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BTS guidelines
Local anaesthetic thoracoscopy: British Thoracic Society pleural disease guideline 2010
  1. Najib M Rahman1,
  2. Nabeel J Ali2,
  3. Gail Brown3,
  4. Stephen J Chapman1,
  5. Robert J O Davies1,
  6. Nicola J Downer2,
  7. Fergus V Gleeson1,
  8. Timothy Q Howes4,
  9. Tom Treasure5,
  10. Shivani Singh4,
  11. Gerrard D Phillips6
  12. on behalf of the British Thoracic Society Pleural Disease Guideline Group
  1. 1Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
  2. 2Department of Respiratory Medicine, King's Mill Hospital, Sutton-in-Ashfield, UK
  3. 3Department of Respiratory Medicine, The Royal Liverpool University Hospital, Liverpool, UK
  4. 4Department of Respiratory Medicine, Colchester General Hospital, Colchester, UK
  5. 5Cardiothoracic Unit, Guy's Hospital, London, UK
  6. 6Department of Respiratory Medicine, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
  1. Correspondence to Dr Najib Rahman, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford OX3 7LJ, UK; naj_rahman{at}yahoo.co.uk

https://doi.org/10.1136/thx.2010.137018

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    Introduction

    Thoracoscopy under local anaesthetic and intravenous sedation, also known as local anaesthetic thoracoscopy, medical thoracoscopy or pleuroscopy, is increasingly being performed by chest physicians in the UK. In 1999, 11 centres across the UK offered a local anaesthetic thoracoscopy service, increasing to 17 centres in May 20041 and 37 centres in 2009 (Dr N Downer, personal communication). This document, which will use the term ‘local anaesthetic thoracoscopy’, aims to consider the following issues and to make appropriate recommendations on the basis of evidence where available:

    • The need for a local anaesthetic thoracoscopy service in the UK.

    • Evidence for use of local anaesthetic thoracoscopy as a diagnostic and therapeutic tool.

    • The conditions and patients in whom local anaesthetic thoracoscopy could be considered.

    • Levels of competence in local anaesthetic thoracoscopy.

    • Practical aspects of performing the procedure.

    Creation of this guideline followed the Appraisal of Guidelines Research and Evaluation/Scottish Intercollegiate Guidelines Network (AGREE/SIGN) methodology of evidence assessment and integration (see introduction to pleural disease guidelines).

    The need for a local anaesthetic thoracoscopy service in the UK

    Is there a need for a physician-based local anaesthetic thoracoscopy service in the UK? The majority of local anaesthetic thoracoscopy is carried out in the context of an undiagnosed exudative pleural effusion, the commonest cause of which is malignancy.2 This section of the document will therefore focus mainly on local anaesthetic thoracoscopy in the context of malignant disease.

    The increasing burden of pleural disease

    Malignant pleural effusion is a common clinical problem. Although the incidence of lung cancer in the UK is falling, the incidence of other cancers is rising. With increasing life expectancy in an ageing population and at current cancer incidence rates, an additional 100 000 cases of cancer per year are expected by 2025.3 Up to 15% of patients who die with malignancy have a pleural effusion at autopsy.4 Studies suggest that exudative effusions are caused by malignancy …

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    Footnotes

    • Competing interests No member of the Guideline Group is aware of any competing interests.

    • Provenance and peer review The draft guideline was available for online public consultation (July/August 2009) and presented to the BTS Winter Meeting (December 2009). Feedback was invited from a range of stakeholder institutions (see Introduction). The draft guideline was reviewed by the BTS Standards of Care Committee (September 2009).