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Endoscopy 2012; 44(01): 13-20
DOI: 10.1055/s-0031-1291421
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Moderate sedation for elective upper endoscopy with balanced propofol versus fentanyl and midazolam alone: a randomized clinical trial

B. E. Levitzky
1   Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA
,
R. Lopez
2   Department of Biostatistics, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA
,
J. A. Dumot
1   Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA
,
J. J. Vargo
1   Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA
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Publikationsverlauf

Submitted: 13. Oktober 2010

Accepted after revision: 08. Juli 2011

Publikationsdatum:
08. November 2011 (online)

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Background and study aims: Balanced propofol sedation (BPS) combines propofol with opiates and benzodiazepines and targets at moderate sedation. Data comparing outcomes of BPS and standard sedation with opiates and benzodiazepines during elective esophagogastroduodenoscopy (EGD) are sparse. The primary end point of this study was to compare, in the recovery area, patient satisfaction with EGD following BPS versus standard sedation.

Patients and methods: Prospective, single-blinded randomized trial in 110 outpatients undergoing elective EGD and randomized 1:1 to BPS or standard sedation. Upon full recovery, the primary outcome of patient satisfaction was assessed using a 100-mm visual analogue scale (VAS) (1 = not at all satisfied, 100 = completely satisfied). Sedation recovery times and recall of pain and gagging (1 = none, 100 = severe) were also evaluated using a VAS.

Results: The BPS and standard sedation groups were similar regarding American Society of Anesthesiologists (ASA), Mallampati class, age, sex, and body mass index (BMI). Compared with the standard sedation arm, the BPS group exhibited higher median procedural satisfaction (99 vs. 85, P < 0.001), and lower median scores for recall of pain (P < 0.001) and gagging (P < 0.001). BPS resulted in a shorter median recovery time (min) (11 vs. 23, P < 0.001). On multivariable regression analysis, predictors of patient satisfaction included use of propofol, increased age, and higher fentanyl dosage.

Conclusions: BPS targeted to moderate sedation by adequately trained endoscopists results in superior patient satisfaction and shorter recovery times than standard sedation alone during EGD.

 

  • References

  • 1 White PF, Negus JB. Sedative infusions during local and regional anesthesia: a comparison of midazolam and propofol. J Clin Anesth 1991; 3: 32-39
    CrossrefPubMedGoogle Scholar
  • 2 Cohen LB, Wecsler JS, Gaetano JN et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 2006; 101: 967-974
    CrossrefPubMedGoogle Scholar
  • 3 Rex DK, Deenadayalu VP, Eid E et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology 2009; 137: 1229-1237
    CrossrefPubMedGoogle Scholar
  • 4 Vargo JJ, Zuccaro jr G, Dumot JA et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology 2002; 123: 8-16
    CrossrefPubMedGoogle Scholar
  • 5 Qadeer MA, Vargo JJ, Khandwala F et al. Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis. Clin Gastroenterol Hepatol 2005; 3: 1049-1056
    CrossrefPubMedGoogle Scholar
  • 6 Ulmer BJ, Hansen JJ, Overley CA et al. Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clin Gastroenterol Hepatol 2003; 1: 425-432
    CrossrefPubMedGoogle Scholar
  • 7 Tohda G, Higashi S, Wakahara S et al. Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists. Endoscopy 2006; 38: 360-367
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 8 Rex DK, Heuss LT, Walker JA, Qi R. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy. Gastroenterology 2005; 129: 1384-1391
    CrossrefPubMedGoogle Scholar
  • 9 Clarke AC, Hillman LC. Does the use of propofol require a specialist anesthetist?. Endoscopy 2001; 33: 95-96
    PubMedGoogle Scholar
  • 10 Heuss LT, Schnieper P, Drewe J et al. Risk stratification and safe administration of propofol by registered nurses supervised by the gastroenterologist: a prospective observational study of more than 2000 cases. Gastrointest Endosc 2003; 57: 664-671
    CrossrefPubMedGoogle Scholar
  • 11 Heuss LT, Schnieper P, Drewe J et al. Conscious sedation with propofol in elderly patients: a prospective evaluation. Aliment Pharmacol Ther 2003; 17: 1493-1501
    CrossrefPubMedGoogle Scholar
  • 12 Rex DK, Overley C, Kinser K et al. Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endoscopic cases. Am J Gastroenterol 2002; 97: 1159-1163
    CrossrefPubMedGoogle Scholar
  • 13 Koshy G, Nair S, Norkus EP et al. Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. Am J Gastroenterol 2000; 95: 1476-1479
    CrossrefPubMedGoogle Scholar
  • 14 Heuss LT, Schnieper P, Drewe J et al. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients – a prospective, controlled study. Am J Gastroenterol 2003; 98: 1751-1757
    PubMedGoogle Scholar
  • 15 Kulling D, Rothenbuhler R, Inauen W. Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy. Endoscopy 2003; 35: 679-682
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 16 Cohen LB, Hightower CD, Wood DA et al. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam. Gastrointest Endosc 2004; 59: 795-803
    CrossrefPubMedGoogle Scholar
  • 17 Sipe BW, Rex DK, Latinovich D et al. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc 2002; 55: 815-825
    CrossrefPubMedGoogle Scholar
  • 18 Yusoff IF, Raymond G, Sahai AV. Endoscopist administered propofol for upper-GI EUS is safe and effective: a prospective study in 500 patients. Gastrointest Endosc 2004; 60: 356-360
    CrossrefPubMedGoogle Scholar
  • 19 Vargo JJ, Cohen LB, Rex DK, Kwo PY. Position statement: Nonanesthesiologist administration of propofol for GI endoscopy. Gastroenterology 2009; 137: 2161-2167
    CrossrefPubMedGoogle Scholar
  • 20 Rex DK, Overley CA, Walker J. Registered nurse-administered propofol sedation for upper endoscopy and colonoscopy: Why? When? How?. Rev Gastroenterol Disord 2003; 3: 70-80
    PubMedGoogle Scholar
  • 21 VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol 2006; 101: 2209-2217
    CrossrefPubMedGoogle Scholar
  • 22 Cohen LB, Dubovsky AN, Aisenberg J, Miller KM. Propofol for endoscopic sedation: A protocol for safe and effective administration by the gastroenterologist. Gastrointest Endosc 2003; 58: 725-732
    CrossrefPubMedGoogle Scholar
  • 23 Cohen LB, Delegge MH, Aisenberg J et al. AGA Institute review of endoscopic sedation. Gastroenterology 2007; 133: 675-701
    CrossrefPubMedGoogle Scholar
  • 24 Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995; 7: 89-91
    Google Scholar
  • 25 Qadeer MA, Vargo JJ, Dumot JA et al. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography. Gastroenterology 2009; 136: 1568-1576
    CrossrefPubMedGoogle Scholar
  • 26 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96: 1004-1017
    CrossrefPubMedGoogle Scholar