title: Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey.
abstract: 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.
  
  
  
  An anonymous questionnaire was sent to 299 pulmonologists. Only respondents who were active physicians in adult respiratory medicine performing FB were subsequently analysed.
  
  
  
  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 %).
  
  
  
  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.
authors: Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. Thomas.Gaisl@usz.ch.|Spital Zollikerberg, Zollikerberg, Switzerland. Thomas.Gaisl@usz.ch.
authors: Thomas
authors: 0000-0002-9017-6143
authors: T
authors: Gaisl
authors: Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors: Daniel J
authors: DJ
authors: Bratton
authors: Spital Zollikerberg, Zollikerberg, Switzerland.
authors: Ludwig T
authors: LT
authors: Heuss
authors: Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.|Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.|Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland.
authors: Malcolm
authors: M
authors: Kohler
authors: Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors: Christian
authors: C
authors: Schlatzer
authors: Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.
authors: Marco P
authors: MP
authors: Zalunardo
authors: Klinik Barmelweid, Barmelweid, Switzerland.
authors: Martin
authors: M
authors: Frey
authors: Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors: Daniel
authors: D
authors: Franzen
mesh_terms: D001999:Bronchoscopy; D016292:Procedural Sedation; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008874:Midazolam / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015742:Propofol / Q000627:therapeutic use; D000072106:Pulmonologists / Q000706:statistics & numerical data*; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013557:Switzerland
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol
keywords: Bronchoscopy; Education; Midazolam; Propofol; Sedation; Survey