Pre-procedure preparation, monitoring, premedication and sedation practices of bronchoscopists in Türkiye.

Abstract

Introduction: Sedation is often required during flexible fiberoptic bronchoscopy (FFB) to ensure patient comfort and the success of the procedure. The choice of sedative agents may differ between anesthesiologists and pulmonologists. This pilot study aimed to investigate the current pre-procedure preparation, monitoring, premedication and sedation practices for FFB in Türkiye, focusing on the preferences and practices of pulmonologists.

Materials and methods: A structured survey consisting of 30 questions was distributed to pulmonologists at various hospitals in Türkiye via Google Forms. A total of 97 responses were received, of which 80 were analyzed. Participants were divided into two groups based on their FFB experience: Group 1 with ≥10 years of experience and Group 2 with <10 years of experience.

Result: The majority of pulmonologists ordered complete blood count, biochemistry, and coagulation tests before the procedure. The most preferred oral ingestion duration was 6-8 hours. Additionally, 98% of the physicians reported using at least one agent for premedication purposes. Routine topical local anesthetic use was high in both groups (88.3% and 85%, respectively). In addition, 40% of the physicians stated that they always applied sedation during FOB, and 48% stated that they applied sedation in certain situations, and that patient request was the most effective factor. Without the assistance of an anesthesiologist, pulmonologists preferred mono midazolam or a combination of midazolam and fentanyl for sedation. In Group I, two physicians reported using dexmedetomidine for combination sedation. It was also determined that propofol was not used in cases where an anesthesiologist was not available. Additionally, 47% of the physicians reported that they found current sedation practices completely adequate.

Conclusions: Findings highlight the variability in sedation practices for FFB in Türkiye and underscore the need for standardized guidelines to optimize patient care and procedural outcomes. This study can be considered as a fundamental step towards more comprehensive studies by pulmonologists.