Lessons To Be Learned From Patients? Recollections Of Flexible Bronchoscopy

Introduction. Flexible bronchoscopy is usually undertaken using topical anaesthesia and sedation with midazolam. Patients’ long-term recollections of the procedure are poorly documented.
Methods. 60 patients who underwent bronchoscopy between January and October 2009 were selected at random to receive telephone follow-up in February 2010. Their experience of various aspects of the procedure were graded from 1 (worst) to 10 (best) and they were asked whether they would be willing to undergo it again. Local ethics committee approval was obtained.
Results. 29 (48%) had died by February 2010 so 31 were interviewed. Mean midazolam dose was 2.4mg (SD 1.3). 24 (77%) remembered the procedure and 22 (71%) said they would be willing to undergo the procedure again.
Mean score (SD) was 5.9 (2.4) for topical anaesthesia, 6.7 (2.5) for the procedure itself, and 8.9 (1.6) for the nursing care.
For the nasal element of topical anaesthesia, 14 (45%) used gel and 17 (55%) spray. There was no difference in scores for experience of anaesthesia (t-test, p=0.74) or nursing care (Mann-Whitney U-test, p=0.81) between gel and spray, but experience of the procedure itself was significantly better with gel (mean 8.3 vs. 5.3, Mann-Whitney U-test, p<0.01).
There were patients who retained distressing false memories or impressions of the bronchoscopy, particularly relating to conversations between staff during their procedure.
Conclusions. Several months after bronchoscopy the majority of patients recalled the procedure and would be willing to undergo it again, though some retained distressing false memories. On average, topical anaesthesia was rated a worse experience than the bronchoscopy itself, with nasal gel associated with better scores than nasal spray. Staff should focus on optimal topical anaesthetic technique and on creating an atmosphere reassuring to patients.