Sedation for fibreoptic bronchoscopy.

Shelley, Maire; Wilson, P. N.; Norman, John

doi:10.1136/thx.44.10.769

Cited by 58 publications

(39 citation statements)

References 77 publications

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“…Optimal sedation for flexible bronchoscopy has been assessed in a number of studies evaluating different sedative drug regimens using single agents or combinations thereof [6][7][8][9][10]. Propofol (2,6-di-isopropylphenol), a sedative hypnotic, has recently proved to be a safe and attractive alternative to combined sedation with midazolam and hydrocodone due to its rapid onset of action and fast recovery time, particularly if timely discharge was a priority [11][12][13][14][15][16][17][18]. Additionally, as compared with midazolam alone, propofol seems to provide a higher quality of sedation in terms of neuropsychometric recovery and patient tolerance [18].…”

Section: Introductionmentioning

confidence: 99%

Propofol sedation for flexible bronchoscopy: a randomised, noninferiority trial

Grendelmeier

Tamm

Pflimlin

et al. 2013

European Respiratory Journal

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Propofol has been established as a reliable method for sedation in flexible bronchoscopy. There are no data comparing propofol administered as intravenous boluses versus continuous infusion.702 consecutive patients undergoing flexible bronchoscopy were randomly allocated to receive intravenous propofol using either an intermittent bolus technique or a continuous infusion. The primary end-point was the number of adverse events assessed at the end of flexible bronchoscopy and at 24 h.The number of any adverse event was similar in both randomised groups (219 versus 211, p50.810). There were complications in eight cases (seven major bleedings, one respiratory failure). As compared with the bolus group, the amount of propofol required was significantly higher in the infusion group (226 ¡147 mg versus 308¡204.8 mg, p,0.0001). In a multivariate regression model, this difference remained significant independent of the duration and the interventions performed during the procedure. The duration of bronchoscopy was significantly longer in the infusion group (median 14 (interquartile range 9-24) versus 17 (12-27) min, p,0.0001).Propofol continuous infusion is as safe as bolus administration; however, it is associated with higher propofol requirements and a longer duration of the bronchoscopy. @ERSpublications Propofol continuous infusion is as safe as bolus administration, but has higher requirements and longer bronchoscopy

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Section: Introductionmentioning

confidence: 99%

Propofol sedation for flexible bronchoscopy: a randomised, noninferiority trial

Grendelmeier

Tamm

Pflimlin

et al. 2013

European Respiratory Journal

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“…The short-acting benzodiazepine midazolam is most often used in combination with different opiates for sedation given the sedative and amnestic properties of benzodiazepines, and the analgesic and antitussive properties of opiates [1,7,8,9] although newer drugs like fospropofol have also been introduced for FB [9,10]. However, sedation induced by the combination of drugs is supposedly associated with a greater extent of deoxygenation and carbon dioxide (CO 2 ) retention, particularly in patients with pre-existing respiratory failure [1].…”

Section: Introductionmentioning

confidence: 99%

Sedation during Flexible Bronchoscopy in Patients with Pre-Existing Respiratory Failure: Midazolam versus Midazolam plus Alfentanil

et al. 2009

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Background: The use of sedation during flexible bronchoscopy (FB) is undisputed; however, the combination of benzodiazepines and opiates, although reasonable, is suggested to cause hypoventilation, particularly in patients with pre-existing respiratory failure. Objectives: To assess respiratory function during FB. Methods: Transcutaneous PCO₂(PtcCO₂), oxygen saturation, patients’ tolerance, time after FB until recovery and application of drug dosage were assessed in patients receiving either midazolam with alfentanil (n = 15) or midazolam alone (n = 15) for sedation for FB. Results: There were no differences in PtcCO₂ values during FB between the two groups (all p > 0.05). However, PtcCO₂significantly increased over time in both groups (both p < 0.001; RM-ANOVA on ranks). Minimum oxygen saturation (SaO₂) [89 (interquartile range 79.8/92.8) vs. 86 (interquartile range 82.3/87.8)%; p = 0.46] and the duration until recovery, i.e., achieving an ALDRETE score of ≧9 [30 (interquartile range 10/90) vs. 10 (interquartile range 10/105) min; p = 0.68] were comparable for monosedation and combined sedation, respectively. The total amount of midazolam [4.0 (interquartile range 4.0/4.0) vs. 2.0 (interquartile range 2.0/2.0) mg; p < 0.001] was lower in patients receiving combined sedation. Significantly lower scores for pain and asphyxia, and a clear tendency to less nausea and cough were reported by patients receiving combined sedation. Conclusions: Combined sedation during FB produced a comparable degree of desaturation and hypoventilation, and is associated with a comparable time to full recovery compared to monosedation in patients with pre-existing respiratory failure. Importantly, FB using combined sedation is better tolerated by patients despite only 50% midazolam consumption.

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“…In such patients, midazolam is the most commonly used benzodiazepine because of its short duration of action [5]. However, the pharmacokinetic properties of midazolam include a significant variation in individual dose requirements and delayed metabolism, leading to accumulation of the drug in ,6% of the population [9,10]. Both attributes may lead to a prolonged recovery period [11][12][13][14].…”

mentioning

confidence: 99%

Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial

Stolz¹,

Kurer²,

Meyer³

et al. 2009

European Respiratory Journal

109

115

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Combined sedation with a benzodiazepine and an opiate has been proposed as standard sedation for bronchoscopy. Propofol is a sedative-hypnotic with a rapid onset of action and fast recovery time, but carries the potential risk of respiratory failure.Consecutive patients (n5200) were randomly allocated to receive either the combination midazolam and hydrocodone or intravenous propofol. The primary end-points were the mean lowest arterial oxygen saturation during bronchoscopy and the readiness-for-discharge score 1 h after the procedure.The mean lowest arterial oxygen saturation during bronchoscopy did not differ across treatment groups (p50.422), and the number of patients recording an arterial oxygen saturation of f90% on at least one occasion was similar in both groups (p50.273). The median (interquartile range) readiness-for-discharge score 1 h after the procedure was significantly higher in the propofol group than in the combined sedation group (8 (6-9) versus 7 (5-9); p50.035). Patients assigned propofol exhibited less tachycardia during bronchoscopy and for o1 h after the examination. Minor procedural complications were noted in 71 (35.5%) patients and exhibited a similar incidence in both treatment arms (p50.460).Propofol is as effective and safe as combined sedation in patients undergoing flexible bronchoscopy, thus representing an appealing option if timely discharge is a priority.

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Sedation for fibreoptic bronchoscopy.

Cited by 58 publications

References 77 publications

Propofol sedation for flexible bronchoscopy: a randomised, noninferiority trial

Propofol sedation for flexible bronchoscopy: a randomised, noninferiority trial

Sedation during Flexible Bronchoscopy in Patients with Pre-Existing Respiratory Failure: Midazolam versus Midazolam plus Alfentanil

Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial

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