Patient-Controlled Sedation by Non-Anaesthesiologists during Flexible Bronchoscopy: A One-Year Experience Regarding Safety, Feasibility and Costs

Abstract

Background: Patient-controlled sedation (PCS) is an efficient and costsaving method for sedation during flexible bronchoscopy (FB) in the presence of anaesthetic staff, but no data is available for PCS in a non-anaesthesiologist environment. Methods: This descriptive study describes PCS with propofol in a non-anaesthesiologist setup during outpatient FB procedures, including transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy and/or multistation endobronchial ultrasound, and endoscopic ultrasound with bronchoscope. Results: 287 procedures were completed. The median (range) duration for the procedures was 45 (10-105) minutes. The median (range) total propofol dose administered was 201 (55-570) mg, and 61 procedures (21%) required bolus doses of alfentanil. Desaturation occurred during 21% of the procedures and was resolved spontaneously (59%) or by using a jaw thrust (41%). No evidence was found that alfentanil contributed to desaturation (p=0.081). Inconsistent results were shown regarding the impact of alfentanil on the reduction of cough. The post-procedural assessment revealed high score of satisfaction and feasibility. 3 (1%) procedures were cancelled due to insufficient sedation. No prolonged recovery with need of overnight stay was reported. The direct costs for sedation were 180 USD/procedure. Conclusion: PCS with propofol and the presence of trained nonanaesthesiologists during outpatient FB has shown to result in high procedure feasibility and satisfaction without compromising patient safety or increasing the risk for unhandled respiratory adverse events. The method reduces costs for sedation and offers the possibility to increase patient turn over due to no prolonged recovery.