Safety of Monitored Anesthesia Care Using Propofol-Based Sedation for Pleuroscopy

Abstract

Background: The optimal approach to sedation for pleuroscopy remains undefined. Propofol is the favored sedative-hypnotic for many proceduralists but has a narrow therapeutic window and the risk for oversedation is high. Propofol-based sedation administered by anesthesiologists and the routine use of end-tidal capnography and bispectral index (BIS) monitoring may attenuate risks of complications. Objectives: The purpose of our study was to evaluate the safety and efficacy of monitored anesthesia care for pleuroscopy. Methods: We conducted a retrospective cohort study of patientswho underwent pleuroscopy. The primary outcome of interest was the incidence of anesthesia complications in patients undergoing pleuroscopy. Hypoxia was defined as oxygen saturation of less than 90% for 2 min and hypotension was defined as the need for vasopressors. Results: Of 199 enrolled patients, there were no significant complications attributed directly to anesthesia. Minor complications included hypoxia in 9 patients (4.5%), hypotension in 76 patients (38.2%), and insertion of a nasopharyngeal tube airway in 2 patients (1.0%). There was no significant difference in anesthesia-related complications between those with BIS monitoring and those without. Lower mean oxygen saturations (p = 0.028) and hypoxia (p = 0.021) were found in patients receiving the combination of propofol plus narcotics plus sedatives compared to those receiving propofol only, propofol plus narcotics or propofol plus sedatives. Conclusion: Our study demonstrates that pleuroscopy using propofol with end-tidal capnography monitoring, with or without BIS monitoring, is safe and effective. The combination of propofol with narcotics and sedatives is associated with more hypoxia and lower mean oxygen saturation compared with propofol alone, propofol plus narcotics or propofol plus sedatives.

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

“…However, end tidal CO 2 measurements were considered unreliable in a prior study where most patients showed false low-end tidal CO 2 levels due to an unsealed dual nasal cannula and room-air dilution of expired gases ( Ibrahim et al, 2019 ). Despite the fact that recent evidence supports the use of capnography in deep sedation, its use in moderate sedation has not been shown to improve patient safety ( Vakil et al, 2018 ). Despite various monitoring methods, the incidence of oxygen desaturation in this study was still relatively high, which may be due to inhibition of the respiratory centre in the brainstem by RF, especially when associated with benzodiazepines; hypoventilation secondary to sedation; and airway obstruction by the bronchoscope itself ( Zha et al, 2021 ).…”

Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study

“…Pleuroscopy was performed as per institutional standard of care, as previously described [10][11][12] (see Appendix S1 in the Supporting Information).…”

Review of the Physiology and Anesthetic Considerations for Pleuroscopy/Medical Thoracoscopy

“…Hypoxemic events (SpO 2 <90% for at least 2 min) were observed in 4 patients (7.6%), but all of them were resolved with gentle patient stimulation, while hypotensive events occurred in 34 (64.1%) patients, but vasopressors were needed in only 4 patients. Vakil and colleagues [26], in a retrospective cohort study of 199 patients, contended that propofol sedation with etCO 2 monitoring is a safe technique, though in this series the sedation was again performed by anesthesiologists. Specifically, no major complications were observed, and hypoxia (SpO 2 <90% for 2 min) and hypotension (need for vasopressors) occurred in 4.5% and 38.2%, respectively.…”