A Comparative Evaluation of Propofol and Midazolam as Sedative Agents in Fiberoptic Bronchoscopy

doi:10.1378/chest.104.4.1029

Chest

Volume 104, Issue 4, October 1993, Pages 1029-1031

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Propofol, a new intravenous sedative agent, was investigated in 41 asthmatic patients undergoing day-case (outpatient) fiberoptic bronchoscopy. The study design was a randomized comparison between propofol and midazolam, which is a well-established intravenous sedative agent. The age, weight, and American Society of Anesthesiologists physical status and lung function of the two groups were not significantly different. Mean (SD) induction dose of propofol was 104.7 (30.1) mg with a maintenance dose of 121.9 (38.5) mg. Corresponding values of midazolam were 9.3 (3.1) mg and 3.7 (2.3) mg. The required level of sedation was achieved significantly faster with propofol, mean (SD) 125.4 (39.8) s, compared with midazolam, 179.4 (55.2) s (p<0.001). Significantly faster recovery was noted with propofol compared with midazolam in terms of time to recall name and date of birth 2.3 (1.7) min vs 6.3 (8.6) min, (p<0.045). Alertness scored with the digital symbol substitution test (DSST) returned to prebronchoscopy values in the propofol group at 30 min, DSST score = 35.9 (18.2) vs 13.4 (9.1), in the midazolam group (p<.0001) and was still significantly higher at 90 min–39.4 (17.9) and 23.1 (13.8) (p<0.01). We conclude that propofol is a useful sedating agent in fiberoptic bronchoscopy with similar efficacy to midazolam but with a faster onset of action and a more rapid recovery. These represent significant advantages for day-case procedures.

Section snippets

Patients

Forty-one consecutive patients with known bronchial asthma (American Thoracic Society criteria) undergoing elective fiberoptic bronchoscopy were randomly allocated to receive either intravenous midazolam or propofol as a sedative agent. Indications for bronchoscopy included persistent cough, hemoptysis, or suspected bronchogenic neoplasm. Informed consent was obtained from each patient and the study was approved by the James Connolly Memorial Hospital Ethics Committee. All patients were

Results

Forty-one patients were studied, of whom 20 received midazolam and 21 received propofol. There were no significant differences between the propofol and midazolam groups in terms of age, weight, indications for bronchoscopy, baseline FEV₁ values, or ASA physical status (Table 1). Bronchoscopic procedures carried out were similar in both groups, including bronchoalveolar lavage in six patients in both groups and endobronchial biopsies in four and three patients in the midazolam and propofol

Discussion

To our knowledge, there are no data available on propofol as a sedating agent in day-case fiberoptic bronchoscopy. At present, midazolam is the most commonly used sedative agent in this procedure, because it has a documented rapid onset and short duration of action in normal subjects. However, side effects of midazolam include a significant variation in individual dose requirements and respiratory depression. In about 6 percent of the population, it has a delayed metabolism leading to

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La broncoscopia flexible (FB) es un método común utilizado para el muestreo diagnóstico del tórax. Aunque la seguridad y eficacia de la FB en la población general están bien establecidas, los datos sobre la población anciana son limitados. El objetivo de este estudio es determinar la seguridad y eficacia de la FB en ancianos ≥80 años.
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Los resultados de este estudio indican que la FB se puede Los resultados de este estudio indican que la FB puede realizarse de forma eficaz y segura en pacientes de edad ≥80 años, de forma similar a los pacientes no ancianos.
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Citation Excerpt :
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Chest

Clinical Investigations: Bronchos-Copy/LavageA Comparative Evaluation of Propofol and Midazolam as Sedative Agents in Fiberoptic Bronchoscopy

Section snippets

Patients

Results

Discussion

Chest

Propofol pharmacokinetics and metabolism—an overview

Postgrad Med J

Use of propofol for sedation during gastrointestinal endoscopies

Anaesthesia

Conscious sedation with propofol

Br Dent J

Propofol sedation for out-patient endoscopy— a comparison with midazolam

Anesth Analg

Clinical Investigations: Bronchos-Copy/Lavage
A Comparative Evaluation of Propofol and Midazolam as Sedative Agents in Fiberoptic Bronchoscopy