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Propofol safety in bronchoscopy: prospective randomized trial using transcutaneous carbon dioxide tension monitoring
Uri Carmi1, Mordechai R Kramer, Dmitry Zemtzov
1Department of Anesthesia, Rabin Medical Center, Petach Tikva, Israel.
Background:
Midazolam is commonly used for sedation during flexible bronchoscopy because of its relatively wide therapeutic window. Recently, sedation with propofol for bronchoscopy has gained popularity, although concern has been raised regarding its potential ability to induce severe respiratory depression.
Objectives:
The aim of this study was to evaluate the safety of sedation under midazolam + alfentanil compared to propofol.
Methods:
We conducted a prospective randomized trial using continuous transcutaneous carbon dioxide tension monitoring. The study group included 115 patients undergoing bronchoscopy, prospectively randomized to receive sedation with either midazolam + alfentanil (n = 59) or propofol (n = 56).
Results:
Intra-procedural carbon dioxide tension values were higher in the midazolam + alfentanil group than in the propofol group (maximum 53.72 vs. 49.49 mm Hg, mean 46.78 vs. 43.78 mm Hg), but the differences did not reach statistical significance (p = 0.149 and 0.193, respectively). Carbon dioxide tension values were significantly higher in the midazolam + alfentanil group than in the propofol group at 5 and 10 min following procedure (51.7 vs. 49.3 mm Hg, p = 0.026, and 50.8 vs. 42.7 mm Hg, p < 0.01, respectively), and significantly more patients in the midazolam + alfentanil group needed oxygen supplementation or airway support (24 vs. 8 patients, respectively).
Conclusion:
Midazolam + alfentanil and propofol are equally safe for sedation during bronchoscopy. Sedation with propofol, using small boluses at short intervals, does not cause excessive respiratory drive depression and represents an excellent alternative to traditional sedation agents.
Insights
Midazolam + alfentanil and propofol demonstrate equal safety for bronchoscopy sedation. Propofol offers a safe alternative, avoiding excessive respiratory depression when administered carefully.
Area of Science:
- Pulmonology
- Anesthesiology
- Critical Care Medicine
Background:
- Midazolam is a common sedative for flexible bronchoscopy due to its safety margin.
- Propofol is increasingly used for bronchoscopy sedation, but concerns exist regarding respiratory depression.
- Evaluating sedative safety is crucial for patient outcomes during endoscopic procedures.
Purpose of the Study:
- To compare the safety of midazolam + alfentanil versus propofol for sedation during flexible bronchoscopy.
- To assess respiratory function using continuous transcutaneous carbon dioxide tension monitoring.
Main Methods:
- A prospective randomized trial involving 115 patients undergoing bronchoscopy.
- Patients were randomized to receive sedation with either midazolam + alfentanil (n=59) or propofol (n=56).
- Continuous transcutaneous carbon dioxide tension monitoring was employed to assess respiratory status.
Main Results:
- Intra-procedural carbon dioxide tension was higher in the midazolam + alfentanil group but not statistically significant.
- Post-procedure, carbon dioxide tension was significantly higher in the midazolam + alfentanil group (p=0.026 at 5 min, p<0.01 at 10 min).
- More patients in the midazolam + alfentanil group required oxygen supplementation or airway support (24 vs. 8).
Conclusions:
- Midazolam + alfentanil and propofol are equally safe for sedation during bronchoscopy.
- Propofol sedation, administered in small, frequent doses, is a safe alternative to traditional agents.
- Propofol does not appear to cause excessive respiratory drive depression in this setting.
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