Médecine pulmonaire et respiratoire

A Prospective Study of the Safety of Flexible Bronchoscopy under Propofol Sedation in Patients with and without Chronic Obstructive Pulmonary Disease

Abstract

Marco Solis, Marcos Hernandez, Cesar Duran, Roberto Dure, Silvia Quadrelli

Background and objective: The British Thoracic Society (BTS) recommends that sedation for fiber-optic bronchoscopy (FOB) should be offered to all patients. This study evaluates the safety of FOB under sedation in patients with COPD.
Methods: Is a prospective observational study, with the approval of institutional review board. Sedation was administered by a board-certified anaesthetist. Patients were premedicated (IV) with metoclopramide 10 mg, fentanyl initial dose: 25 μg, midazolam initial dose 2-3 mg. After an initial 50 mg IV propofol, the dose was then carefully titrated according to the ASA physical status classification.
Results: The duration of the procedure was not different between the two groups (14.7 ± 3.551 vs. 14.9 ± 3.8 min p=0.695). Serious complications were very infrequent in both groups (2.1 vs. 0.07%, p=0.148). In the group of COPD patients there was no correlation between the lowest SaO2 during the procedure (r=0.03, p=0.518) or the SaO2 at the end of the procedure (r=-0.006, p=0.909) and the baseline FEV1. Neither the presence of a fall in the SaO2 greater than 4 points (HR 0.895, IC 0.452-1.773, p=0.750) nor a SaO2 lower than 90% during the procedure (HR 0.346, IC 0.060-1.918, p=0.233) or the general rate of complications (including desaturation) (HR: 0.627, CI: 0.257-1.529, p=0.305) were predicted by a baseline FEV1 lower than 50%.
Conclusions: We conclude that FOB under conscious sedation by a certified anesthesiologist is a safe procedure in patients with COPD with a low incidence of adverse effects.