Comparison of alfetanil and ketamine in combination with propofol for patient‐controlled sedation during fiberoptic bronchoscopy

Hwang, Jung‐Won; Jeon, Young-Tae; Park, Hee Pyoung; Lim, Young Jin; Oh, Yong Seok

doi:10.1111/j.1399-6576.2005.00842.x

Cited by 66 publications

(55 citation statements)

References 22 publications

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“…7 Propofol given by patient-controlled sedation (PCS) may be an alternative for moderate sedation for gynecological procedures outside the anesthetic room. Although PCS has been reported as safe 8,9 and studies on propofol PCS commonly have used opioid supplements for pain control [10][11][12] , the impact of opioids for PCS on safety and ease of treatment has not been sufficiently evaluated. PCS seems to decrease doses of sedatives and analgesics compared to sedation by anesthetists.…”

Section: Introductionmentioning

confidence: 99%

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Nilsson

Ustaal

et al. 2012

Acta Anaesthesiol Scand

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BackgroundWidespread use of patient‐controlled sedation (PCS) demands simplicity and a predictable outcome. We evaluated patients’ safety and ease of use of PCS for gynaecological outpatient procedures.MethodsIn a prospective double‐blind study, 165 patients were randomized to use propofol or propofol with alfentanil as PCS combined with local anaesthetic for pain control. Data on cardiopulmonary function, consciousness, and need for interventions were collected at baseline and every fifth minute. The surgeons’ evaluation of the ease and the duration of the procedure were recorded.ResultsOne hundred and fifty‐five patients used PCS for the entire procedure, 76 patients propofol, and 79 patients propofol/alfentanil. Fifteen procedures in the propofol group were limited or could not be done, compared with four in the propofol/alfentanil group (P = 0.02). The duration of surgery was not affected. The addition of alfentanil affected respiratory function compared with the propofol group: five patients compared with none were manually ventilated (P = 0.03), and two thirds, compared with a quarter, were given supplementary oxygen as their saturation decreased below 90% (P < 0.001). Overall cardiovascular stability was maintained. The propofol group had deeper conscious sedation as measured by the bispectral index (P = 0.03), but all patients could be roused. In the propofol/alfentanil group, five patients became apnoeic and could not be roused.ConclusionsPCS using propofol alone supports patients’ safety, as the addition of alfentanil increased the need for specific interventions to maintain respiratory stability. However, alfentanil increases the feasibility of the procedure, as complementary doses of propofol were not required.

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Section: Introductionmentioning

confidence: 99%

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Nilsson

Ustaal

et al. 2012

Acta Anaesthesiol Scand

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“…(2) The use of propofol (with or without opiates; administered intravenously via intermittent bolus or patient-controlled analgesia pump) for MS in bronchoscopy has been increasingly reported. (6,9,16) In this study, we administered propofol and remifentanil using TCI. These two intravenous medications are optimal for delivery via TCI because of their short context-sensitive half-lives.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of target-controlled infusion of propofol and remifentanil with high frequency jet ventilation in fibre-optic bronchoscopy

Wang¹,

Yang²,

Zhang³

et al. 2013

smedj

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O r i g i n a l A r tic le 689 I NTRO D U C TIO NOf all endoscopic procedures, bronchoscopy without sedation might be one of the most painful and uncomfortable experiences. Therefore, unless absolute contraindications exist, sedation or anaesthesia is recommended for patients undergoing bronchoscopy.( Recently, propofol has proven effective during bronchoscopy, achieving similar results as the combined administration of midazolam and opiates in aspects such as sedation, amnesia and patient tolerance. (6) Moreover, propofol has the advantage of a shorter recovery time.(7-8)The widely used combination of either midazolam or propofol and opiates to achieve MS for bronchoscopy has been known to result in a high incidence (~30%-50%) of hypoxaemia (i.e. SpO 2 < 90%) and a relatively high cough score. (9 -11) However, the use of high frequency jet ventilation (HFJV) can provide adequate gas exchange, thus avoiding hypoxaemia without interfering with the manoeuvre of the bronchoscopist.HFJV has been successfully applied in rigid bronchoscopy and difficult airway intubation. (12)(13)(14) In light of this, the combination of general anaesthesia (GA) with HFJV might be a more acceptable regimen than conventional MS in bronchoscopy, especially with the former's lower incidence of hypoxaemia and lower cough score. To the best of our knowledge, there has been no published randomised controlled study comparing MS with GA achieved via target-controlled infusion (TCI) of propofol and remifentanil with HFJV, with respect to the incidence of oxygen desaturation, haemodynamic parameters, cough score, duration of bronchoscopy and patient satisfaction.

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“…Midazolamla karşılaştırıldığında, propofol benzer etkinlik ve güvenirliliğe sahiptir ancak etkisinin hızlı başlaması ve anesteziden hızlı çıkış hem de hasta toleransının daha iyi olması nedeniyle giderek daha fazla önerilmeye başlanmıştır (14,19). Propofol, analjezi sağlamak, öksürüğü azaltmak, gerekli propofol dozunu azaltmak ve anestezi ve sedasyonu artırmak için opiyat ve sedatiflerle kombinasyon tedavisinde de kullanılabilir (20,21). Propofol-opiyat kombinasyonu (orta düzeyde sedasyon) ile oksijen desatürasyonları arasında ilişki bulunmuş ancak bazı çalışmalarda midazolamın kısa etkili opiyatlarla kombinasyonu propofolün tek başına kullanımı ile karşılaştırıldığında daha fazla CO 2 retansiyonu ve daha fazla O 2 desteğine ihtiyaç ile sonuçlandığı gösterilmiştir (22,23).…”

Section: Propofolunclassified

Sedation for fiberoptic bronchoscopy: review of the literature

Talay¹,

Kargi²,

Yaşar³

et al. 2015

Tuberk Toraks

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Comparison of alfetanil and ketamine in combination with propofol for patient‐controlled sedation during fiberoptic bronchoscopy

Abstract: Our results show that although both techniques proved effective for sedation in patients undergoing fiberoptic bronchoscopy, ketamine is superior to alfentanil when used in combination with propofol because of the high patient satisfaction and amnesia.

Cited by 66 publications

References 22 publications

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Efficacy of target-controlled infusion of propofol and remifentanil with high frequency jet ventilation in fibre-optic bronchoscopy

Sedation for fiberoptic bronchoscopy: review of the literature

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