Authors (including presenting author) :
Cheng YF, Yim CW, Tseng CK, Kwok CT, Ng PK, Yip KC, Li CY, Kwan HY
Affiliation :
Department of Respiratory Medicine, Kowloon Hospital
Keyword 1: :
Procedural sedation
Introduction :
Quality and Safety of bronchoscopy service is always our major concern in the Department of Respiratory Medicine (RMD), Kowloon Hospital (KH). However, complication may arise from procedural sedation and the procedure itself. Procedural and sedation safety are especially important to us since there is no intensive care unit nor anesthetist support in KH. For procedural sedation, Midazolam and Fentanyl are used which may cause possible complications like over-sedation and respiratory failure. Precedex (Dexmedetomidine) is a newer sedation drug with favorable safety profile and good doctors and patients’ satisfaction. To enhance the sedation safety of the endoscopy procedure, we introduced the use of Precedex. For procedural safety, we implemented regular resuscitation drills in bronchoscopy suite with the use of 3-D airway model in different scenarios. We have also enhanced doctors and nurses training, and performed audits on procedural and sedation safety.
Objectives :
To enhance quality and safety of bronchoscopy service by implementing the use of Precedex, regular resuscitation drills and enhancing training and audits in endoscopy suite in RMD, KH.
Methodology :
We started the preparation work of Precedex use since late 2024. Lecture on the use of Precedex was given to doctors and nurses. All endoscopy nurses have joined staff training and past quiz on the use of Precedex. Local guideline was written with reference to cluster guideline. The use Precedex was endorsed by various hospital committee before use. Drill of the use of Precedex and management of adverse effect was also performed before the implement of the use of Precedex. We also started regular resuscitation drills in bronchoscopy suite in 2025.
Result & Outcome :
We have successfully started to use Precedex since October 2025. Until the end of December 2025, 8 cases were given Precedex as procedural sedation in the endoscopy suite in RMD, KH. No severe adverse effect likely bradycardia or hypotension requiring supportive medication. Only one case experienced mild hypotension requiring adjustment of Precedex infusion rate and intravenous fluid, and the hypotension was reversed shortly. 4 in 8 cases required addition of Midazolam or Fentanyl but the dosage was much lower than the usual dose given when Precedex was not used. Overall satisfaction of doctors and patients were high. There was no procedural complication like pneumothorax, pneumomediastinum, bleeding or desaturation observed in these 8 cases. Procedural time was around one hour. For procedural safety, two resuscitation drills were performed in 2025, one on massive bleeding after biopsy, and one on desaturation during bronchoscopy. Both drills were successfully and highly increased staff awareness on procedural safety.
