title: Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial.
abstract: Combined sedation with a benzodiazepine and an opiate has been proposed as standard sedation for bronchoscopy. Propofol is a sedative-hypnotic with a rapid onset of action and fast recovery time, but carries the potential risk of respiratory failure. Consecutive patients (n = 200) were randomly allocated to receive either the combination midazolam and hydrocodone or intravenous propofol. The primary end-points were the mean lowest arterial oxygen saturation during bronchoscopy and the readiness-for-discharge score 1 h after the procedure. The mean lowest arterial oxygen saturation during bronchoscopy did not differ across treatment groups (p = 0.422), and the number of patients recording an arterial oxygen saturation of < or =90% on at least one occasion was similar in both groups (p = 0.273). The median (interquartile range) readiness-for-discharge score 1 h after the procedure was significantly higher in the propofol group than in the combined sedation group (8 (6-9) versus 7 (5-9); p = 0.035). Patients assigned propofol exhibited less tachycardia during bronchoscopy and for > or =1 h after the examination. Minor procedural complications were noted in 71 (35.5%) patients and exhibited a similar incidence in both treatment arms (p = 0.460). Propofol is as effective and safe as combined sedation in patients undergoing flexible bronchoscopy, thus representing an appealing option if timely discharge is a priority.
authors.affiliation: Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. dstolz@uhbs.ch
authors.forename: D
authors.initials: D
authors.lastname: Stolz
authors.forename: G
authors.initials: G
authors.lastname: Kurer
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.forename: P N
authors.initials: PN
authors.lastname: Chhajed
authors.forename: E
authors.initials: E
authors.lastname: Pflimlin
authors.forename: W
authors.initials: W
authors.lastname: Strobel
authors.forename: M
authors.initials: M
authors.lastname: Tamm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D015742:Propofol / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D006853:Hydrocodone; D008874:Midazolam; D010100:Oxygen; D015742:Propofol