Wang Longfei, Wang Mengyan, Xu Rong, Li Jianjun, Cao Yunfei, Ji FuCheng
Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, P.R. China.
These authors contributed equally to this work and should be considered as co-first authors.
Eur Respir Rev. 2025 Aug 20;34(177). doi: 10.1183/16000617.0045-2025. Print 2025 Jul.
Flexible bronchoscopy is an essential, invasive procedure used in clinical practice for diagnosing and treating bronchial, pulmonary, thoracic and other diseases. Due to concerns about the potential for intense stimulation during flexible bronchoscopy operations, sedation is recommended by most countries and regions for all patients without contraindications. However, the use of sedative and analgesic substances for sedation during flexible bronchoscopy may result in respiratory depression, potentially leading to hypoxaemia and/or hypercapnia. Considering these side-effects and associated risks, some countries and regions do not recommend this approach.
This review aims to compare and analyse differences between currently published guidelines on sedation during flexible bronchoscopy and expert consensus in five key aspects: the necessity of sedation, qualifications of the person in charge of sedation, selection of sedative or anaesthetic drugs, sedation depth and perioperative monitoring, and oxygen supplementation and remedies.
Undeniably, more attention and clinical evidence are needed to address the controversies and disputes existing among currently published guidelines on sedation during flexible bronchoscopy or expert consensus. Furthermore, international cooperation is necessary to establish standard international training and practice guidelines for sedation during flexible bronchoscopy.
可弯曲支气管镜检查是临床实践中用于诊断和治疗支气管、肺部、胸部及其他疾病的一项重要的侵入性操作。由于担心可弯曲支气管镜操作过程中可能产生强烈刺激，大多数国家和地区建议对所有无禁忌证的患者进行镇静。然而，在可弯曲支气管镜检查期间使用镇静和镇痛药物进行镇静可能会导致呼吸抑制，进而可能导致低氧血症和/或高碳酸血症。考虑到这些副作用及相关风险，一些国家和地区不推荐这种方法。
本综述旨在比较和分析当前已发表的关于可弯曲支气管镜检查期间镇静的指南与专家共识在五个关键方面的差异：镇静的必要性、镇静负责人的资质、镇静或麻醉药物的选择、镇静深度及围手术期监测，以及氧疗和补救措施。
不可否认，需要更多关注和临床证据来解决当前已发表的关于可弯曲支气管镜检查期间镇静的指南或专家共识中存在的争议和分歧。此外，有必要开展国际合作，以制定可弯曲支气管镜检查期间镇静的标准国际培训和实践指南。
