title: Propofol versus midazolam in medical thoracoscopy: a randomized, noninferiority trial.
abstract: BACKGROUND
  Hypoxemia is a surrogate marker for periprocedural endoscopic complications. There are no data comparing the safety of propofol sedation with another sedative regimen in medical thoracoscopy.
  
  
  OBJECTIVE
  To evaluate whether sedation with propofol is as safe and effective as sedation with midazolam.
  
  
  METHODS
  Ninety consecutive patients undergoing medical thoracoscopy were randomly allocated to receive either intravenous propofol or midazolam. Predefined periprocedural complications included hypoxemia, hypotension, bleeding, need for airway insertion, mechanical ventilation, intensive care unit transfer and death. The primary endpoint was the mean lowest oxygen saturation during the procedure.
  
  
  RESULTS
  Randomized groups had similar demographics (64 ± 16 years, 57% male, 91% American Society of Anesthesiologists class III-IV) and a balanced distribution of procedures. The mean lowest oxygen saturation during the procedure was significantly lower in the propofol group as compared to the midazolam group (93 ± 6 vs. 96 ± 3%, p = 0.007). Patients randomized to propofol showed more episodes of hypoxemia (27 vs. 4%, p = 0.007) and hypotension (82 vs. 40%, p < 0.0001). No procedure had to be aborted. None of the patients required an artificial airway, mechanical ventilation or intensive care unit care, and none died.
  
  
  CONCLUSIONS
  As assessed by the surrogate marker hypoxemia, propofol should not be considered the first choice for sedation in medical thoracoscopy.
authors: Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland.
authors: Peter
authors: P
authors: Grendelmeier
authors: Michael
authors: M
authors: Tamm
authors: Kathleen
authors: K
authors: Jahn
authors: Eric
authors: E
authors: Pflimlin
authors: Daiana
authors: D
authors: Stolz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D054810:Deep Sedation / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D013906:Thoracoscopy
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam; D010100:Oxygen; D015742:Propofol