The Use of Propofol for Sedation in Medical Thoracoscopy

Propofol has been shown to be a safe for sedation during flexible bronchoscopy, but data for its use in medical thoracoscopy is limited. Aims and objectives: We initiated a multicentre randomized study, aiming to compare both the safety and adequacy of medical thoracoscopy performed with two different conscious sedation regimens (midazolam/fentanyl vs. propofol/fentanyl) administered by a non-specialist anaesthetist. Methods: Either propofol or midazolam was given in boluses. Fentanyl was used in all. Procedure time, complications and patient discomfort were defined and documented. The adequacy of the sedation according to the endoscopist and recovery time were measured. Results: We enrolled 38 patients (67.5±11.9 years, 23 males), with 18 patients randomised to propofol and 20 to midazolam. We observed no differences in procedure time (37.6 vs. 36.2 min, p = 0.57), recovery time (20.1 vs. 20.8 min, p=0.86), adequacy of sedation as perceived by the endoscopist (p=0.73). There were, however, 10 adverse events observed in the propofol group compared to 4 in the midazolam group (p = 0.04). Adverse events in the propofol group included desaturation responsive to supplementary oxygen (n=6), desaturation requiring temporary bag valve ventilation (n = 1), hypotension requiring intravenous fluid resuscitation (n=2) and the need to abort the procedure (n=1); compared to the midazolam group which included desaturation responsive to supplementary oxygen (n=3) and hypotension not requiring intervention (n=1). Conclusion: Propofol is not the drug of choice for sedation during medical thoracoscopy, given the increased risk of complications.