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Duke's Momen Wahidi and other luminaries bring you a consensus statement on use of peri-procedure medications during bronchoscopy. I'm assuming you've done a few already, so here are some highlights (with slight liberties in paraphrasing):
- Use topical anesthesia as well as moderate sedation in all patients, unless there are contraindications or you practice at a secret CIA prison. An opiate-benzo cocktail is ideal due to its synergistic pharmaco-mechanisms.
- Propofol works nicely. It has a faster recovery time without increased adverse events in trials compared to benzo/opiates. Authors disclose they were investigators in the multicenter trials of fospropofol.
- Don't use cocaine (on the patient as a topical anesthetic). The authors respectfully suggest lidocaine.
- Don't use atropine or glycopyrrolate for secretions, bronchodilation etc ... they don't work and might harm.
Wahidi MM et al. American College of Chest Physicians Consensus Statement on the Use of Topical Anesthesia, Analgesia, and Sedation During Flexible Bronchoscopy in Adult Patients. CHEST 2011;140(5):1342-1350.