Prospective randomized trial evaluating ketamine for adult bronchoscopy

Purpose: Ketamine has been used in pediatric flexible fiberoptic bronchoscopy (FFB). Its efficacy and safety for sedation of adults undergoing FFB has not been thoroughly investigated and consequently it is not used by most interventional bronchoscopists. The aim of this study was to evaluate the safety and efficacy of sedation for FFB under ketamine- -propofol- midazolam (KPM) compared to fentanil- propofol -midazolam- (FPM) regimen. Methods: Prospective randomized trial of adult patients (n = 80) undergoing FFB, randomized to receive sedation with either KPM (n=39) or FPM (n=41).Vital signs including trancutaneous carbon dioxide tension (TcPCO 2 ) were continuously monitored. Sedation –related complications and interventions to maintain respiratory and hemodynamic stability were compared. Both operator and patient were blinded to sedation regimen used. Operator9s and patient9s satisfaction from sedation were assessed following recovery. Results: Maximal intra-procedural TcPCO 2 values and minimal oxygen saturation did not differ significantly between KPM and FPM groups (63.2 ± 11.4 mmHg vs. 61.1 ± 7.2 mmHg ) and ( 77.1 ± 12.5 % vs. 81.8 ± 12.0 % ) , respectively. No significant differences were noted between KPM and FPM groups with respect to sedation –related respiratory or hemodynamic complications. Operator9s and patient9s satisfaction from sedation was similar between groups. Conclusion: Ketamine is as safe and effective as fentanyl for adult analgesia and sedation during FFB. In light of the fact that ketamine does not cause hemodynamic suppression like most sedative agents and is a potent bronchodilator, should encourage its more widespread use for adult sedation during FFB.