Chest
Volume 69, Issue 6, June 1976, Pages 747-751
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Deaths and Complications Associated with Fiberoptic Bronchoscopy

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A questionnaire was sent to 1,041 owners of fiberoptic bronchoscopes requesting data about complications of bronchoscopic examination; 323 (31 percent) of the questionnaires were returned. From approximately 48,000 procedures, ten deaths were reported and are described. Information about two additional deaths not obtained from data on the questionnaires is also included. All patients who died had either myocardial disease, severe chronic pulmonary disease, serious pneumonia, or cancer. Two deaths were associated with evidence on necropsy of fresh myocardial Infarctions that had been unsuspected prior to the procedure. Two deaths occurred after administration of local anesthesia prior to bronchoscopic examination. Two were patients who previously had slowly hemorrhaging tumors that hemorrhaged massively following, respectively, forceps biopsy and saline lavage. Four brushes broke off in bronchi. Ten cardiac arrests and 41 life-threatening reactions to anesthesia also occurred.

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MATERIALS AND METHODS

A new questionnaire was sent to 1,041 known owners of fiberoptic bronchoscopes. Information was solicited regarding the number of procedures and biopsies performed, the anesthetics employed, the method of cleaning the fiberoptic bronchoscope, and the life-threatening complications encountered. Follow-up letters were sent to physicians if a death, broken bronchial brush, or pneumothorax was reported. In addition, two deaths that were not disclosed by data from the questionnaires are also

RESULTS

Of 1,041 questionnaires sent, 323 (31 percent) were returned. Approximately 48,000 bronchoscopic examinations and 6,300 biopsies were reported by the replying physicians. Since the exact number of bronchoscopic examinations could not be verified, incidences of complications were not calculated.

Twelve deaths were reported by 11 physicians, including the two that were not obtained from data on the questionnaires. Of the 12 deaths, two that occurred after the administration of anesthetics but

DISCUSSION

There have been few reports of deaths associated with fiberoptic bronchoscopic examination. Credle et al1 reported four deaths occurring in 24,521 procedures. One death was associated with excessive tetracaine anesthesia; another occurred in a patient with metastatic carcinoma who developed a cardiac arrest. The third death occurred while a seriously ill patient underwent bronchoscopic examination through an 8-mm endotracheal tube, and the fourth was related to an unspecified ancillary

ACKNOWLEDGMENTS

We wish to thank the 323 cooperating physicians for their candid replies to the questionnaire and Dr. John Guerrant for his critical review of this manuscript.

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Read before the Combined American Thoracic Society and Canadian Thoracic Society Conference on Lung Disease, Montreal, May 20, 1975.

Manuscript received November 17; revision accepted December 19.

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