The Use of Fospropofol During Bronchoscopy

McLarney, J. Thomas; Hatton, Kevin; Swan, Matthew J.

doi:10.1378/chest.09-0499

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…Among nonanesthesiologists, midazolam remains the preferred sedative drug, although gastrointestinal endoscopists have gained much experience with the administration of propofol [9,10,11,12,13]. In patients undergoing flexible bronchoscopy, preliminary results also support the feasibility, safety and potential advantages of propofol sedation compared with midazolam [14,15,16,17]. Therefore, in 2007 we elected to modify our sedation protocol, switching from the classic midazolam/pethidine regimen to the combination of propofol/fentanyl for all pulmonary interventional procedures.…”

Section: Introductionmentioning

confidence: 99%

Titrated Sedation with Propofol for Medical Thoracoscopy: A Feasibility and Safety Study

Tschopp¹,

Purek

Frey

et al. 2011

Respiration

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Background: Bispectral index (BIS) is a valuable tool for assessing the depth of sedation and guiding the administration of sedative drugs. We previously demonstrated the benefits of BIS-guided propofol sedation in patients undergoing flexible bronchoscopy. Objective: To examine the feasibility and safety profile of propofol sedation in patients undergoing medical thoracoscopy (MT). Methods: Patients undergoing MT for diagnostic evaluation or treatment of pleuropulmonary diseases were enrolled over a 2-year period. Nurses and chest physicians were trained by anesthetists to provide analgosedation, to detect and correct cardiopulmonary disturbances. The level of sedation was optimized individually by titrating the propofol infusion according to the BIS and clinical evaluation. Patients’ clinical data, procedure time, medications and any adverse events were recorded. Results: Fifty-three patients (60% male) with a median age of 62 years (range 19–84 years) underwent MT. The operative procedure lasted a median time of 28 min (range 9–112 min). The median doses of anesthetic drugs were 145 mg of propofol (range 20–410 mg) and 84 µg of fentanyl (range 0–225 µg). Hemodynamic disturbances occurred in 39 patients (bradycardia n = 4, tachycardia n = 12, hypotension n = 34) and required drug administration in only 4 cases. Hypoxemic events (n = 4) resolved upon gentle patient stimulation (verbal command, chin lift, oral cannula). All patients could be discharged from the recovery unit within 105 min after the procedure. Conclusions: BIS-guided propofol sedation is a safe method that might replace midazolam sedation in MT and can be managed by well-trained nonanesthesiologist personnel.

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Section: Introductionmentioning

confidence: 99%

Titrated Sedation with Propofol for Medical Thoracoscopy: A Feasibility and Safety Study

Tschopp¹,

Purek

Frey

et al. 2011

Respiration

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“…It is noteworthy that the impact of age on the outcomes of flexible bronchoscopy is controversial: While some claim that adverse events are increased in elderly patients, others claim that outcomes after bronchoscopy are not attributable to age alone [60][61][62][63][64][65]. Thus, the reports of fospropofol being able to provide adequate sedation for bronchoscopy mixed with the reported adverse events that can be serious,sparked the debate regarding the FDA recommendation concerning the training and skills of the clinicians adminstering fospropofol that were obviously patients' safety motivated [59]…”

Section: B Use In Bronchoscopymentioning

confidence: 99%

Fospropofol, A New Sedative Anesthetic, and Its Utility in the Perioperative Period

Abdelmalak¹,

Khanna²,

Tetzlaff³

2012

CPD

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Fospropofol is an intravenous sedative-anesthetic agent that is FDA-approved for monitored anesthesia care (MAC) sedation in adult patients undergoing diagnostic or therapeutic procedures. As a prodrug of propofol, fospropofol's pharmacologic activity results from its breakdown by alkaline phosphatase and release of propofol, which is the active molecule. It exhibits a longer time to peak clinical effect and a more prolonged action compared to propofol. Thus patients may exhibit smoother hemodynamic and respiratory depression compared to propofol lipid emulsion bolus. Another advantage over propofol is that it does not induce a burning sensation on IV administration. Side effects include perineal paresthesia and itching, respiratory depression, hypoxemia, hypotension, loss of consciousness, and apnea with higher IV boluses. Therefore, current recommendations call for it to be administered only by clinicians trained in general anesthesia, who are thus skilled in advanced airway management. Fospropofol has a unique dosing regimen, with a standard dose for adults 18-65 years of age, and a modified dose (75% of the standard dose) for patients > 65 years of age and for sicker adult patients whose American Society of Anesthesiologists physical status score is ≥ 3. Also, the minimum and maximun IV bolus doses are body-weight adjusted to 60 and 90 kg respectively. Available evidence demonstrates that fospropofol in MAC sedation is successful in patients undergoing esophagogastroscopy, colonoscopy and flexible bronchoscopy. The use of fospropofol is also now being explored in many other perioperative settings. In light of current shortages of many anesthetic drugs, whether forspropofol can take the place of propofol in ICUs and operating rooms remains to be determined.

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Bolus-Dose Fospropofol Disodium (Lusedra): Is 10 mg/Kg Superior To 6.5 mg/Kg for Sedation in Patients Undergoing Regional Anesthesia Blocks Prior to Orthopedic Surgery?

L¹,

Misra²,

Rosenfeld³

2015

J Anesth Clin Res

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The Use of Fospropofol During Bronchoscopy

Cited by 3 publications

References 4 publications

Titrated Sedation with Propofol for Medical Thoracoscopy: A Feasibility and Safety Study

Titrated Sedation with Propofol for Medical Thoracoscopy: A Feasibility and Safety Study

Fospropofol, A New Sedative Anesthetic, and Its Utility in the Perioperative Period

Bolus-Dose Fospropofol Disodium (Lusedra): Is 10 mg/Kg Superior To 6.5 mg/Kg for Sedation in Patients Undergoing Regional Anesthesia Blocks Prior to Orthopedic Surgery?

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