Target-controlled versus fractionated propofol sedation in flexible bronchoscopy: A randomized noninferiority trial.
Fractionated propofol administration (FPA) in flexible bronchoscopy (FB) may lead to oversedation and an increased risk of adverse events, because a stable plasma concentration of propofol is not maintainable. The purpose of this randomized noninferiority trial was to evaluate whether target-controlled infusion (TCI) of propofol is noninferior to FPA in terms of safety in FB.



Coprimary outcomes were the mean lowest arterial oxygen saturation (SpO2) during FB and the number of propofol dose adjustments in relation to procedure duration. Secondary outcomes were the number of occasions with SpO2< 90% and/or oxygen desaturations of >4% from baseline, number of occasions with systolic blood pressure < 90 mm Hg, cough frequency, cumulative propofol dose, recovery time, maximum transcutaneous CO2, mean SpO2and O2delivery during FB.



Seventy-seven patients were included. TCI was noninferior to FPA in terms of mean (standard deviation) lowest SpO2during the procedure (88.3% (5.4%) vs 86.9% (7.3%)) and required fewer dose adjustments (0.04/min vs 0.28/min, P < 0.001) but a higher cumulative propofol dose (264 vs 194 mg, P = 0.003). All other secondary outcomes were comparable between the groups.



We suggest that TCI of propofol is a favourable sedation technique for FB with equal safety issues and fewer dose adjustments compared with FPA.
Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland. daniel.franzen@usz.ch.
Daniel
D
Franzen
Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Daniel J
DJ
Bratton
Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Christian F
CF
Clarenbach
Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Lutz
L
Freitag
Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Malcolm
M
Kohler
D000368:Aged; D000771:Anesthesia, Intravenous / Q000379:methods / Q000592:standards; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure; D001999:Bronchoscopy / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000032:analysis; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D020379:Risk Adjustment; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D010100:Oxygen; D015742:Propofol
flexible bronchoscopy; propofol; sedation