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

Abstract

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.