0
Correspondence |

The Use of Fospropofol During Bronchoscopy FREE TO VIEW

John Thomas McLarney, MD; Kevin Wayne Hatton, MD; Matthew J. Swan, MD
Author and Funding Information

University of Kentucky College of Medicine Lexington, KY

Correspondence to: Kevin Wayne Hatton, MD, N-202 UKMC, 800 Rose St, Lexington, KY 40536; e-mail: kwhatt2@email.uky.edu


The authors have reported to the ACCP that no significant 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).


© 2009 American College of Chest Physicians


Chest. 2009;136(3):944-945. doi:10.1378/chest.09-0499
Text Size: A A A
Published online

To the Editor:

We read in a recent issue of CHEST (January 2009) the editorial1 entitled “The Old and New of Sedation for Bronchoscopy” and were greatly concerned by the comments regarding the new sedative/hypnotic agent fospropofol disodium (Lusedra; Eisai Corporation; Woodcliff Lake, NJ). In the opening paragraph of this editorial, the author discussed several important reasons to provide safe and effective sedation during bronchoscopic procedures, including the ability to perform advanced diagnostic and therapeutic procedures, and the increased likelihood that the patient will undergo additional procedures. In these statements, we completely agree with the author and his intent; however, we believe he has missed the mark in regard to safety when he suggests that fospropofol is an entirely new drug that should not be subjected to the same rigorous patient safety standards as other general anesthetic agents.

Fospropofol is a water-soluble prodrug that is metabolized by the liver into its active form, the sedative/hypnotic agent propofol. Propofol (and fospropofol) have powerful physiologic effects including the possibility of inducing significant hemodynamic and respiratory depression, which, if not detected and treated aggressively by a clinician trained to recognize these effects, could prove to be disastrous to the very patients we are trying to benefit.2

Recently, the American Society of Anesthesiologists (ASA), the largest association of physicians dedicated to raising and maintaining the standards of the medical practice of anesthesiology in the United States sent a letter3 to the US Food and Drug Administration (FDA) requesting specific labeling for fospropofol similar to the labeling for propofol. In response to ASA member testimony before the FDA and at the request of patient safety groups, the FDA, in December 2008, approved fospropofol with the following bolded labeling, as suggested by the ASA4: “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. Patients should be continuously monitored during sedation and through the recovery process for early signs of hypotension, apnea, airway obstruction, and/or oxygen desaturation. Facilities for providing cardiopulmonary resuscitation must be immediately available.”

We believe, therefore, that the use of fospropofol, while potentially beneficial to patients undergoing bronchoscopic evaluations and other complex therapeutic and diagnostic interventions, should only be used as approved by the FDA and with the highest regard for patient safety.

Jantz MA. The old and new of sedation for bronchscopy. Chest. 2009;135:4-6. [PubMed] [CrossRef]
 
Dershwitz M, Rosow CE.Longnecker DE, Brown DL, Newman MF, et al. Pharmacology of intravenous anesthetics. Anesthesiology. 2008; New York, NY McGraw-Hill:849-868
 
American Society of Anesthesiologists FDA approves fospropofol and follows ASA's labeling recommendation.Accessed April 16, 2009 Available at:http://www.asahq.org/news/asanews121508.htm.
 
US Food and Drug Administration Drug approval reports by month.Accessed April 16, 2009 Available at:http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_Approval_History.
 

Figures

Tables

References

Jantz MA. The old and new of sedation for bronchscopy. Chest. 2009;135:4-6. [PubMed] [CrossRef]
 
Dershwitz M, Rosow CE.Longnecker DE, Brown DL, Newman MF, et al. Pharmacology of intravenous anesthetics. Anesthesiology. 2008; New York, NY McGraw-Hill:849-868
 
American Society of Anesthesiologists FDA approves fospropofol and follows ASA's labeling recommendation.Accessed April 16, 2009 Available at:http://www.asahq.org/news/asanews121508.htm.
 
US Food and Drug Administration Drug approval reports by month.Accessed April 16, 2009 Available at:http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_Approval_History.
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543