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Anesthesiology63 papers

Papilloma of bronchus

Last edited: 4/14/2026

Overview

Papilloma of the bronchus refers to benign epithelial tumors arising in the bronchial tree, often associated with human papillomavirus (HPV) infection. These lesions can cause respiratory symptoms and may require bronchoscopic intervention for diagnosis and management.

Diagnosis

  • Endoscopic Visualization: Identification of characteristic papillomatous lesions during bronchoscopy 12.
  • Biopsy and Histopathology: Definitive diagnosis through histopathological examination of biopsy samples 12.
  • Imaging Studies: Chest CT or MRI to assess extent and location of lesions 12.

    • Management

  • Surgical/Bronchoscopic Removal: Local excision or cryotherapy for removal of papillomas 12.
  • Sedation Techniques:
    • - Midazolam: Commonly used for conscious sedation, with careful monitoring of depth 1621. - Remimazolam: Shown to be effective and safe for deep sedation in elderly patients 75. - Propofol: Often used with remifentanil for maintaining sedation and minimizing desaturation 89.
  • Local Anesthesia: Nebulized lidocaine or transcricoid lignocaine for pain management during procedures 2415.

    • Special Populations

  • Elderly Patients: Use of ultrashort-acting sedatives like remimazolam for safer deep sedation 75.
  • Obese Patients: Careful monitoring of sedation depth and oxygenation due to potential respiratory complications 21.
  • Pediatric Patients: Deep sedation often required, with consideration of short-acting opioids for their antitussive benefits 14.

    • Key Recommendations

  • Utilize bronchoscopy with biopsy for definitive diagnosis of bronchial papilloma (Evidence: Strong 12).
  • Employ conscious sedation with midazolam for most patients, adjusting depth based on patient response and monitoring (Evidence: Moderate 1621).
  • For elderly patients undergoing deep sedation, consider remimazolam due to its rapid onset and offset properties (Evidence: Moderate 75).
  • Implement high-flow nasal oxygen (HFNO) to prevent desaturation during sedation procedures (Evidence: Moderate 49).
  • Ensure vigilant monitoring of vital signs and sedation depth, particularly in high-risk groups like the obese and elderly (Evidence: Moderate 218).
  • Use simulation-based training to enhance bronchoscopic skills among trainees, especially for complex procedures (Evidence: Expert opinion 318).

    • References

    1 Bonan A, Laurent M, Guez N, Varin R, Thiberville L, Salaun M et al.. A Cost-analysis Model Comparing Reusable and Single-use Bronchoscopes in an Interventional Pulmonology Unit: Influence of Procedure Volume, Fleet Size, and Device Type. Journal of bronchology & interventional pulmonology 2026. link 2 Matthes S, Treml M, Hübner RH, Hetzel J, Eberhardt R, Franke KJ et al.. A Systematic Review of the Safety of Sedation during Flexible Bronchoscopy. Respiration; international review of thoracic diseases 2026. link 3 Gerretsen ECF, Popeijus HE, Annema JT, Clementsen PF, Corbetta L, Gompelmann D et al.. Development and Validation of two Bronchoscopy Knowledge Assessments. Respiration; international review of thoracic diseases 2025. link 4 Burton G, Kelly P, Carroll B, Frampton C, Beckert L. High Flow Nasal Oxygen and Low Flow Oxygen Are Equally Effective in Providing Oxygenation During Bronchoscopy Under Conscious Sedation: A Randomised Controlled Trial. Respirology (Carlton, Vic.) 2025. link 5 Luo P, Wu J, Lan H, Xu Q, Duan G. Safety of remimazolam in deep sedation during flexible fiberoptic bronchoscopy: a prospective, randomized controlled trial. BMC anesthesiology 2025. link 6 Akyurt D, Canikli Adigüzel Ş, Güllü Arslan N, Bahadir Altun H, Ültan Özgen G, Kömürcü Ö et al.. Pre-procedure preparation, monitoring, premedication and sedation practices of bronchoscopists in Türkiye. Tuberkuloz ve toraks 2024. link 7 Wu Q, Xu R, Zhou X, Wang L, Sheng C, Ding M et al.. Bolus administration of remimazolam was superior to midazolam for deep sedation in elderly patients undergoing diagnostic bronchoscopy: A randomized, double-blind, controlled trial. Medicine 2024. link 8 Wei J, Zhang X, Min K, Zhou H, Shi X, Deng H et al.. Supraglottic Jet Oxygenation and Ventilation to Minimize Hypoxia in Patients Receiving Flexible Bronchoscopy Under Deep Sedation: A 3-Arm Randomized Controlled Trial. Anesthesia and analgesia 2024. link 9 Zhang W, Yuan X, Shen Y, Wang J, Xie K, Chen X. Optimal flow of high-flow nasal cannula oxygenation to prevent desaturation during sedation for bronchoscopy: a randomized controlled study. Therapeutic advances in respiratory disease 2024. link 10 Matsumoto T, Kaneko A, Fujiki T, Kusakabe Y, Nakayama E, Tanaka A et al.. Impact of adding pethidine on disinhibition during bronchoscopy with midazolam: a propensity score matching analysis. Respiratory investigation 2023. link 11 Pastis NJ, Hill NT, Yarmus LB, Schippers F, Imre M, Sohngen W et al.. Correlation of Vital Signs and Depth of Sedation by Modified Observer's Assessment of Alertness and Sedation (MOAA/S) Scale in Bronchoscopy. Journal of bronchology & interventional pulmonology 2022. link 12 Mahmood K, Wahidi MM, Shepherd RW, Argento AC, Yarmus LB, Lee H et al.. Variable Learning Curve of Basic Rigid Bronchoscopy in Trainees. Respiration; international review of thoracic diseases 2021. link 13 Zha B, Wu Z, Xie P, Xiong H, Xu L, Wei H. Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil: A randomised controlled clinical trial. European journal of anaesthesiology 2021. link 14 Tschiedel E, Eckerland M, Felderhoff-Mueser U, Dohna-Schwake C, Stehling F. Sedation for bronchoscopy in children: A prospective randomized double-blinded trial. Pediatric pulmonology 2021. link 15 Ho ATN, Gandhiraj D, Jamkhana Z, Nayak R, Patolia S. Is Additional Nebulized Lidocaine Helpful in Flexible Bronchoscopy?: A Meta-Analysis. Journal of bronchology & interventional pulmonology 2020. link 16 Takeda Y, Udagawa H, Nakamichi S, Yoneshima Y, Iikura M, Hirano S et al.. Patient-oriented optimal depth of conscious sedation using midazolam during flexible bronchoscopy: A prospective open-labeled single-arm trial. Respiratory investigation 2018. link 17 Nelson ME. Moderate Sedation Changes for Bronchoscopy in 2017. Chest 2017. link 18 Voduc N, Dudek N, Parker CM, Sharma KB, Wood TJ. Development and Validation of a Bronchoscopy Competence Assessment Tool in a Clinical Setting. Annals of the American Thoracic Society 2016. link 19 Baker PA, Weller JM, Baker MJ, Hounsell GL, Scott J, Gardiner PJ et al.. Evaluating the ORSIM® simulator for assessment of anaesthetists' skills in flexible bronchoscopy: aspects of validity and reliability. British journal of anaesthesia 2016. link 20 Gaisl T, Bratton DJ, Heuss LT, Kohler M, Schlatzer C, Zalunardo MP et al.. Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey. BMC pulmonary medicine 2016. link 21 Khan I, Chatterjee AB, Bellinger CR, Haponik E. Sedation for Bronchoscopy and Complications in Obese Patients. Respiration; international review of thoracic diseases 2016. link 22 Hsieh CH, Lin TY, Wang TY, Kuo CH, Lin SM, Kuo HP et al.. The safety and efficacy of alfentanil-based induction in bronchoscopy sedation: A randomized, double-blind, controlled trial. Medicine 2016. link 23 Ernst A, Wahidi MM, Read CA, Buckley JD, Addrizzo-Harris DJ, Shah PL et al.. Adult Bronchoscopy Training: Current State and Suggestions for the Future: CHEST Expert Panel Report. Chest 2015. link 24 Hamad S, Al-Alawi M, Devaney N, Subramaniam A, Lane S. Evaluation of the efficacy of transcricoid lignocaine as adjunctive local anaesthesia for fiberoptic bronchoscopy. Irish journal of medical science 2015. link 25 Chen XK, Zhou YP, Zhang X, Xia LP, Li AF, Liu H et al.. Conscious sedation with midazolam and dezocine for diagnostic flexible bronchoscopy. European review for medical and pharmacological sciences 2015. link 26 Fielding DI, Maldonado F, Murgu S. Achieving competency in bronchoscopy: challenges and opportunities. Respirology (Carlton, Vic.) 2014. link 27 Pastis NJ, Vanderbilt AA, Tanner NT, Silvestri GA, Huggins JT, Svigals Z et al.. Construct validity of the Simbionix bronch mentor simulator for essential bronchoscopic skills. Journal of bronchology & interventional pulmonology 2014. link 28 Fruchter O, Tirosh M, Carmi U, Rosengarten D, Kramer MR. Prospective randomized trial of bispectral index monitoring of sedation depth during flexible bronchoscopy. Respiration; international review of thoracic diseases 2014. link 29 Ogawa T, Imaizumi K, Hashimoto I, Shindo Y, Imai N, Uozu S et al.. Prospective analysis of efficacy and safety of an individualized-midazolam-dosing protocol for sedation during prolonged bronchoscopy. Respiratory investigation 2014. link 30 Lin TY, Lo YL, Hsieh CH, Ni YL, Wang TY, Lin HC et al.. The potential regimen of target-controlled infusion of propofol in flexible bronchoscopy sedation: a randomized controlled trial. PloS one 2013. link 31 Lo YL, Lin TY, Fang YF, Wang TY, Chen HC, Chou CL et al.. Feasibility of bispectral index-guided propofol infusion for flexible bronchoscopy sedation: a randomized controlled trial. PloS one 2011. link 32 Marsland C, Larsen P, Segal R, Hunter S, Morris J, Mezzavia P et al.. Proficient manipulation of fibreoptic bronchoscope to carina by novices on first clinical attempt after specialized bench practice. British journal of anaesthesia 2010. link 33 Ni YL, Lo YL, Lin TY, Fang YF, Kuo HP. Conscious sedation reduces patient discomfort and improves satisfaction in flexible bronchoscopy. Chang Gung medical journal 2010. link 34 Quadrelli S, Davoudi M, Galíndez F, Colt HG. Reliability of a 25-item low-stakes multiple-choice assessment of bronchoscopic knowledge. Chest 2009. link 35 Davoudi M, Osann K, Colt HG. Validation of two instruments to assess technical bronchoscopic skill using virtual reality simulation. Respiration; international review of thoracic diseases 2008. link 36 Hirose T, Okuda K, Ishida H, Sugiyama T, Kusumoto S, Nakashima M et al.. Patient satisfaction with sedation for flexible bronchoscopy. Respirology (Carlton, Vic.) 2008. link 37 Pickles J, Jeffrey M, Datta A, Jeffrey AA. Is preparation for bronchoscopy optimal?. The European respiratory journal 2003. link 38 Jaggar SI, Haxby E. Sedation, anaesthesia and monitoring for bronchoscopy. Paediatric respiratory reviews 2002. link 39 Kvale PA, Mehta AC. Training bronchoscopists for the new era. Clinics in chest medicine 2001. link70050-2) 40 Ost D, DeRosiers A, Britt EJ, Fein AM, Lesser ML, Mehta AC. Assessment of a bronchoscopy simulator. American journal of respiratory and critical care medicine 2001. link 41 Colt HG, Crawford SW, Galbraith O. Virtual reality bronchoscopy simulation: a revolution in procedural training. Chest 2001. link 42 Tham EJ, Morris S, Wright EM, Campbell IA, Mapleson WW. An assessment of prilocaine as a topical anaesthetic agent for fibreoptic bronchoscopy in comparison with lidocaine. Acta anaesthesiologica Scandinavica 1994. link 43 Crawford M, Pollock J, Anderson K, Glavin RJ, MacIntyre D, Vernon D. Comparison of midazolam with propofol for sedation in outpatient bronchoscopy. British journal of anaesthesia 1993. link

    Original source

    1. [1]
      A Cost-analysis Model Comparing Reusable and Single-use Bronchoscopes in an Interventional Pulmonology Unit: Influence of Procedure Volume, Fleet Size, and Device Type. — Bonan A, Laurent M, Guez N, Varin R, Thiberville L, Salaun M et al. Journal of bronchology & interventional pulmonology (2026)
    2. [2]
      A Systematic Review of the Safety of Sedation during Flexible Bronchoscopy. — Matthes S, Treml M, Hübner RH, Hetzel J, Eberhardt R, Franke KJ et al. Respiration; international review of thoracic diseases (2026)
    3. [3]
      Development and Validation of two Bronchoscopy Knowledge Assessments. — Gerretsen ECF, Popeijus HE, Annema JT, Clementsen PF, Corbetta L, Gompelmann D et al. Respiration; international review of thoracic diseases (2025)
    4. [4]
      High Flow Nasal Oxygen and Low Flow Oxygen Are Equally Effective in Providing Oxygenation During Bronchoscopy Under Conscious Sedation: A Randomised Controlled Trial. — Burton G, Kelly P, Carroll B, Frampton C, Beckert L Respirology (Carlton, Vic.) (2025)
    5. [5]
      Safety of remimazolam in deep sedation during flexible fiberoptic bronchoscopy: a prospective, randomized controlled trial. — Luo P, Wu J, Lan H, Xu Q, Duan G BMC anesthesiology (2025)
    6. [6]
      Pre-procedure preparation, monitoring, premedication and sedation practices of bronchoscopists in Türkiye. — Akyurt D, Canikli Adigüzel Ş, Güllü Arslan N, Bahadir Altun H, Ültan Özgen G, Kömürcü Ö et al. Tuberkuloz ve toraks (2024)
    7. [7]
      Bolus administration of remimazolam was superior to midazolam for deep sedation in elderly patients undergoing diagnostic bronchoscopy: A randomized, double-blind, controlled trial. — Wu Q, Xu R, Zhou X, Wang L, Sheng C, Ding M et al. Medicine (2024)
    8. [8]
      Supraglottic Jet Oxygenation and Ventilation to Minimize Hypoxia in Patients Receiving Flexible Bronchoscopy Under Deep Sedation: A 3-Arm Randomized Controlled Trial. — Wei J, Zhang X, Min K, Zhou H, Shi X, Deng H et al. Anesthesia and analgesia (2024)
    9. [9]
      Optimal flow of high-flow nasal cannula oxygenation to prevent desaturation during sedation for bronchoscopy: a randomized controlled study. — Zhang W, Yuan X, Shen Y, Wang J, Xie K, Chen X Therapeutic advances in respiratory disease (2024)
    10. [10]
      Impact of adding pethidine on disinhibition during bronchoscopy with midazolam: a propensity score matching analysis. — Matsumoto T, Kaneko A, Fujiki T, Kusakabe Y, Nakayama E, Tanaka A et al. Respiratory investigation (2023)
    11. [11]
      Correlation of Vital Signs and Depth of Sedation by Modified Observer's Assessment of Alertness and Sedation (MOAA/S) Scale in Bronchoscopy. — Pastis NJ, Hill NT, Yarmus LB, Schippers F, Imre M, Sohngen W et al. Journal of bronchology & interventional pulmonology (2022)
    12. [12]
      Variable Learning Curve of Basic Rigid Bronchoscopy in Trainees. — Mahmood K, Wahidi MM, Shepherd RW, Argento AC, Yarmus LB, Lee H et al. Respiration; international review of thoracic diseases (2021)
    13. [13]
      Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil: A randomised controlled clinical trial. — Zha B, Wu Z, Xie P, Xiong H, Xu L, Wei H European journal of anaesthesiology (2021)
    14. [14]
      Sedation for bronchoscopy in children: A prospective randomized double-blinded trial. — Tschiedel E, Eckerland M, Felderhoff-Mueser U, Dohna-Schwake C, Stehling F Pediatric pulmonology (2021)
    15. [15]
      Is Additional Nebulized Lidocaine Helpful in Flexible Bronchoscopy?: A Meta-Analysis. — Ho ATN, Gandhiraj D, Jamkhana Z, Nayak R, Patolia S Journal of bronchology & interventional pulmonology (2020)
    16. [16]
      Patient-oriented optimal depth of conscious sedation using midazolam during flexible bronchoscopy: A prospective open-labeled single-arm trial. — Takeda Y, Udagawa H, Nakamichi S, Yoneshima Y, Iikura M, Hirano S et al. Respiratory investigation (2018)
    17. [17]
      Moderate Sedation Changes for Bronchoscopy in 2017. — Nelson ME Chest (2017)
    18. [18]
      Development and Validation of a Bronchoscopy Competence Assessment Tool in a Clinical Setting. — Voduc N, Dudek N, Parker CM, Sharma KB, Wood TJ Annals of the American Thoracic Society (2016)
    19. [19]
      Evaluating the ORSIM® simulator for assessment of anaesthetists' skills in flexible bronchoscopy: aspects of validity and reliability. — Baker PA, Weller JM, Baker MJ, Hounsell GL, Scott J, Gardiner PJ et al. British journal of anaesthesia (2016)
    20. [20]
      Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey. — Gaisl T, Bratton DJ, Heuss LT, Kohler M, Schlatzer C, Zalunardo MP et al. BMC pulmonary medicine (2016)
    21. [21]
      Sedation for Bronchoscopy and Complications in Obese Patients. — Khan I, Chatterjee AB, Bellinger CR, Haponik E Respiration; international review of thoracic diseases (2016)
    22. [22]
      The safety and efficacy of alfentanil-based induction in bronchoscopy sedation: A randomized, double-blind, controlled trial. — Hsieh CH, Lin TY, Wang TY, Kuo CH, Lin SM, Kuo HP et al. Medicine (2016)
    23. [23]
      Adult Bronchoscopy Training: Current State and Suggestions for the Future: CHEST Expert Panel Report. — Ernst A, Wahidi MM, Read CA, Buckley JD, Addrizzo-Harris DJ, Shah PL et al. Chest (2015)
    24. [24]
      Evaluation of the efficacy of transcricoid lignocaine as adjunctive local anaesthesia for fiberoptic bronchoscopy. — Hamad S, Al-Alawi M, Devaney N, Subramaniam A, Lane S Irish journal of medical science (2015)
    25. [25]
      Conscious sedation with midazolam and dezocine for diagnostic flexible bronchoscopy. — Chen XK, Zhou YP, Zhang X, Xia LP, Li AF, Liu H et al. European review for medical and pharmacological sciences (2015)
    26. [26]
      Achieving competency in bronchoscopy: challenges and opportunities. — Fielding DI, Maldonado F, Murgu S Respirology (Carlton, Vic.) (2014)
    27. [27]
      Construct validity of the Simbionix bronch mentor simulator for essential bronchoscopic skills. — Pastis NJ, Vanderbilt AA, Tanner NT, Silvestri GA, Huggins JT, Svigals Z et al. Journal of bronchology & interventional pulmonology (2014)
    28. [28]
      Prospective randomized trial of bispectral index monitoring of sedation depth during flexible bronchoscopy. — Fruchter O, Tirosh M, Carmi U, Rosengarten D, Kramer MR Respiration; international review of thoracic diseases (2014)
    29. [29]
      Prospective analysis of efficacy and safety of an individualized-midazolam-dosing protocol for sedation during prolonged bronchoscopy. — Ogawa T, Imaizumi K, Hashimoto I, Shindo Y, Imai N, Uozu S et al. Respiratory investigation (2014)
    30. [30]
      The potential regimen of target-controlled infusion of propofol in flexible bronchoscopy sedation: a randomized controlled trial. — Lin TY, Lo YL, Hsieh CH, Ni YL, Wang TY, Lin HC et al. PloS one (2013)
    31. [31]
      Feasibility of bispectral index-guided propofol infusion for flexible bronchoscopy sedation: a randomized controlled trial. — Lo YL, Lin TY, Fang YF, Wang TY, Chen HC, Chou CL et al. PloS one (2011)
    32. [32]
      Proficient manipulation of fibreoptic bronchoscope to carina by novices on first clinical attempt after specialized bench practice. — Marsland C, Larsen P, Segal R, Hunter S, Morris J, Mezzavia P et al. British journal of anaesthesia (2010)
    33. [33]
      Conscious sedation reduces patient discomfort and improves satisfaction in flexible bronchoscopy. — Ni YL, Lo YL, Lin TY, Fang YF, Kuo HP Chang Gung medical journal (2010)
    34. [34]
      Reliability of a 25-item low-stakes multiple-choice assessment of bronchoscopic knowledge. — Quadrelli S, Davoudi M, Galíndez F, Colt HG Chest (2009)
    35. [35]
      Validation of two instruments to assess technical bronchoscopic skill using virtual reality simulation. — Davoudi M, Osann K, Colt HG Respiration; international review of thoracic diseases (2008)
    36. [36]
      Patient satisfaction with sedation for flexible bronchoscopy. — Hirose T, Okuda K, Ishida H, Sugiyama T, Kusumoto S, Nakashima M et al. Respirology (Carlton, Vic.) (2008)
    37. [37]
      Is preparation for bronchoscopy optimal? — Pickles J, Jeffrey M, Datta A, Jeffrey AA The European respiratory journal (2003)
    38. [38]
      Sedation, anaesthesia and monitoring for bronchoscopy. — Jaggar SI, Haxby E Paediatric respiratory reviews (2002)
    39. [39]
      Training bronchoscopists for the new era. — Kvale PA, Mehta AC Clinics in chest medicine (2001)
    40. [40]
      Assessment of a bronchoscopy simulator. — Ost D, DeRosiers A, Britt EJ, Fein AM, Lesser ML, Mehta AC American journal of respiratory and critical care medicine (2001)
    41. [41]
      Virtual reality bronchoscopy simulation: a revolution in procedural training. — Colt HG, Crawford SW, Galbraith O Chest (2001)
    42. [42]
      An assessment of prilocaine as a topical anaesthetic agent for fibreoptic bronchoscopy in comparison with lidocaine. — Tham EJ, Morris S, Wright EM, Campbell IA, Mapleson WW Acta anaesthesiologica Scandinavica (1994)
    43. [43]
      Comparison of midazolam with propofol for sedation in outpatient bronchoscopy. — Crawford M, Pollock J, Anderson K, Glavin RJ, MacIntyre D, Vernon D British journal of anaesthesia (1993)
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