Bronchoscopy Under Titrated Sedation With Propofol or Midazolam: a Randomized Trial.

Sedation using anxiolytic, hypnotic and /or analgesic drugs is currently used during flexible bronchoscopy (FB) to facilitate the diagnostic process and improve patient comfort.[The technique of sedation varies widely and depends primarily on the experience of the chest physician. FB can also be done without sedation. However, according to a recent survey, 80% of patients prefer to be sedated during FB and it is also well known that the operator has a tendency to overstate the tolerance of patients during the procedure.

The use of benzodiazepines for sedation undoubtedly enhances the perception and tolerance during FB and they are by far the most widely used drugs because of their ease of administration, their speed of action and the possibility to administer an antidote. The drawback of these sedative agents is related to a high variable individual sensitivity, which can lead to drug overdose and to severe respiratory depression requiring ventilatory assistance. In addition, their sedative and amnesic effects might persist several hours after the procedure.

Over the last decade, major advances in technology and pharmacology have resulted in better cerebral monitoring of anaesthesia with tools like electroencephalographic bispectral index and synthesis of sedative agents of short duration of action as propofol (P).

P is a lipidic emulsion used intravenously for induction and maintenance of anaesthesia. Its effect begins rapidly and ends faster than midazolam (M). The main advantage of P is therefore a faster recovery of mnesic, cognitive and motor functions, whereas M induces anterograde amnesia (1-2 h after bolus) and slower motor reaction . This gives to P a keen interest in ambulatory practice. While P is commonly and safely used in several gastroenterological endoscopic procedures, its use by pneumologist is currently hampered by a lack of expertise and could benefit from collaboration with the anaesthesia team.

This is a randomised trial comparing recovery of brain function and patient subjective tolerance following FB after administration either of P or M for sedation. Patients and operators are blinded to the sedative drug, which is administered and titrated by another chest physician.