Anesthesia in Flexible Bronchoscopy

Bronchoscopy is usually performed under topical anesthesia with or without sedation to promote patient comfort and the ideal conditions for the physician to perform the examination. The objective of the study was to establish which anesthetic protocol used during flexible bronchoscopy (FB) has the lowest index of complications. This prospective randomized study analyzed 80 patients undergoing FB. Patients were randomly assigned to 4 groups of 20 patients each according to the anesthetic combination used: 200 mg topical lidocaine (LID group); 200 mg topical lidocaine and 2 mg/kg propofol (PPF group); 200 mg topical lidocaine and 20 mcg/kg alfentanil (ALF group); or 200 mg topical lidocaine and 0.05 mg/kg midazolam (MID group). Scores were assigned to patients according to the different variables observed during the endoscopic procedure; the lower the score, the lower the complication index. Results of the composite score (mean and SD) for the evaluation of the variables observed during FB were 4.6±3.9 for the PPF group, 7.9±6.6 for the ALF group, 10.0±4.5 for the LID group, and 11.3±5.8 for the MID group (P=0.001). Results revealed that the combination of propofol and topical lidocaine was a superior anesthetic method for FB than lidocaine alone or in association with midazolam or alfentanil.