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Journal of Bronchology:
doi: 10.1097/LBR.0b013e3180de4984
Review Articles

An Update on Sedation and Analgesia During Flexible Bronchoscopy

Vincent, Brad D. MD; Silvestri, Gerard A. MD, FCCP

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Abstract

Sedation during bronchoscopy is commonly used to facilitate patient comfort such that the procedure provides diagnostic or therapeutic results without interruption. An ideal sedative agent should have analgesic and amnestic properties and a favorable pharmacokinetic profile (eg, rapid onset, short duration of action, quick recovery) and minimal hemodynamic effects. The currently available agents (benzodiazepines, opioids, propofol) have some, but not all, of these properties. Midazolam, the most frequently used sedative, is highly lipid soluble, rapidly distributes across the central nervous system, and provides rapid onset of action and recovery. Opioids (eg, fentanyl, meperidine) are potent analgesic and sedative agents and have the added benefit of an antitussive effect. Propofol is also an effective sedative agent with amnestic and analgesic properties and a favorable pharmacokinetic profile but there is less experience with this drug in the outpatient setting. Sedative combinations are often used to produce synergistic effects. Although sedation is generally safe during bronchoscopy, all sedative regimens produce some cardiopulmonary depressant effects. This is particularly true for combination regimens. Careful monitoring of all patients is important to ensure a safe outcome. Here, we review pharmacologic sedation in the bronchoscopy laboratory and explore new agents which may become available in the future.

© 2007 Lippincott Williams & Wilkins, Inc.

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