Table 3. Pharmacological properties of common sedatives used in bronchoscopy
DrugFentanylAlfentanilMorphineMidazolamLorazepamDiazepamPropofol 1%Fospropofol
Dose i.v.Initial: 25–50 μgInitial: 250 μgInitial: 2.5 mgInitial: 2–2.5 mg
(0.5–1 mg in the elderly)
Initial dose: 1.5–2 mgInitial dose: 5–10 mgInitial: 10–50 mg titrated to effectInitial: 6.5 mg·kg−1
Supplemental: 25 μgSupplemental: 250 μgSupplemental: 2.5 mgSupplemental: 1 mg (0.5–1 mg in the elderly) at 2–5 min intervalsSupplemental: usually not required
Wait at least 10 min
Supplemental: usually not required
Wait at least 10 min
Supplemental: 25% of initial doseSupplemental: 1.6 mg·kg−1
Infusion: 25–100 μg·kg−1·min−1
Onset of action3–5 minImmediate5–10 min30–60 s8–15 min1 min30–60 s6.5 min
Peak effect5 minImmediate15–30 min5–10 min15–30 min2–3 min2 min12 min
Duration of action1–2 h1–2 h1–6 h30–120 min8 h1–3 h4–8 min17 min
Renal excretion<5%<1%90%<1%<1%<1%70%70%
Elimination half-life3–4 h1–2 h2 h1.5–2.5 h11–22 h20–50 h3–12 h45 min
Major/common adverse evensRespiratory depression, nausea and vomitingSee fentanylSee fentanylRespiratory depression, hypotensionSee midazolamSee midazolamRespiratory depression, bradycardia, hypotension, pain at the injection siteRespiratory depression, hypotension, paraesthesiae, pruritus
AntagonistsNaloxone 100–200 μg (1.5-3 μg·kg−1) with supplemental doses of 100 μg every 2 min until reversal occursFlumazenil 0.2 mg, repeated every 60 s up to 1 mg; if a continuous infusion is required the dose is 0.1–0.4 mg·h−1No antagonist available
CommentsCombination with benzodiazepines may enhance respiratory depression
Administer prior to the benzodiazepines, as a lower dose of benzodiazepine will be required to achieve the desired degree of sedation
See fentanylSee fentanylCombination with opiates may enhance respiratory depressionSee midazolamSee midazolamCombination with opiates may enhance respiratory depression
Dose and rate of administration should be adjusted according to desired level of sedation and response
For patients >65 years or with severe systemic disease reduce the dose by 25%
See propofol
  • Adapted from [10, 18, 36].