title: Titrated sedation with propofol for medical thoracoscopy: a feasibility and safety study.
abstract: BACKGROUND
  Bispectral index (BIS) is a valuable tool for assessing the depth of sedation and guiding the administration of sedative drugs. We previously demonstrated the benefits of BIS-guided propofol sedation in patients undergoing flexible bronchoscopy.
  
  
  OBJECTIVE
  To examine the feasibility and safety profile of propofol sedation in patients undergoing medical thoracoscopy (MT).
  
  
  METHODS
  Patients undergoing MT for diagnostic evaluation or treatment of pleuropulmonary diseases were enrolled over a 2-year period. Nurses and chest physicians were trained by anesthetists to provide analgosedation, to detect and correct cardiopulmonary disturbances. The level of sedation was optimized individually by titrating the propofol infusion according to the BIS and clinical evaluation. Patients' clinical data, procedure time, medications and any adverse events were recorded.
  
  
  RESULTS
  Fifty-three patients (60% male) with a median age of 62 years (range 19-84 years) underwent MT. The operative procedure lasted a median time of 28 min (range 9-112 min). The median doses of anesthetic drugs were 145 mg of propofol (range 20-410 mg) and 84 μg of fentanyl (range 0-225 μg). Hemodynamic disturbances occurred in 39 patients (bradycardia n = 4, tachycardia n = 12, hypotension n = 34) and required drug administration in only 4 cases. Hypoxemic events (n = 4) resolved upon gentle patient stimulation (verbal command, chin lift, oral cannula). All patients could be discharged from the recovery unit within 105 min after the procedure.
  
  
  CONCLUSIONS
  BIS-guided propofol sedation is a safe method that might replace midazolam sedation in MT and can be managed by well-trained nonanesthesiologist personnel.
authors: Department of Internal Medicine, Chest Medical Centre, Montana, Switzerland.
authors: Jean-Marie
authors: JM
authors: Tschopp
authors: Lesek
authors: L
authors: Purek
authors: Jean-Georges
authors: JG
authors: Frey
authors: Jean-Marie
authors: JM
authors: Schnyder
authors: John
authors: J
authors: Diaper
authors: Vanessa
authors: V
authors: Cartier
authors: Marc
authors: M
authors: Licker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation / Q000379:methods*; D056805:Consciousness Monitors; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects*; D008171:Lung Diseases / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000175:diagnosis / Q000601:surgery; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol