Comparison of alfetanil and ketamine in combination with propofol for patient-controlled sedation during fiberoptic bronchoscopy.
BACKGROUND
During fiberoptic bronchoscopy, propofol, ketamine, benzodiazepines, and opiates are most commonly used, alone or in combination for sedation. The aim of this study was to compare the clinical efficacy of propofol/ketamine with propofol/alfentanil for patient-controlled sedation (PCS) during fiberoptic bronchoscopy.


METHODS
Patients undergoing fiberoptic bronchoscopy were randomly assigned to receive either propofol/alfentanil (PA group; n = 138) or propofol/ketamine (PK group; n = 138) via a patient-controlled analgesia (PCA) device for sedation and analgesia. Changes in blood pressure, heart rate (HR), and oxygen saturation were monitored. Degree of patient and bronchoscopist satisfaction was evaluated using a 10-cm visual analog scale (VAS) (0 = extremely uncomfortable to 10 = extremely comfortable).


RESULTS
After sedation, systolic arterial pressure (SAP) decreased in the PA group, but SAP was stable in the PK group. Compared with values immediately before starting bronchoscopy, SAP and HR increased during the procedure in both groups (P < 0.05). Patients in the PK group showed more satisfaction [(9.5 (6-10) vs. 9.0 (6-10)), P < 0.05] and amnesia (82% vs. 61%, P < 0.01). Despite these differences, the majority (greater than 90%) of the patients in both groups stated that they were comfortable during the procedure.


CONCLUSIONS
Our results show that although both techniques proved effective for sedation in patients undergoing fiberoptic bronchoscopy, ketamine is superior to alfentanil when used in combination with propofol because of the high patient satisfaction and amnesia.
Hwang
J
J
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea.
Jeon
Y
Y
Park
H-P
HP
Lim
Y-J
YJ
Oh
Y-S
YS
D000293:Adolescent; D000328:Adult; D000368:Aged; D015760:Alfentanil / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled; D000778:Anesthetics, Dissociative / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D001999:Bronchoscopy; D016292:Procedural Sedation / Q000009:adverse effects; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005336:Fiber Optic Technology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007649:Ketamine / Q000009:adverse effects; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D017060:Patient Satisfaction; D015742:Propofol / Q000009:adverse effects; D011446:Prospective Studies
D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D015760:Alfentanil; D007649:Ketamine; D015742:Propofol