Feasibility and safety of propofol sedation in flexible bronchoscopy
BACKGROUND: Propofol is a sedative-hypnotic with a rapid onset of action. There are only limited data evaluating propofol for flexible bronchoscopy. We analysed the feasibility and safety of propofol for bronchoscopy in a high output tertiary care centre.
METHODS: Prospective data on patients undergoing flexible bronchoscopy at the University Hospital Basel, Switzerland, were analysed. Patient demographics, ASA class, Mallampati class, indication for bronchoscopy, bronchoscopic procedures, duration of examination, medication requirements, minor and major adverse events, haemodynamic parameters, as well as cough scores during the procedure were documented. Patients were followed up to discharge from the bronchoscopy suite.
RESULTS: Data from 440 patients with a mean age 60 years (±15.5, 260 male) were analysed. The main indication for bronchoscopy was a suspicion of malignancy. The most common diagnostic procedures were bronchoalveolar lavage in 253 cases (31.5%) and bronchial washing in 174 cases (21.7%). The mean duration of the procedure was 19.6 min (±12.08). The mean propofol dose was 200 mg (±107.5) corresponding to 2.89 mg/kg (±1.70). Minor adverse events included oxygen desaturation in 72 (16.4%), hypotension in 68 (15.4%) and minor bleeding in 11 (2.5%) patients. No major adverse events were recorded. The median decline in systolic blood pressure after initiation of sedation was 14 mm Hg (3–28). A drop in systolic blood pressure greater than 20 mm Hg was observed in 166 of the 440 patients (37%).
CONCLUSION: Propofol sedation for flexible bronchoscopy is feasible and safe.
- British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001;56(Suppl 1): i1-21.
- Gonzalez R, De-La-Rosa-Ramirez I, Maldonado-Hernandez A, Dominguez-Cherit G. Should patients undergoing a bronchoscopy be sedated? Acta Anaesthesiol Scand. 2003;47(4):411–5.
- Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A. Patient satisfaction with conscious sedation for bronchoscopy. Chest. 1999;115(5):1437–40.
- Matot I, Kramer MR. Sedation in outpatient bronchoscopy. Respir Med. 2000;94(12):1145–53.
- Pickles J, Jeffrey M, Datta A, Jeffrey AA. Is preparation for bronchoscopy optimal? Eur Respir J. 2003;22(2):203–6.
- Chhajed PN, Wallner J, Stolz D, Baty F, Strobel W, Brutsche MH, et al. Sedative drug requirements during flexible bronchoscopy. Respiration. 2005;72(6):617–21.
- Stolz D, Chhajed PN, Leuppi J, Pflimlin E, Tamm M. Nebulized lidocaine for flexible bronchoscopy: a randomized, double-blind, placebo-controlled trial. Chest. 2005;128(3):1756–60.
- Stolz D, Chhajed PN, Leuppi JD, Brutsche M, Pflimlin E, Tamm M. Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: a randomised, double blind, placebo controlled trial. Thorax. 2004;59(9):773–6.
- Greig JH, Cooper SM, Kasimbazi HJ, Monie RD, Fennerty AG, Watson B. Sedation for fibre optic bronchoscopy. Respir Med. 1995;89(1):53–6.
- Stolz D, Pollak V, Chhajed PN, Gysin C, Pflimlin E, Tamm M. A randomized, placebo-controlled trial of bronchodilators for bronchoscopy in patients with COPD. Chest. 2007;131(3):765–72.
- Stolz D, Kurer G, Meyer A, Chhajed PN, Pflimlin E, Strobel W, Tamm M. Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial. Eur Respir J. 2009;34(5):1024–30.
- Fulton B, Sorkin EM. Propofol. An overview of its pharmacology and a review of its clinical efficacy in intensive care sedation. Drugs. 1995;50(4):636–57.
- Shelley MP, Wilson P, Norman J. Sedation for fibreoptic bronchoscopy. Thorax. 1989;44(10):769–75.
- Bosslet GT, Devito ML, Lahm T, Sheski FD, Mathur PN. Nurse-administered propofol sedation: feasibility and safety in bronchoscopy. Respiration. 79(4): 315–21.
- Clarkson K, Power CK, O’Connell F, Pathmakanthan S, Burke CM. A comparative evaluation of propofol and midazolam as sedative agents in fiberoptic bronchoscopy. Chest. 1993;104(4):1029–31.
- Bryson HM, Fulton BR, Faulds D. Propofol. An update of its use in anaesthesia and conscious sedation. Drugs. 1995;50(3):513–59.
- Clark G, Licker M, Younossian AB, Soccal PM, Frey JG, Rochat T, et al. Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomised trial. Eur Respir J. 2009;34(6):1277–83.
- Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients-a prospective, controlled study. Am J Gastroenterol. 2003;98(8):1751–7.
- Rex DK, Overley C, Kinser K, Coates M, Lee A, Goodwine BW, et al. Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endoscopic cases. Am J Gastroenterol. 2002;97(5):1159–63.
- Silvestri GA, Vincent BD, Wahidi MM, Robinette E, Hansbrough JR, Downie GH. A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy. Chest. 2009;135(1):41–7.
- Zed PJ, Abu-Laban RB, Chan WW, Harrison DW. Efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the emergency department: a prospective study. Cjem. 2007;9(6):421–7.
- Berkenbosch JW, Graff GR, Stark JM, Ner Z, Tobias JD. Use of a remifentanil-propofol mixture for pediatric flexible fiberoptic bronchoscopy sedation. Paediatric anaesthesia. 2004;14(11):941–6.
- Hohl CM, Nosyk B, Sadatsafavi M, Anis AH. A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department. Acad Emerg Med. 2008;15(1):32–9.
- Rodrigo MR, Jonsson E. Conscious sedation with propofol. Br Dental J. 1989;166(3):75–80.
- Gasparovic S, Rustemovic N, Opacic M, Premuzic M, Korusic A, Bozikov J, et al. Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures: a three year prospective study. World J Gastroenterol. 2006;12(2):327–30.
- Chhajed PN, Glanville AR. Management of hypoxemia during flexible bronchoscopy. Clin Chest Med. 2003;24(3):511–6.
- White P, Bonacum JT, Miller CB. Utility of fiberoptic bronchoscopy in bone marrow transplant patients. Bone Marrow Transplant. 1997;20(8):681–7.