Sedation in Outpatient Flexible Bronchoscopy

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Abstract
Sedation is considered standard care in ambulatory flexible bronchoscopy (FFB) by most pulmonologists. Methods of sedation, however, differ from one center to another. In a prospective randomized study, we compared sedation for FFB provided by alfentanil-propofol (Group A, n = 30) with that provided by meperidine-midazolam (Group B, n = 30). These methods were compared in terms of hemodynamics, frequency of desaturation, bronchoscopist acceptability, and patient comfort. The groups were comparable in terms of patient characteristics, bronchoscopic procedures, and the total duration of the procedure. When compared with presedation values, there was a significant rise in heart rate (mean [with SE] during the procedure (82 [4]-119 [4] beats/min and 91 [3]-126 [4] beats/min) and a significant fall in oxygen saturation (96 [0.6]-90% [1%] and 96 [0.5]-90% [1.3%]), in Groups A and B, respectively. Significant elevations in systolic (142 [5]-180 [9] mmHg) and diastolic (79 [5]-93− [3] mmHg) blood pressures were observed only in patients sedated with meperidinemidazolam. The results of the questionnaire completed by the patients and the bronchoscopist indicated similar levels of satisfaction in each group. We conclude that compared to sedation with alfentanil-propofol, sedation with meperidine-midazolam gives equally good operating conditions, provides comparable levels of patient comfort and satisfaction, produces satisfactory amnesia, and is safe. Because alfentanil-propofol sedation attenuates the blood pressure response to FFB, however, it may be the most appropriate technique for use in patients with known or those at risk for coronary artery disease.

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