Comparison of alfetanil and ketamine in combination with propofol for patient-controlled sedation during fiberoptic bronchoscopy

• Published in: Acta anaesthesiologica Scandinavica Vol. 49; no. 9; pp. 1334 - 1338
• Main Authors: Hwang, J., Jeon, Y., Park, H.-P., Lim, Y.-J., Oh, Y.-S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Blackwell Publishing Ltd/Inc 01-10-2005; Blackwell
• Subjects: Adolescent; Adult; Aged; alfentanil; Alfentanil - adverse effects; Analgesia, Patient-Controlled; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics; Anesthetics, Dissociative - adverse effects; Anesthetics, Intravenous - adverse effects; Biological and medical sciences; Bronchoscopy; Conscious Sedation - adverse effects; Double-Blind Method; Drug Combinations; Female; Fiber Optic Technology; Hemodynamics - physiology; Humans; Hypnotics and Sedatives - adverse effects; intravenous; ketamine; Ketamine - adverse effects; Male; Medical sciences; Mental Recall; Middle Aged; patient controlled; Patient Satisfaction; propofol; Propofol - adverse effects; Prospective Studies; sedation; Bronchoscopy; Human; patient controlled; Intravenous administration; Opiates; Glutamate receptor; Sedation; Narcotic analgesic; Anesthetics; Ketamine; intravenous; General anesthetic; Alfentanil; Anesthesia; Antagonist; Propofol; NMDA receptor; Comparative study
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2005.00842.x

Background:  During fiberoptic bronchoscopy, propofol, ketamine, benzodiazepines, and opiates are most commonly used, alone or in combination for sedation. The aim of this study was to compare the clinical efficacy of propofol/ketamine with propofol/alfentanil for patient‐controlled sedation (PCS) during fiberoptic bronchoscopy.
Method:  Patients undergoing fiberoptic bronchoscopy were randomly assigned to receive either propofol/alfentanil (PA group; n = 138) or propofol/ketamine (PK group; n = 138) via a patient‐controlled analgesia (PCA) device for sedation and analgesia. Changes in blood pressure, heart rate (HR), and oxygen saturation were monitored. Degree of patient and bronchoscopist satisfaction was evaluated using a 10‐cm visual analog scale (VAS) (0 = extremely uncomfortable to 10 = extremely comfortable).
Results:  After sedation, systolic arterial pressure (SAP) decreased in the PA group, but SAP was stable in the PK group. Compared with values immediately before starting bronchoscopy, SAP and HR increased during the procedure in both groups (P < 0.05). Patients in the PK group showed more satisfaction [(9.5 (6–10) vs. 9.0 (6–10)), P < 0.05] and amnesia (82% vs. 61%, P < 0.01). Despite these differences, the majority (greater than 90%) of the patients in both groups stated that they were comfortable during the procedure.
Conclusion:  Our results show that although both techniques proved effective for sedation in patients undergoing fiberoptic bronchoscopy, ketamine is superior to alfentanil when used in combination with propofol because of the high patient satisfaction and amnesia.