000 FB. Sedation was used in 95 % of bronchoscopies. The main drugs used for PSA were propofol (77 %) and midazolam (46 %). In 84 % of PSAs propofol was used without the attendance of an anaesthesiologist. The use of propofol was associated with high volume bronchoscopists (p < 0.010) and career-young pulmonologists (p < 0.001). While monitoring vital parameters has become standard practice, pulmonologists reported a very low rate of systematic basic education and training in the field of PSA (50 %).

Conclusions: In Switzerland, PSA during FB is mostly performed with propofol without the attendance of an anaesthesiologist and the use of this drug is expected to increase in the future. While monitoring standards are very high there is need for policies to improve education, systematic training, and support for pulmonologists for PSA during FB.

Keywords: Bronchoscopy; Education; Midazolam; Propofol; Sedation; Survey.

Figures

Fig 1

Flow chart of the study. An overall response rate of 78 % was achieved by the use of online questionnaires and reminders (hardcopies on paper) sent via post

Fig. 2

Background and Education. a Professional background of the participants. Part-time employment was considered in the analysis. b Methods of education & training of Swiss pulmonologists in flexible bronchoscopy. Multiple answers were possible

Fig 3

Sedatives a Frequency of sedatives/hypnotics used for flexible bronchoscopies by survey participants. Sedatives/hypnotics in general were used in a median of 100 % (IQR 90–100) of flexible bronchoscopies. 77 % of respondents reported the use of propofol on a regular basis (either mono or combination therapy). The most common mono therapy was propofol (47 %) and the most common combination therapy was propofol + codein (11 %, data not shown). Combination therapy included the combination of two or more drugs. b Network plot of drug combinations. The relative size of the circles/bars represents the frequency of the usage/combination. Combination patterns ≤5 % are not labelled. Combination patterns are shown in % of all possible combinations. IQR = Interquartile range

Fig. 4

Propofol and career-age. Box plot summarising the career-age of pulmonologists either not using propofol or using it alone or in combination. Career-young pulmonologists were more likely to use propofol (either mono or in combination) for procedural sedation and analgesia of their flexible bronchoscopy-patients. The career-age was determined by the year of board certification as specialist/consultant (by the Swiss Medical Association [FMH]). ** p < 0.001