Comparison of propofol and the combination of propofol and alfentanil during bronchoscopy: a randomized study

Background Propofol is an excellent sedative agent for use in patients undergoing bronchoscopy. The addition of an opioid to propofol can be advantageous because of the antitussive effect of the opioid and the possible improvement in sedation quality. However, it may increase the risk of hypoxaemia. To investigate the effect of the addition of alfentanil to propofol, we performed a prospective study to compare propofol-only sedation with propofol-alfentanil combination sedation in patients undergoing bronchoscopy. Methods Patients were randomly assigned either to the propofol-only (group P, n=32) or to the propofol-alfentanil combination group (group PA, n=32). The average peripheral oxygen saturation (SpO(2)) and the lowest SpO(2) during the sedation were compared. Patient and bronchoscopist satisfaction as well as the degree of coughing were compared using a 100 mm visual analogue scale, where 0 indicated the least and 100 indicated the most satisfied. Results Group P had the higher average SpO(2) (%) during the procedure than group PA (97.8 +/- 1.6 and 96.4 +/- 1.1, P < 0.01) as well as the lowest SpO(2) (%) (95.4 +/- 2.7and 94.0 +/- 2.4, P < 0.05). Patient satisfaction (92.2 +/- 13.5 and 92.3 +/- 18.2), bronchoscopist satisfaction (76.6 +/- 18.1 and 72.8 +/- 19.1), and degree of cough (73.4 +/- 22.7 and 72.2 +/- 18.5; group P and group PA, respectively) were not different between the groups. Conclusions The combination of propofol and alfentanil resulted in a greater respiratory depression than propofol alone; furthermore, the addition of an opioid did not improve the quality of sedation. In conclusion, we do not recommend sedation with propofol and alfentanil during bronchoscopy.