title: American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients.
abstract: BACKGROUND
  Optimal performance of bronchoscopy requires patient's comfort, physician's ease of execution, and minimal risk. There is currently a wide variation in the use of topical anesthesia, analgesia, and sedation during bronchoscopy.
  
  
  METHODS
  A panel of experts was convened by the American College of Chest Physicians Interventional/Chest Diagnostic Network. A literature search was conducted on MEDLINE from 1969 to 2009, and consensus was reached by the panel members after a comprehensive review of the data. Randomized controlled trials and prospective studies were given highest priority in building the consensus.
  
  
  RESULTS
  In the absence of contraindications, topical anesthesia, analgesia, and sedation are suggested in all patients undergoing bronchoscopy because of enhanced patient tolerance and satisfaction. Robust data suggest that anticholinergic agents, when administered prebronchoscopy, do not produce a clinically meaningful effect, and their use is discouraged. Lidocaine is the preferred topical anesthetic for bronchoscopy, given its short half life and wide margin of safety. The use of a combination of benzodiazepines and opiates is suggested because of their synergistic effects on patient tolerance during the procedure and the added antitussive properties of opioids. Propofol is an effective agent for sedation in bronchoscopy and can achieve similar sedation, amnesia, and patient tolerance when compared with the combined administration of benzodiazepines and opiates.
  
  
  CONCLUSIONS
  We suggest that all physicians performing bronchoscopy consider using topical anesthesia, analgesic and sedative agents, when feasible. The existing body of literature supports the safety and effectiveness of this approach when the proper agents are used in an appropriately selected patient population.
authors: Department of Medicine, Duke University Medical Center, Durham, NC. Electronic address: momen.wahidi@duke.edu.
authors: Momen M
authors: MM
authors: Wahidi
authors: Louis A. Johnson VA Medical Center, Clarksburg, WV.
authors: Prasoon
authors: P
authors: Jain
authors: University of Florida, Gainesville, FL.
authors: Michael
authors: M
authors: Jantz
authors: National University Hospital, Singapore.
authors: Pyng
authors: P
authors: Lee
authors: Department of Anesthesia, Duke University Medical Center, Durham, NC.
authors: G Burkhard
authors: GB
authors: Mackensen
authors: Department of Pharmacy, Duke University Medical Center, Durham, NC.
authors: Sally Y
authors: SY
authors: Barbour
authors: Lahey Clinic, Burlington, MA.
authors: Carla
authors: C
authors: Lamb
authors: Medical University of South Carolina, Charleston, SC.
authors: Gerard A
authors: GA
authors: Silvestri
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001999:Bronchoscopy / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives