ABSTRACT
BACKGROUND: The techniques, drugs and depth of sedation for flexible fiberoptic bronchoscopy is controversial, and several reports consider that the routine use of sedation is not a prerequisite. We evaluate whether the addition of sedation with propofol improves patient tolerance, compared to local anesthesic of the airway only. METHODS: Eighteen patients with pneumonia undergoing flexible fiberoptic bronchoscopy were included in a randomized, single blind, prospective controlled study. The non-sedation group received airway topical anesthesia, whereas the sedation group received topical anesthesia and intravenous sedation with propofol. The degree of pain, cough, sensation of asphyxiation, degree of amnesia, global tolerance and acceptance of another bronchoscopy in the future were noted. Changes in blood pressure, heart rate and saturation of oxygen by pulse oximetry were also evaluated. RESULTS: The patients in sedation group had less cough (P < 0.05), pain (P < 0.01) and sensation of asphyxiation (P < 0.001). Global tolerance to the procedure was significantly better in the group under sedation (P < 0.01). These patients had total amnesia to the procedure (P < 0.0001), thus is more probable that will accept another bronchoscopy in the future (P < 0.01). There was a significant rise in heart rate and blood pressure in the patients without sedation. There were no differences in oxygen saturation (P = 0.75). CONCLUSIONS: Our results show that if we administer propofol for sedation, in addition to local anesthesia of the airway, the tolerance to the procedure is much better. Also it appears that sedation with propofol is safe if we carefully select and monitor the patient.
Subject(s)
Bronchoscopy , Conscious Sedation , Adult , Anesthesia, Local , Anesthetics, Local/administration & dosage , Blood Pressure , Bronchoscopy/adverse effects , Female , Heart Rate , Humans , Hypnotics and Sedatives/administration & dosage , Injections, Intravenous , Lidocaine/administration & dosage , Male , Middle Aged , Oximetry , Pain Measurement , Patient Satisfaction , Propofol/administration & dosage , Prospective Studies , Single-Blind MethodABSTRACT
We analysed the perioperative course of 17 surgeries in 16 patients with pheochromocytoma between January 1981 and February 1995. The proportion of women was high (14/16 = 88%). All patients, except one, had hypertension (in three it was only sporadic). Twelve patients had complications or associated diseases. In 13 cases the pheochromocytoma was diagnosed before the operation: they were given preoperative pharmacological protection. The intraoperative monitoring included ECG, invasive blood pressure, CVP and when considered useful, a pulmonary catheter. During tumor handling, the increase in arterial pressure reached a higher level (p < 0.01) in the patients who did not receive preoperative adrenergic blockade versus those who did receive it (p < 0.05). Intraoperative nitroprussiate was needed in 13 cases (76%). Following tumour removal five patients required vasopressor support. One patient died two weeks after surgery due to septic shock. In the postoperative period eight patients had hypokalemia, a complication which has not been reported previously.
