Sedation for fibreoptic bronchoscopy: comparison of alfentanil with papaveretum and diazepam

Sedation for fibreoptic bronchoscopy should produce optimal conditions for the operator, patient comfort and rapid recovery allowing early discharge home. We have compared a regimen producing ‘light’ sedation with a more traditional regimen producing ‘deep’ sedation. Seventy-six patients undergoing fibreoptic bronchoscopy under topical anaesthesia were randomized to receive either light sedation with the short acting opiate, alfentanil (median dose 1·1 mg, range 0·5–2·6 mg) or deep sedation with a combination of papaveretum (median dose 10 mg, range 5–15 mg) and diazepam (median dose 8 mg, range 0–20 mg). Both techniques gave equally good operating conditions, although patients given alfentanil coughed less than those given papaveretum and diazepam (U = 2·814 P < 0·01). Patients recorded their degree of apprehension on a visual analogue scale prior to sedation and the actual degree of comfort experienced after recovery. There was no significant difference between apprehension or comfort between the groups. This was despite a higher degree of amnesia for an irrelevant object shown during the bronchoscopy in the deeply sedated group (χ 2 = 21·084 P < 0·001). Patients given alfentanil performed significantly better in a modified Romberg test (χ 2 = 4·357 P < 0·05) and a visualisation test ( t = 3·035 P < 0·01) two hours after the bronchoscopy. Alfentanil produced good operating conditions, patient comfort, less cough and a more rapid recovery, compared to the deep sedation regimen, and is an ideal sedative for fibreoptic bronchoscopy.