Propofol sedation for flexible bronchoscopy: randomized, non-inferiority trial

Propofol has been established as a reliable method for sedation in flexible bronchoscopy. There are no data comparing propofol administered as intravenous boluses versus continuous infusion. 702 consecutive patients undergoing flexible bronchoscopy were randomly allocated to receive intravenous propofol using either an intermittent bolus technique or a continuous infusion. The primary endpoint was the number of adverse events assessed at the end of flexible bronchoscopy and at 24 hours. The number of any adverse event was similar in both randomized groups (219 vs. 211, p = 0.810). There were complications in 8 cases (7 major bleedings, 1 respiratory failure). As compared to the bolus group, the amount of propofol required was significantly higher in the infusion group (226 mg ± 147 versus 308 mg ± 204.8, p < 0.0001). In a multivariate regression model, this difference remained significant independently of the duration and the interventions performed during the procedure. The duration of bronchoscopy was significantly longer in the infusion group (14 [9 24] versus 17 [12 27] minutes, p < 0.0001). Propofol continuous infusion is as safe as bolus administration; however, it is associated with higher propofol requirements and a longer duration of the bronchoscopy.