title: Feasibility of bispectral index-guided propofol infusion for flexible bronchoscopy sedation: a randomized controlled trial.
abstract: OBJECTIVE
  There are safety issues associated with propofol use for flexible bronchoscopy (FB). The bispectral index (BIS) correlates well with the level of consciousness. The aim of this study was to show that BIS-guided propofol infusion is safe and may provide better sedation, benefiting the patients and bronchoscopists.
  
  
  METHODS
  After administering alfentanil bolus, 500 patients were randomized to either propofol infusion titrated to a BIS level of 65-75 (study group) or incremental midazolam bolus based on clinical judgment to achieve moderate sedation. The primary endpoint was safety, while the secondary endpoints were recovery time, patient tolerance, and cooperation.
  
  
  RESULTS
  The proportion of patients with hypoxemia or hypotensive events were not different in the 2 groups (study vs. control groups: 39.9% vs. 35.7%, p = 0.340; 7.4% vs. 4.4%, p = 0.159, respectively). The mean lowest blood pressure was lower in the study group. Logistic regression revealed male gender, higher American Society of Anesthesiologists physical status, and electrocautery were associated with hypoxemia, whereas lower propofol dose for induction was associated with hypotension in the study group. The study group had better global tolerance (p<0.001), less procedural interference by movement or cough (13.6% vs. 36.1%, p<0.001; 30.0% vs. 44.2%, p = 0.001, respectively), and shorter time to orientation and ambulation (11.7±10.2 min vs. 29.7±26.8 min, p<0.001; 30.0±18.2 min vs. 55.7±40.6 min, p<0.001, respectively) compared to the control group.
  
  
  CONCLUSIONS
  BIS-guided propofol infusion combined with alfentanil for FB sedation provides excellent patient tolerance, with fast recovery and less procedure interference.
  
  
  BACKGROUND
  ClinicalTrials. gov NCT00789815.
authors: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.
authors: Yu-Lun
authors: YL
authors: Lo
authors: Ting-Yu
authors: TY
authors: Lin
authors: Yueh-Fu
authors: YF
authors: Fang
authors: Tsai-Yu
authors: TY
authors: Wang
authors: Hao-Cheng
authors: HC
authors: Chen
authors: Chun-Liang
authors: CL
authors: Chou
authors: Fu-Tsai
authors: FT
authors: Chung
authors: Chih-Hsi
authors: CH
authors: Kuo
authors: Po-Hao
authors: PH
authors: Feng
authors: Chien-Ying
authors: CY
authors: Liu
authors: Han-Pin
authors: HP
authors: Kuo
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D056805:Consciousness Monitors; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D010100:Oxygen / Q000378:metabolism; D010147:Pain Measurement; D010349:Patient Compliance; D018583:Pliability; D015742:Propofol / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D018686:Anesthetics, Intravenous; D010100:Oxygen; D015742:Propofol