The safety of flexible fibre-optic bronchoscopy and proceduralist-administered sedation: a tertiary referral centre experience.
BACKGROUND
Flexible fibre-optic bronchoscopy has become an essential investigation and is widely regarded as safe, but wider published prospective data regarding delayed complications are limited. There is continuing debate concerning the safety of proceduralist-administered sedation. We evaluated complication rates of bronchoscopy and proceduralist-administered sedation at our tertiary institution, and their clinical significance.


METHODS
Prospective evaluation of all patients undergoing bronchoscopy over a 12-month period at a tertiary referral centre. Immediate minor and major complications were documented within 4 h of bronchoscopy, delayed complications at 48 h, case notes and bronchoscopy records were reviewed 1 month later.


RESULTS
Five hundred and fifty-eight flexible fibre-optic bronchoscopies were performed, 216 with transbronchial biopsy or nodal aspiration, 19 had therapeutic airways intervention. The minor complication rate at 4 h was 4.12% (23), rising to 26% (145) at 48 h. All 2.2% (12) major complications occurred exclusively within 4 h of bronchoscopy. No complications could be attributed to proceduralist-administered sedation.


CONCLUSIONS
Complication rates at 4 h were comparable with previously reported data. Delayed minor complications were greater than expected, and did not require additional medical input. There were no complications from proceduralist-administered sedation. Flexible fibre-optic bronchoscopy and proceduralist-administered sedation within our institution's guidelines are safe.
Dang
D
D
Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, South Australia, Australia. dien.dang@health.sa.gov.au
Robinson
P C
PC
Winnicki
S
S
Jersmann
H P A
HP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001999:Bronchoscopy / Q000009:adverse effects*; D016292:Procedural Sedation; D004417:Dyspnea / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D005336:Fiber Optic Technology; D006469:Hemoptysis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012017:Referral and Consultation; D013748:Tetracaine / Q000008:administration & dosage
D013748:Tetracaine; D008012:Lidocaine; D008874:Midazolam; D005283:Fentanyl