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Michael A. Jantz, MD, FCCP
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From the Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida.

Correspondence to: Michael A. Jantz, MD, FCCP, Director of Interventional Pulmonology, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, 1600 SW Archer Road-Box 100225, Gainesville, FL 32610; e-mail: Michael.Jantz@medicine.ufl.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):234-235. doi:10.1378/chest.09-1825
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To the Editor:

I appreciate the comments in response to my editorial1 provided by Dr. Fuhrman regarding the use of fospropofol during bronchoscopy.

I am in agreement with the US Food and Drug Administration labeling for fospropofol that “patients should be continuously monitored during sedation and through the recovery process for early signs of hypotension, apnea, airway obstruction, and/or oxygen desaturation.”2 I do not necessarily believe, however, that “LUSEDRA should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the diagnostic or therapeutic procedure.” Available data suggest that fospropofol can be used safely for moderate sedation without anesthesia monitoring. In addition to the study in CHEST by Silvestri and colleagues (January 2009)3 involving 252 patients undergoing bronchoscopy and demonstrating an acceptable safety profile, a study of 101 patients undergoing colonoscopy treated with fospropofol plus fentanyl for sedation showed a low incidence of hypoxemia.4

I do think that physicians who use fospropofol should be able to manage the airway in the event that the patient has a temporary state of deep sedation or general anesthesia. In my opinion, most pulmonologists have the skills to do this and most bronchoscopy suites have the capabilities for airway management and cardiopulmonary resuscitation. I would encourage additional studies of fospropofol compared with standard medications for sedation during bronchoscopy. In the appropriate clinical setting and with institutional review approval, I do not feel that anesthesia monitoring is necessarily warranted for these studies. Whether the Food and Drug Administration will modify the labeling for fospropofol after completion of additional studies is certainly open to conjecture. I believe the data will ultimately show that fospropofol can be safely used for sedation during bronchoscopy by pulmonary and critical care physicians.

Jantz MA. The old and the new of sedation for bronchoscopy. Chest. 2009;1351:4-6. [CrossRef] [PubMed]
 
US Food and Drug Administration Lusedra (Fospropofol disodium) prescribing information. http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/022244lbl.pdf. Accessed July 31, 2009.
 
Silvestri GA, Vincent BD, Wahidi MM, Robinette E, Hansbrough JR, Downie GH. A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy. Chest. 2009;1351:41-47. [CrossRef] [PubMed]
 
Cohen LB. Clinical trial: a dose-response study of fospropofol disodium for moderate sedation during colonoscopy. Aliment Pharmacol Ther. 2008;277:597-608. [CrossRef] [PubMed]
 

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References

Jantz MA. The old and the new of sedation for bronchoscopy. Chest. 2009;1351:4-6. [CrossRef] [PubMed]
 
US Food and Drug Administration Lusedra (Fospropofol disodium) prescribing information. http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/022244lbl.pdf. Accessed July 31, 2009.
 
Silvestri GA, Vincent BD, Wahidi MM, Robinette E, Hansbrough JR, Downie GH. A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy. Chest. 2009;1351:41-47. [CrossRef] [PubMed]
 
Cohen LB. Clinical trial: a dose-response study of fospropofol disodium for moderate sedation during colonoscopy. Aliment Pharmacol Ther. 2008;277:597-608. [CrossRef] [PubMed]
 
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