title: Sedation for flexible bronchoscopy: current and emerging evidence.
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.
authors.affiliation: Dept of Thoracic Medicine, University College Hospital, London, UK. r.jose@ucl.ac.uk
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: José
authors.forename: Shahzad
authors.initials: S
authors.lastname: Shaefi
authors.forename: Neal
authors.initials: N
authors.lastname: Navani
mesh_terms: D001999:Bronchoscopy / Q000379:methods* / Q000592:standards; D002983:Clinical Competence; D016292:Procedural Sedation / Q000009:adverse effects / Q000592:standards; D054810:Deep Sedation / Q000009:adverse effects / Q000592:standards; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011292:Premedication
chemical_list: D006993:Hypnotics and Sedatives
keywords: Anaesthesia; bronchoscopy; midazolam; proceduralist administered; propofol; sedation