Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1986 Apr;41(4):311–317. doi: 10.1136/thx.41.4.311

Postal survey of bronchoscopic practice by physicians in the United Kingdom.

F G Simpson, A G Arnold, A Purvis, P W Belfield, M F Muers, N J Cooke
PMCID: PMC460316  PMID: 3738850

Abstract

In 1983 a postal survey of the bronchoscopic practice of chest physicians in the United Kingdom produced a 90% response rate. Two hundred and thirty one physicians were carrying out bronchoscopy; they had performed about 40 000 bronchoscopies in the preceding year, 87% of these being fibreoptic procedures with topical anaesthesia. The mortality rate of fibreoptic bronchoscopy was 0.04%, with a 0.12% incidence of major complications. Transbronchial biopsy carried both an appreciably higher mortality rate of 0.12% and a major complication rate of 2.7%. There is wide variation in the use and choice of sedative drugs for fibreoptic bronchoscopy. Many of the drug combinations could be criticised on pharmacological grounds. The mean dose of lignocaine was 342 mg, most operators exceeding the usual maximum recommended dose; but adverse reactions were rare. Routine supplemental oxygen was given by only 18% of bronchoscopists. Basic resuscitation equipment was often inadequate. Radiological screening was used for transbronchial lung biopsy by 53% of respondents and significantly reduced the incidence of pneumothorax from 2.9% to 1.8%. Both the number of bronchoscopies performed and the complication rate were higher than previous estimates. Bronchoscopists should re-examine their policy on drugs and safety precautions to minimise the risks of the procedure.

Full text

PDF
311

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albertini R. E., Harrell J. H., 2nd, Kurihara N., Moser K. M. Arterial hypoxemia induced by fiberoptic bronchoscopy. JAMA. 1974 Dec 23;230(12):1666–1667. [PubMed] [Google Scholar]
  2. Credle W. F., Jr, Smiddy J. F., Elliott R. C. Complications of fiberoptic bronchoscopy. Am Rev Respir Dis. 1974 Jan;109(1):67–72. doi: 10.1164/arrd.1974.109.1.67. [DOI] [PubMed] [Google Scholar]
  3. Dorward A. J., Berkin K. E., Elliott J. A., Stack B. H. A double-blind controlled study comparing temazepam with papaveretum as premedication for fibreoptic bronchoscopy. Br J Dis Chest. 1983 Jan;77(1):60–65. [PubMed] [Google Scholar]
  4. Dreisin R. B., Albert R. K., Talley P. A., Kryger M. H., Scoggin C. H., Zwillich C. W. Flexible fiberoptic bronchoscopy in the teaching hospital. Yield and complications. Chest. 1978 Aug;74(2):144–149. doi: 10.1378/chest.74.2.144. [DOI] [PubMed] [Google Scholar]
  5. Editorial: Safety and fibreoptic bronchoscopy. Br Med J. 1974 Aug 31;3(5930):542–543. doi: 10.1136/bmj.3.5930.542. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Efthimiou J., Higenbottam T., Holt D., Cochrane G. M. Plasma concentrations of lignocaine during fibreoptic bronchoscopy. Thorax. 1982 Jan;37(1):68–71. doi: 10.1136/thx.37.1.68. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fry W. A. Techniques of topical anesthesia for bronchoscopy. Chest. 1978 May;73(5 Suppl):694–696. doi: 10.1378/chest.73.5.694. [DOI] [PubMed] [Google Scholar]
  8. Fulkerson W. J. Current concepts. Fiberoptic bronchoscopy. N Engl J Med. 1984 Aug 23;311(8):511–515. doi: 10.1056/NEJM198408233110806. [DOI] [PubMed] [Google Scholar]
  9. Goroszeniuk T., Nicholas I. H., Marchant P., Turner J. A., Johnson N. M. Premedication for fibreoptic bronchoscopy: fentanyl, diazepam, and atropine compared with papaveretum and hyoscine. Br Med J. 1980 Aug 16;281(6238):486–486. doi: 10.1136/bmj.281.6238.486. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Herf S. M., Suratt P. M. Complications of transbronchial lung biopsies. Chest. 1978 May;73(5 Suppl):759–760. doi: 10.1378/chest.73.5_supplement.759. [DOI] [PubMed] [Google Scholar]
  11. Jones D. A., McBurney A., Stanley P. J., Tovey C., Ward J. W. Plasma concentrations of lignocaine and its metabolites during fibreoptic bronchoscopy. Br J Anaesth. 1982 Aug;54(8):853–857. doi: 10.1093/bja/54.8.853. [DOI] [PubMed] [Google Scholar]
  12. Karetzky M. S., Garvey J. W., Brandstetter R. D. Effect of fiberoptic bronchoscopy on arterial oxygen tension. N Y State J Med. 1974 Jan;74(1):62–63. [PubMed] [Google Scholar]
  13. Knight R. K., Clarke S. W. An analysis of the first 300 fibreoptic bronchoscopies at the Brompton Hospital. Br J Dis Chest. 1979 Apr;73(2):113–120. [PubMed] [Google Scholar]
  14. Ludlam R., Bennett J. R. Comparison of diazepam and morphine as premedication for gastrointestinal endoscopy. Lancet. 1971 Dec 25;2(7739):1397–1399. doi: 10.1016/s0140-6736(71)90671-4. [DOI] [PubMed] [Google Scholar]
  15. Macdonald J. B. Fibreoptic bronchoscopy today: a review of 255 cases. Br Med J. 1975 Sep 27;3(5986):753–755. doi: 10.1136/bmj.3.5986.753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Mitchell D. M., Emerson C. J., Collins J. V., Stableforth D. E. Transbronchial lung biopsy with the fibreoptic bronchoscope: analysis of results in 433 patients. Br J Dis Chest. 1981 Jul;75(3):258–262. doi: 10.1016/0007-0971(81)90003-6. [DOI] [PubMed] [Google Scholar]
  17. Nimmo W. S., Forrest J. A., Heading R. C., Finlayson N. D., Prescott L. F. Premedication for upper gastrointestinal endoscopy: a comparative study of flunitrazepam, diazepam and neuroleptanalgesia. Endoscopy. 1978 Aug;10(3):183–186. doi: 10.1055/s-0028-1098290. [DOI] [PubMed] [Google Scholar]
  18. Patterson J. R., Blaschke T. F., Hunt K. K., Meffin P. J. Lidocaine blood concentrations during fiberoptic bronchoscopy. Am Rev Respir Dis. 1975 Jul;112(1):53–57. doi: 10.1164/arrd.1975.112.1.53. [DOI] [PubMed] [Google Scholar]
  19. Pearce S. J. Fibreoptic bronchoscopy: is sedation necessary? Br Med J. 1980 Sep 20;281(6243):779–780. doi: 10.1136/bmj.281.6243.779. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Pereira W., Jr, Kovnat D. M., Snider G. L. A prospective cooperative study of complications following flexible fiberoptic bronchoscopy. Chest. 1978 Jun;73(6):813–816. doi: 10.1378/chest.73.6.813. [DOI] [PubMed] [Google Scholar]
  21. Perry L. B. Topical anesthesia for bronchoscopy. Chest. 1978 May;73(5 Suppl):691–693. doi: 10.1378/chest.73.5_supplement.691. [DOI] [PubMed] [Google Scholar]
  22. Rees P. J., Hay J. G., Webb J. R. Premedication for fibreoptic bronchoscopy. Thorax. 1983 Aug;38(8):624–627. doi: 10.1136/thx.38.8.624. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Sackner M. A. Bronchofiberscopy. Am Rev Respir Dis. 1975 Jan;111(1):62–88. doi: 10.1164/arrd.1975.111.1.62. [DOI] [PubMed] [Google Scholar]
  24. Schillaci C. R., Iacovoni V. F., Conte R. S. Transtracheal aspiration complicated by fatal endotracheal hemorrhage. N Engl J Med. 1976 Aug 26;295(9):488–490. doi: 10.1056/NEJM197608262950907. [DOI] [PubMed] [Google Scholar]
  25. Stableforth D. E., Knight R. K., Collins J. V., Heard B. E., Clarke S. W. Transbronchial lung biopsy through the fibreoptic bronchoscope. Br J Dis Chest. 1978 Apr;72(2):108–114. doi: 10.1016/0007-0971(78)90019-0. [DOI] [PubMed] [Google Scholar]
  26. Suratt P. M., Smiddy J. F., Gruber B. Deaths and complications associated with fiberoptic bronchoscopy. Chest. 1976 Jun;69(6):747–751. doi: 10.1378/chest.69.6.747. [DOI] [PubMed] [Google Scholar]
  27. Zavala D. C. Complications following fiberoptic bronchoscopy. The "good news" and the "bad news". Chest. 1978 Jun;73(6):783–785. doi: 10.1378/chest.73.6.783. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES