From the Guidelines
It is recommended that patients have no food by mouth for 4 hours and clear fluids can be allowed up to 2 hours before bronchoscopy. This guideline is based on the British Thoracic Society guidelines on diagnostic flexible bronchoscopy 1. The main concern with eating before bronchoscopy is the risk of aspiration, which can be life-threatening. By allowing a period of fasting, the risk of aspiration is minimized, ensuring a safer procedure for the patient. Some key points to consider when preparing for bronchoscopy include:
- Verbal and written patient information improves tolerance of the procedure by the patient and should be provided 1.
- Patients with certain medical conditions, such as severe COPD, may require additional precautions before the procedure, including spirometric parameters checks and arterial blood gas tensions measurements 1.
- Sedation should be offered to patients where there is no contraindication, and intravenous access should be established in all patients before bronchoscopy is commenced 1.
- The decision to allow clear fluids up to 2 hours before the procedure should be made on a case-by-case basis, taking into account the patient's individual needs and medical history. Overall, the goal is to minimize risks and ensure the best possible outcome for the patient, in terms of morbidity, mortality, and quality of life.
From the Research
NPO Status for Bronchoscopy
- There is no direct evidence in the provided studies that specifically addresses the requirement of NPO (nil per os) status for bronchoscopy.
- However, the studies discuss various aspects of anesthesia and sedation for bronchoscopy, including the use of topical anesthesia, analgesia, and sedation to enhance patient comfort and tolerance during the procedure 2.
- The choice of anesthesia and sedation may depend on the type of bronchoscopy procedure, patient comorbidities, and the expertise of the proceduralist or anesthesiologist 3, 4.
- Some studies suggest that bronchoscopist-directed continuous flow propofol-based analgosedation is a safe and feasible approach for interventional flexible bronchoscopy and endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) 5.
- Recent updates on anesthesia for bronchoscopy highlight the growing recognition of interventional pulmonology as a subspecialty, with new procedures posing unique challenges for anesthesiologists 6.
Sedation and Anesthesia for Bronchoscopy
- The use of sedation and anesthesia for bronchoscopy is a common practice to enhance patient comfort and tolerance during the procedure 2, 3, 4, 5, 6.
- Different types of sedation and anesthesia are available, including topical anesthesia, analgesia, and sedation, as well as general anesthesia with an endotracheal tube 2, 4, 6.
- The choice of sedation and anesthesia may depend on the type of bronchoscopy procedure, patient comorbidities, and the expertise of the proceduralist or anesthesiologist 3, 4, 6.