Cardiovascular consequences of fibreoptic bronchoscopy.
Fibreoptic bronchoscopy (FOB) is now commonly performed, and the number of elderly patients undergoing the procedure is increasing. Problems with oxygenation during FOB are well-recognised, but there are few data about its cardiovascular effects. Forty five patients (median age 65 yrs) undergoing elective FOB were studied prospectively. Patients were connected to a 12-lead computerized electrocardiographic recorder, a finger plethysmographic blood pressure (FPBP) monitor and pulse oximeter. Forty three patients were sedated with fentanyl and droperidol, and all were given 5 mL 2.5% cocaine intratracheally and xylocaine spray to the pharynx. Mean sphygmomanometric cuff blood pressure was raised initially (167/88 mmHg). Mean blood pressure recorded by FPBP rose on intratracheal injection (178/96 mmHg) and remained high throughout the procedure. Mean (SD) initial cardiac frequency was 93 (5.1) beats x min(-1) and rose to 134 (7.5) beats x min(-1) during the procedure. Four of the 45 patients showed unexpected ST segment depression of >1 mm for >1 min, and a further three developed bundle branch block. These seven patients had significantly greater tachycardia (152 vs 131 beats x min(-1)) and higher blood pressure (238/131 vs 207/109 mmHg). They were older (72 vs 61 yrs), had smoked more (63 vs 39 pack-years), but had similar lung function and similar changes in oxygen saturation. Oxygen desaturation occurred in 19 patients and this was associated with poor lung function (69 vs 84% predicted forced expiratory volume in one second), but was independent of the cardiovascular changes. Significant cardiovascular changes occur during fibreoptic bronchoscopy, with evidence of cardiac strain in 21% of patients over the age of 60 yrs.
Davies
L
L
Aintree Chest Centre, Fazakerley Hospital, Liverpool, UK.
Mister
R
R
Spence
D P
DP
Calverley
P M
PM
Earis
J E
JE
Pearson
M G
MG
D000759:Adjuvants, Anesthesia; D000367:Age Factors; D000368:Aged; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D001794:Blood Pressure; D015924:Blood Pressure Monitors; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000009:adverse effects*; D002037:Bundle-Branch Block / Q000503:physiopathology; D003042:Cocaine; D004329:Droperidol; D004562:Electrocardiography; D005260:Female; D005283:Fentanyl; D005336:Fiber Optic Technology; D005541:Forced Expiratory Volume; D006339:Heart Rate; D006801:Humans; D008012:Lidocaine; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010092:Oximetry; D011446:Prospective Studies; D012907:Smoking; D013610:Tachycardia / Q000503:physiopathology
D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D008012:Lidocaine; D003042:Cocaine; D004329:Droperidol; D005283:Fentanyl