Midazolam-morphine combined with TCI of propofol for endobranchial ultrasound-guided transbronchial needle aspiration

Abstract

Objective To evaluate the effectiveness of midazolam and morphine combined with TCI of propofol for endobronchial ultrasound-guided transbronchial needle aspiration （ EBUS-TBNA ）. Methods Forty ASA Ⅰ or Ⅱ patients undergoing elective EBUS-TBNA were randomly divided into 2 groups according to the plasma concentration （Cp） of TCI of propofol （n=20 each）： group Ⅰ Cp = 3 μg/ml （group P1） and group Ⅱ Cp = 4 μg/ml （group P2 ）. Midazolam 0.03 mg/kg and morphine 0.05 mg/kg were administered iv followed by topical anesthesia of laryngopharynx with 4% hdocaine. TCI of propofol was started at 5 min before surgery. The patients kept spontaneous breathing during operation. MAP, HR and SpO2 were continuously monitored and recorded before anesthesia （baseline） and at 30 min after beginning of surgery and emergence from anesthesia. Arterial blood gas analysis was performed at 30 min after beginning of surgery and PETCO2 was measured at the end of surgery. The amount of 4% lidocaine used for topical anesthesia, the adverse reactions and the level of patient＇s satisfaction were recorded. Results PaO2 and pH value were significantly lower while PaCO2 and PET CO2 higher in group P2 than in group P1. There was no significant difference in the emergence time, the amount of 4% lidocaine used,the adverse reactions and the level of patient＇s satisfaction between the 2 groups. Conclusion TCI of propofol at Cp of 3 μg/ml can provide satisfactory anesthesia for EBUS-TBNA with less respiratory depression and more rapid emergence than that at Cp of 4 μg/ml. Key words: Propofol; Midazolam; Morphine; Anesthesia, general; Biopsy, fine-needle