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Correspondence |

Propofol and Fospropofol Sedation During Bronchoscopy FREE TO VIEW

Klaus Mönkemüller, MD, PhD; Lars Zimmermann, MD
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From the Department of Internal Medicine, Gastroenterology and Infectious Diseases, Marienhospital Bottrop, and Otto-von-Guericke University.

Correspondence to: Klaus Mönkemüller, MD, PhD, Department of Internal Medicine, Gastroenterology and Infectious Diseases, Marienhospital Bottrop, Josef-Albers-Str 70, 46236 Bottrop, Germany; e-mail: klaus.moenkemueller@mhb-bottrop.de


Financial/nonfinancial disclosures: The authors have 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.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1489. doi:10.1378/chest.10-0010
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To the Editor:

We read with interest the excellent editorial by Michael Jantz (January 2009)1 that nicely summarized the existing data on the safety of propofol for pulmonary endoscopy. We would like to add that propofol also has an excellent record of safety for GI endoscopy. A recently published study documented the safety of propofol-assisted sedation in > 500,000 patients undergoing various GI endoscopies.2 When using propofol sedation, we basically need to follow the same precautions as when using any other drugs for analgosedation, such as benzodiazepine and opioids. This means that the physician and nurse performing the endoscopy should properly select the patient, adequately monitor the patient during the procedure, and be qualified to rescue patients whose levels of sedation become deeper than initially intended. The physician should be educated and trained in the pharmacology of sedative drugs used, airway management, and advanced life support. An advantage of pulmonary endoscopists over GI endoscopists, though, is their familiarity with the upper airways, potentially enabling a more efficient and smooth endotracheal intubation in an emergency situation. In addition, if an intubation should become difficult, the bronchoscope itself also could be used as a guiding instrument to advance the endotracheal tube and achieve proper tracheal intubation.

To finish, we disagree with Jantz regarding the classification of propofol. Jantz asked us to keep in mind “that fospropofol is a different drug than propofol and that fospropofol is not a general anesthetic.”1 Indeed, propofol is not classified as an anesthetic either. Propofol (2,6 diisopropylphenol) is an ultra-short-acting sedative-hypnotic agent with amnesic but no analgesic properties. Originally, it was mainly used for the induction of general anesthesia,3 but currently, it is widely used for sedation of patients on mechanical ventilation and various types of endoscopic procedures. Thus, we conclude that based on the available data, propofol (and not only fospropofol) appears safe for mild-to-moderate sedation in gastrointestinal and pulmonary endoscopy.

Jantz MA. The old and the new of sedation for bronchoscopy. Chest. 2009;1351:4-6. [CrossRef] [PubMed]
 
Rex DK, Deenadayalu VP, Eid E, et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology. 2009;1374:1229-1237. [CrossRef] [PubMed]
 
Mackenzie N, Grant IS. Propofol for intravenous sedation. Anaesthesia. 1987;421:3-6. [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]
 
Rex DK, Deenadayalu VP, Eid E, et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology. 2009;1374:1229-1237. [CrossRef] [PubMed]
 
Mackenzie N, Grant IS. Propofol for intravenous sedation. Anaesthesia. 1987;421:3-6. [CrossRef] [PubMed]
 
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