Authors (including presenting author) :
Cheng YF, Yim CW, Tseng CK, Kwok CT, Ng PK, Yip CK, Li CY, Kwan HY
Affiliation :
Department of Respiratory Medicine, Kowloon Hospital
Keyword 1: :
Procedural sedation
Introduction :
Bronchoscopy is an important but challenging investigation performed under conscious sedation for diagnosing lung cancer and other respiratory condition. Procedural and sedation safety are particularly crucial in our unit as there is no intensive care unit nor on-site anesthetist support.
Objectives :
To assess the effectiveness of various measures implemented in KH RMD in enhancing quality and safety of bronchoscopic service.
Methodology :
Various measures have been implemented: 1. Dexmedetomidine (Precedex), a new sedative with good anaesthetic effect and favorable safety profile, was introduced since late 2024. Local guidelines were prepared. Lectures on its use were organized for doctors and nurses. All endoscopy nurses must pass the post-test to get qualified for its administration. Refresher courses and paper drill was conducted to get all staff familiarize with its use, particularly on adverse effect management; 2. Content of regular resuscitation drills in bronchoscopy suite was no longer limited to CPR but modified to scenario-based training involving doctors, endoscopy nurses, and ward nurses, to enhance emergency handling and team-work; 3. Regular audits were conducted and benchmarked with British Thoracic Society guidelines. Diagnostic yield and complication rates were recorded.
Result & Outcome :
Precedex was successfully implemented in KH RMD since October 2025. Until December 2025, eight cases were sedated with Precedex during complicated bronchoscopy procedures. Nil serious adverse reaction was recorded. Four out of eight cases (50%) required addition of other anaesthetics (e.g. Midazolam or Fentanyl) in a lower than usual dose. On retrospect, the Precedex infusion protocol could be modified to avoid the need of extra-sedatives. Overall satisfaction from doctors, nurses, and patients were high. All procedures could be completed within an hour, with no interruption due to under-sedation. Two scenario-based resuscitation drills were successfully organized in 2025, focusing on management of post-biopsy massive bleeding and respiratory failure. Collaboration and clinical handover between endoscopy nurses and ward staff were emphasized. All participants agreed that it helped raise staff awareness on procedural safety. Clinical audit on bronchoscopy 2024/25 revealed a high diagnostic yield (100% for endobronchial and transbronchial lung biopsy performed under fluoroscopy; 83.3% for bronchoscopy with radial-probe) but low complication rate (nil serious adverse events including mortality). Thus quality and safety of bronchoscopy could be optimized with various measures enhancing procedural sedative safety, workflow and training, and team-work. Regular audits help identifying potential deficiency for future improvement.
