American College of Chest Physicians Consensus Statement on the Use of Topical Anesthesia, Analgesia, and Sedation During Flexible Bronchoscopy in Adult Patients
American College of Chest Physicians Consensus Statement on the Use of Topical Anesthesia, Analgesia, and Sedation During Flexible Bronchoscopy in Adult Patients
复制标题
DOI：
10.1378/chest.10-3361
复制
发表时间：
2011-11-01
期刊：
影响因子：
9.6
通讯作者：
Silvestri, Gerard A.
中科院分区：
文献类型：
--
作者：
Wahidi, Momen M.;Jain, Prasoon;Silvestri, Gerard A.
背景：支气管镜检查的最佳性能要求患者舒适，医生易于执行，并将风险降至最低。目前有一个广泛的变化，在使用表面麻醉，镇痛，镇静在bronchoscopic.Methods：一个专家小组召开了美国胸科医师学院介入/胸部诊断网络。在MEDLINE上进行了1969年至2009年的文献检索，专家组成员在全面审查数据后达成共识。随机对照试验和前瞻性研究给予最高优先级，在建设consensus.Results：在没有禁忌症，表面麻醉，镇痛，镇静，建议在所有患者接受支气管镜检查，因为增强患者的耐受性和满意度。稳健的数据表明，抗胆碱能药物，当给予支气管镜检查前，不产生临床意义的影响，他们的使用是不鼓励的。利多卡因是支气管镜检查的首选局部麻醉剂，因为其半衰期短，安全范围宽。建议联合使用苯二氮卓类和阿片类药物，因为它们在手术过程中对患者耐受性具有协同作用，并增加了阿片类药物的镇咳特性。异丙酚是一种有效的镇静剂，在支气管镜检查，可以实现类似的镇静，健忘症，和病人的耐受性相比，苯二氮卓类药物和opiates.Conclusions的联合管理：我们建议所有的医生进行支气管镜检查时，考虑使用表面麻醉，镇痛和镇静剂，在可行的。现有文献支持在适当选择的患者人群中使用适当药物时该方法的安全性和有效性。胸部2011; 140（5）：1342-1350
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. CHEST 2011; 140(5):1342-1350