Comparative analysis of guidelines and recommendations for sedation during flexible bronchoscopy: a narrative review

Eur Respir Rev. 2025 Aug 20;34(177):250045. doi: 10.1183/16000617.0045-2025. Print 2025 Jul.

ABSTRACT

BACKGROUND: 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.

OBJECTIVE: 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.

CONCLUSIONS: 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.

PMID:40835396 | DOI:10.1183/16000617.0045-2025