In this prospective observational study, we monitored blood pressure, heart rate, and oxygen saturation prior to, during, and after 46 consecutive flexible bronchoscopies (FFB) to ascertain the effect of bronchoscopy and its component procedures on blood pressure in patients with and without known hypertension. We performed 43 bronchial washings, 28 bronchoscopic biopsies, and 22 brushings. Blood pressure, pulse, and oxygen saturation were recorded before and after each component of the total procedure. Hypotension (blood pressure, <100 systolic and <60 diastolic) did not occur during bronchoscopy. There were 27 patients who had no history of hypertension. The mean arterial pressure (MAP) was 94 before and 95 after their bronchoscopies. The change in blood pressure (MAP, 104) from the prebron-choscopy baseline was significant only with bronchial washing (p < 0.045). Nineteen patients had a history of hypertension and 13 of these were currently taking medications to control their blood pressure. The MAP was 108 before and after bronchoscopy in this group. The MAP increased 10 to 15 mm Hg with each component of the bronchoscopy procedure. However, the blood pressure response (MAP, 124), compared to the prebronchoscopy measurement, was statistically significant only with bronchial washing (P < 0.02). Eight of the 13 patients who were taking antihypertensive medication, and were nil per os (npo) for the procedure, had sustained hypertension during the procedure (systolic >150 and diastolic >105). The conclusion from this study of patients undergoing bronchoscopy without intravenous sedation is that significant hypertensive changes occur with the procedure. As a result of this study, we changed our npo order for bronchoscopy to npo except for prescribed oral medications.
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