Safety And Efficacy Of Different Initial Target Concentrations Of Propofol In Elderly People During Fiberoptic Bronchoscopy

Objective Aiming at comparing the efficacy and safety of two induction Cet of propofol(1 verus 2μg/ml)in the elderly undergoing FB,we put forward a way to contrast the safety with efficacy of ‘‘effect-site’’ concentration of two different propofol TCIs in elderly patients with bronchoscopy.Method A total of 64 patients undergoing flexible bronchoscopy were randomized to receive propofol with the Cet of 1μg/ml(Group A)or 2μg/ml(Group B).After aperipheral venous cannula was placed in the preparation area,the patients were given supplemental oxygen(4 liter ˙ min-1)via nasal cannula.Topical anesthesia was achieved by 2% lidocaine spraying the bronchoscope channel(the nostril,nasopharynx and oropharynx)before it.Propofol was administered at the Cet of 1μg/ml(Group A)or 2μg/ml(Group B),while remifentanil was simultaneously delivered at a fixed effect-site concentration of 0.8 ng/m L.After the effect-site concentration and the plasma concentration were at equilibrium,the modified observer’s assessment of alertness/sedation(MOAA/S)score was used to evaluate the levels of sedation.Then the procedure started.The primary concern was the number of adverse events(oxygen saturation and hypotension).Haemodynamic variables,total dose of propofol and vasoactive drug,satisfaction scores of patients and bronchoscopists,levels of sedation,and recovery time were also compared.Result The incidence of oxygen desaturation and hypotension were markedly lower in Group A than in Group B(P<0.05).Propofol dose and vasoactive drugs were required significantly lower in Group A(P<0.05).This difference remained significant independent of the induction time and recovery time performed during the procedure(P<0.05).In Group B,there was a significant decline of oxygen saturation at 3 min after sedation and a higher proportion of patients needs airway assistance especially the insertion of oropharyngeal airway(P<0.05).In addition,Group B has a higher maintenance Ce(1.6±0.2μg/ml)as compared to Group A(1.1±0.3μg/ml).Furthermore,levels of sedation were deeper and bronchoscopist satisfaction scores were also higher in Group B.However,there were no significant differences between the two groups in terms of heart rate over time,the duration of bronchoscopy,remifentanil dose,requirement of topical anaesthesia or level of patients’ satisfaction scores(P>0.05).Conclusion The induction Cet1μg/ml of propofol was associated with fewer incidences of oxygen desaturation and hypotension and a reduced need for airway assistance and vasoactive drugs than Cet 2μg/ml during flexible bronchoscopy.For the safety of the patients as a whole,induction Cet 1ug/ml of propofol should be the preferred in elderly patients undergoing flexible bronchoscopy.