The symptoms of lidocaine intoxication include decreased or loss of consciousness, tremors, and convulsions. Check for physical signs, such as bradycardia, cardiac arrhythmia, and the like, during pretreatment and inform the rest of the team. In addition, observe for the presence of tremors and seizures or loss of consciousness and report these to the doctor. In some circumstances, lifesaving measures may be necessary. The maximum dose of lidocaine is 8.2 mg/kg; for a body weight of 50 kg, maximum dose is 410 mg (20.5 ml of 2 % lidocaine).

Sedatives are used in order to calm the patient and avoid pain, as well as to avoid unnecessary body movements that can affect the procedure. The nurse in charge reports the condition of the patient to physicians and administers additional doses of sedatives upon the instructions of the physician. Upon the time of administration of sedatives, it is necessary to pay careful attention to decreases in blood pressure and notify the physician as necessary. Derangements in vital signs on the monitor should be confirmed manually.

Along with the vital signs, the value of SaO₂ should be measured continuously. Before the procedure, the doctor initiates oxygen support at 2–3 l per minute via nasal cannula; this level of support is adjusted as necessary to keep the SaO₂ value within normal. If there is a tendency for the tongue base to obstruct the airway during sedation, chin lift is effective in securing the airway.

The endoscopy room of our hospital is equipped with an X-ray fluoroscopy machine, which can be used to check the status of the lung immediately after bronchoscopic biopsy. In case a pneumothorax develops, the nurse in charge and head nurse should anticipate and quickly prepare the required materials for thoracic drainage, if deemed necessary. In addition, the patient should be monitored for hemodynamic instability, chest pain, dyspnea, and other signs of pneumothorax immediately after the procedure and at the recovery room. Changes in the vital signs or status of the patient should be reported immediately to the physician.

Bronchoscopic biopsy may lead to bleeding, especially in patients with bleeding tendencies, such as those with low platelet count. When bleeding occurs, epinephrine diluted 5,000-fold should be prepared. This solution is applied by the doctor on the site of bleeding, along with other maneuvers, until hemostasis is achieved. During and immediately after hemostatic treatment, vital signs are checked manually and on the monitor to check for early abnormalities. At our hospital, the protocol is to observe the patient at the recovery room for at least 1 h before discharge. The unit should also be equipped with the necessary instruments to manage bleeding and hemodynamic instability.

Antibiotics may be prescribed by the doctor if infection during inspection and treatment is suspected. It is necessary for the nurse to give instructions on the correct intake of medications. After discharge, patients should be advised to watch out for signs of fever, cough, sputum production, and dyspnea which may indicate pneumonia. Therefore, patients should be given instructions on how to contact the hospital in case such symptoms occur.

After the procedure, each patient is wheeled in to the recovery bed to rest and for observation. In the recovery room of our hospital, the SaO₂ value and the pulse rate of every patient are displayed on the central monitor. Also, in anticipation of complications, such as hypoxemia and bleeding, oxygen and suction device are available at each bedside. Equipment for calling the nurse should be made available, and curtains should not be fully closed to enable observation of the respiratory conditions and body movement of the patient. Intravenous access and fluid replacement are also maintained. Flumazenil is made available on standby, in case there is a delay in weaning off from sedative effects.

When the patient awakens, talk to the patient using relaxing words of encouragement. Describe the current status and give assurance that it is expected to have some uncomfortable feeling, such as throat discomfort, mild hemoptysis, and cough.

After about 1 h of observation, confirm that the patient is fully awake and stable before sending home as outpatient. Depending on the status of the patient, the tie of observation at the recovery room may be extended. At our hospital, this assessment is performed using “recovery exit criteria” (Table 30.4).