Table 4. Summary of clinical studies of propofol in flexible bronchoscopy
ArticleStudy typeDrugMain results
Clarkson [54]Randomised, double-blind, prospective-controlled studyPropofol (n=21) versus midazolam (n=20)More rapid onset and recovery from sedation seen in the propofol group
No significant difference in the amount of topical anaesthetic required or in oxygen desaturation
Crawford [55]Randomised, double-blind, prospective-controlled studyPropofol (n=21) versus midazolam–alfentanil (n=21)In three patients in the midazolam–alfentanil and five in the propofol group the depth of sedation exceeded the moderate level
Recovery to an appropriate level was more rapid in the latter group
Oxygen saturations decreased in both groups and there were no significant differences in blood pressure
Those in the midazolam group had more amnesia and longer recovery time
Gonzalez [5]Randomised, single-blind, prospective-controlled studyPropofol (n=9) versus no sedation (n=9)Less cough, pain, sensation of asphyxiation, total amnesia and improved tolerance of the procedure in the propofol group
No differences in oxygen saturations between the groups
Hwang [47]Randomised, double-blind, prospective-controlled studyPropofol–alfentanil (n=138) versus propofol–ketamine (n=138) for patient-controlled sedationPatients in the propofol–ketamine group reported greater amnesia and satisfaction
Haemodynamic stability and adequate oxygenation during the procedure in both groups; however, a significant drop in oxygen saturations below 90% was seen in both groups immediately before the procedure
This was transient and with no sequelae
Clark [20]Randomised, double-blind, prospective-controlled studyPropofol (n=43) versus midazolam (n=39)Propofol resulted in faster recovery from sedation and patient tolerance and satisfaction were improved
There were no differences in operator satisfaction
Safely administered by non-anaesthetis
Stoltz [56]Randomised, non-blinded, prospective-controlled studyPropofol (n=100) versus midazolam–hydrocodone (n=100)Mean oxygen saturation and desaturation below 90% were similar in both groups
Patients receiving propofol had less tachycardia during the procedure and faster recovery from sedation
Grendelmeier [12]Prospective case seriesPropofol (n=440)Systolic blood pressure dropped below 90 mmHg in 15.4% and oxygen saturation dropped below 90% in 16.4% of patients but some of these had higher American Society of Anesthesiology scores and were already hypotensive or hypoxaemic prior to the sedation
None of the patients required intubation
Lo [21]Randomised, non-blinded, prospective-controlled studyPropofol (n=243) versus midazolam (n=249)Bispectral index-guided propofol infusion is as safe as clinically judged midazolam sedation
The proportion of patients with hypoxemia or hypotensive events were not different in the two groups but those in propofol group had the lowest mean arterial blood pressure and oxygen saturation readings
Those in the propofol group had less cough, improved procedure tolerance and faster recovery from sedation
Yoon [57]Randomised, double-blind, prospective-controlled studyPropofol (n=32) versus propofol–alfentanil (n=32)They did not find differences in patient or bronchoscopist satisfaction or in degree of coughing but those in the alfentanil group had significantly lower oxygen saturation levels. However, the lower levels of oxygen saturation reported in the alfentanil are most likely not clinically significant
Schlatter [58]Randomised, double-blind, prospective-controlled studyPropofol (n=154) versus propofol–hydrocodone (n=146)This combination suppressed coughing and reduced patient discomfort during flexible bronchoscopy compared to placebo alone with no differences in complication rates
Carmi [59]Randomised, non-blinded, prospective-controlled studyPropofol (n=56) versus midazolam–alfentanil (n=59)Those in the midazolam–alfentanil group rather than the propofol group had higher carbon dioxide tension values and required more oxygen supplementation or airway support; however, both were considered equally safe and effective