Safety and Viability of Nurse-Administered Propofol Sedation During Bronchoscopy

Abstract

Background: Sedation during bronchoscopy enhances patient comfort and procedure tolerability. Traditionally, moderate sedation has been achieved using benzodiazepines and narcotics, but these agents are associated with risks such as prolonged sedation and respiratory complications. Propofol, a fast-acting intravenous sedative, has gained attention for its effectiveness and rapid recovery times in endoscopic procedures. Nurse-administered propofol sedation (NAPS) has been successfully implemented in gastrointestinal endoscopy but has not been extensively studied in bronchoscopy. This study aims to assess the safety and efficacy of NAPS in flexible bronchoscopy.
Methods: this study was conducted on 498 bronchoscopies performed using NAPS . Patient demographics, procedure details, propofol dosing, and adverse events were reviewed. Adverse events were classified as major or minor and were further analyzed based on their relationship to propofol sedation. The NAPS protocol involved propofol administration by trained nurses with Advanced Cardiac Life Support certification, under physician supervision.
Results: The average patient age was 53 years, and most procedures were performed on outpatient ASA I or II patients. The average propofol dose was 242 mg, with supplemental midazolam and fentanyl administered in most cases. Adverse events occurred in 11.8% of procedures, with 2.8% classified as major events, including pulmonary hemorrhage, hypoxia, and bronchospasm. A comparison with traditional sedation methods revealed similar or lower adverse event rates in NAPS procedures.
Conclusion: This study supports the feasibility and safety of NAPS for bronchoscopy, demonstrating similar or improved outcomes compared to traditional sedation methods. NAPS offers a practical and effective alternative for sedation, especially in settings with limited access to anesthesiologists. Further large-scale studies are needed to confirm these findings and explore NAPS’s potential in diverse patient populations and procedural complexities.