***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Propofol , a new intravenous sedative agent , was investigated in 41 asthmatic patients undergoing day-case ( outpatient ) fiberoptic bronchoscopy . The study design was a r and omized comparison between propofol and midazolam , which is a well-established intravenous sedative agent . The age , weight , and American Society of Anesthesiologists physical status and lung function of the two groups were not significantly different . Mean ( SD ) induction dose of propofol was 104.7 ( 30.1 ) mg with a maintenance dose of 121.9 ( 38.5 ) mg . Corresponding values of midazolam were 9.3 ( 3.1 ) mg and 3.7 ( 2.3 ) mg . The required level of sedation was achieved significantly faster with propofol , mean ( SD ) 125.4 ( 39.8 ) s , compared with midazolam , 179.4 ( 55.2 ) s ( p < 0.001 ) . Significantly faster recovery was noted with propofol compared with midazolam in terms of time to recall name and date of birth 2.3 ( 1.7 ) min vs 6.3 ( 8.6 ) min , ( p < 0.045 ) . Alertness scored with the digital symbol substitution test ( DSST ) returned to prebronchoscopy values in the propofol group at 30 min , DSST score = 35.9 ( 18.2 ) vs 13.4 ( 9.1 ) , in the midazolam group ( p < .0001 ) and was still significantly higher at 90 min-39.4 ( 17.9 ) and 23.1 ( 13.8 ) ( p < 0.01 ) . We conclude that propofol is a useful sedating agent in fiberoptic bronchoscopy with similar efficacy to midazolam but with a faster onset of action and a more rapid recovery . These represent significant advantages for day-case procedures Study Design . Retrospective review of a prospect i ve multicenter data base evaluating surgical adult spinal deformity ( ASD ) patients . Objective . This study aims to identify risk factors for medical complications in ASD patients undergoing surgery . Summary of Background Data . ASD surgery is known for its high complication rate . This study examines baseline patient characteristics for predictors of medical complications in surgical ASD patients . Methods . Intra and perioperative medical complications were included . Medical complications were : infection , pneumonia , urinary tract infection , c-difficile , sepsis , stroke , delirium , deep venous thrombosis , pulmonary embolism , myocardial infa rct ion , arrhythmia , congestive heart failure , pneumothorax , atelectasis , adult respiratory distress syndrome , bowel obstruction , ileus , and renal failure . Potential predictors were identified using univariate testing . Multivariate Poisson regression was used to determine independent predictors of medical complications . Health-related quality of life ( HRQL ) was measured using the Oswestry Disability Index and SF-36 . Multivariate repeated measures mixed models were used to examine HRQL . Results . Four hundred forty-eight patients were included . The incidence of patients with at least one medical complication was 26.8 % . Potential predictors included : age , BMI , anemia , arthritis , depression , cardiac history , hypertension , lung disease , history of PVD , Charlson Comorbidity Index , ASA , smoking , sex , and the number of years with spine problems . Independent predictors identified on multivariate logistic regression modeling included hypertension ( IRR 2.43 P = 0.0001 ) , smoking ( IRR 2.49 P = 0.0001 ) , and number of years with spine problems ( IRR 1.23 P = 0.03 ) . Despite medical complications , patients experienced significant improvements in HRQL , as measured by the SF-36 ( P = 0.0001 ) and oswestry disability index ( P = 0.0001 ) . The rate of improvement and overall improvement compared with baseline were not statistically different than that of patients who did not experience medical complications . Conclusion . Risk factors for the development of postoperative medical complications after correction of ASD include smoking , hypertension , and duration of symptoms . Patients who have one or more of these risk factors should be identified and informed during informed consent of their increased risks . They should be optimized preoperatively , and followed closely during the postoperative period . Level of Evidence : In this study , we question ed whether propofol provided clinical benefits compared with midazolam in terms of neuropsychometric recovery , safety profile and patient tolerance .  Patients , aged > 18 yrs , were r and omised to receive midazolam or propofol  , given by non-anaesthetist physicians to achieve moderate levels of sedation as assessed by the electroencephalographic bispectral index ( BIS ; between 70 and 85 ) . The primary end-point was the time delay until recovery of the BIS above 90 . Other end-points included a neuropsychometric continuous performance test ( CPT ) , serious respiratory adverse events , patient tolerance and physician satisfaction . Neuropsychometric recovery was improved in the propofol compared to the midazolam group as evidence d by faster normalisation of BIS index ( 5.4±4.7 min versus 11.7±10.2 min ; p = 0.001 ) and better results at the CPT . In the midazolam group , 15 % of patients presented profound sedation precluding CPT completion and one patient required mechanical ventilatory support . Patient tolerance was significantly better in the propofol group , whereas the operator ’s assessment was comparable in both groups . Compared with midazolam , propofol provided a higher quality of sedation in terms of neuropsychometric recovery and patient tolerance . BIS-guided propofol administration represents a safe sedation technique that can be performed by the non-anaesthesiologist Background : Topical lidocaine has been found to result in overestimation of the severity of laryngomalacia in infants undergoing flexible bronchoscopy under conscious sedation with midazolam and nalbuphine . This effect has never been confirmed and may depend on the level of sedation and the drugs used . We assessed the effect of topical lidocaine on laryngomalacia in infants undergoing flexible bronchoscopy under general anesthesia with propofol . Methods : Thirteen infants with congenital stridor referred to diagnostic flexible video-bronchoscopy were studied under propofol anesthesia before and 3 minutes after topical lidocaine administration to the larynx at a dose of 3 mg/kg body weight . Laryngomalacia was scored using 60 seconds video recordings of the larynx before and after lidocaine administration in r and om order by 2 independent blinded observers using the previously described arytenoid score ( AS ) , epiglottis score ( ES ) , and the total score ( TS = AS+ES ) . Results : No significant differences in AS , ES , and laryngomalacia score were found between the prelidocaine and postlidocaine assessment s by the 2 raters . The intraclass correlation coefficients were 0.995 ( 95 % confidence interval , 0.986 - 0.998 ) and 0.975 ( 0.930 - 0.991 ) and 0.989 ( 0.971 - 996 ) for AS , ES , and TS , respectively . Conclusions : The assessment of laryngomalacia is not affected by topical lidocaine under propofol anesthesia . The lidocaine effect on laryngomalacia may vary depending on the medication regime used and the depth of procedural sedation Combined sedation with a benzodiazepine and an opiate has been proposed as st and ard sedation for bronchoscopy . Propofol is a sedative – hypnotic with a rapid onset of action and fast recovery time , but carries the potential risk of respiratory failure . Consecutive patients ( n = 200 ) were r and omly allocated to receive either the combination midazolam and hydrocodone or intravenous propofol . The primary end-points were the mean lowest arterial oxygen saturation during bronchoscopy and the readiness-for-discharge score 1 h after the procedure . The mean lowest arterial oxygen saturation during bronchoscopy did not differ across treatment groups ( p = 0.422 ) , and the number of patients recording an arterial oxygen saturation of ≤90 % on at least one occasion was similar in both groups ( p = 0.273 ) . The median ( interquartile range ) readiness-for-discharge score 1 h after the procedure was significantly higher in the propofol group than in the combined sedation group ( 8 ( 6–9 ) versus 7 ( 5–9 ) ; p = 0.035 ) . Patients assigned propofol exhibited less tachycardia during bronchoscopy and for ≥1 h after the examination . Minor procedural complications were noted in 71 ( 35.5 % ) patients and exhibited a similar incidence in both treatment arms ( p = 0.460 ) . Propofol is as effective and safe as combined sedation in patients undergoing flexible bronchoscopy , thus representing an appealing option if timely discharge is a priority Objectives There are safety issues associated with propofol use for flexible bronchoscopy ( FB ) . The bispectral index ( BIS ) correlates well with the level of consciousness . The aim of this study was to show that BIS-guided propofol infusion is safe and may provide better sedation , benefiting the patients and bronchoscopists . Methods After administering alfentanil bolus , 500 patients were r and omized to either propofol infusion titrated to a BIS level of 65 - 75 ( study group ) or incremental midazolam bolus based on clinical judgment to achieve moderate sedation . The primary endpoint was safety , while the secondary endpoints were recovery time , patient tolerance , and cooperation . Results The proportion of  patients with hypoxemia or hypotensive events were not different in the 2 groups ( study vs. control groups : 39.9 % vs. 35.7 % , p = 0.340 ; 7.4 % vs. 4.4 % , p = 0.159 , respectively ) . The mean lowest blood pressure was lower in the study group . Logistic regression revealed male gender , higher American Society of Anesthesiologists physical status , and electrocautery were associated with hypoxemia , whereas lower propofol dose for induction was associated with hypotension in the study group . The study group had better global tolerance ( p<0.001 ) , less procedural interference by movement or cough ( 13.6 % vs. 36.1 % , p<0.001 ; 30.0 % vs. 44.2 % , p = 0.001 , respectively ) , and shorter time to orientation and ambulation ( 11.7±10.2 min vs. 29.7±26.8 min , p<0.001 ; 30.0±18.2 min vs. 55.7±40.6 min , p<0.001 , respectively ) compared to the control group . Conclusions BIS-guided propofol infusion combined with alfentanil for FB sedation provides excellent patient tolerance , with fast recovery and less procedure interference . Trial Registration Clinical Trials . gov BACKGROUND AND OBJECTIVE Fractionated propofol administration ( FPA ) in flexible bronchoscopy ( FB ) may lead to oversedation and an increased risk of adverse events , because a stable plasma concentration of propofol is not maintainable . The purpose of this r and omized noninferiority trial was to evaluate whether target-controlled infusion ( TCI ) of propofol is noninferior to FPA in terms of safety in FB . METHODS Co primary outcomes were the mean lowest arterial oxygen saturation ( SpO2 ) during FB and the number of propofol dose adjustments in relation to procedure duration . Secondary outcomes were the number of occasions with SpO2 < 90 % and /or oxygen desaturations of > 4 % from baseline , number of occasions with systolic blood pressure < 90 mm Hg , cough frequency , cumulative propofol dose , recovery time , maximum transcutaneous CO2 , mean SpO2 and O2 delivery during FB . RESULTS Seventy-seven patients were included . TCI was noninferior to FPA in terms of mean ( st and ard deviation ) lowest SpO2 during the procedure ( 88.3 % ( 5.4 % ) vs 86.9 % ( 7.3 % ) ) and required fewer dose adjustments ( 0.04/min vs 0.28/min , P < 0.001 ) but a higher cumulative propofol dose ( 264 vs 194 mg , P = 0.003 ) . All other secondary outcomes were comparable between the groups . CONCLUSION We suggest that TCI of propofol is a favourable sedation technique for FB with equal safety issues and fewer dose adjustments compared with FPA OBJECTIVE This study aim ed to assess the benefits and risks of conscious sedation with midazolam and dezocine in diagnostic flexible bronchoscopy ( FB ) . PATIENTS AND METHODS This prospect i ve case control study enrolled 40 non-se date d and 40 se date d subjects who underwent diagnostic FB . All received the st and ard upper airway preparation , while se date d subjects received midazolam and dezocine for conscious sedation . Subject discomforts during FB were assessed using the verbal analogue score ( VAS , 0 - 10 scale ) . Willingness to return was assessed as five scales to monitor subject 's satisfaction level . Safety profiles throughout the procedures were also assessed . RESULTS Antero grade amnesia existed in 75.0 % se date d subjects . Compared to non-se date d subjects , se date d 
    Output:
    
Conclusion : Propofol sedation is able to reduce recovery time and shows similar safety compared with midazolam sedation during bronchoscopy