A prospective, randomized, comparative trial evaluating respiratory depression during patient-controlled versus anesthesiologist-administered propofol-remifentanil sedation for elective colonoscopy

Mandel, Jeff E.; Lichtenstein, Gary R.; Metz, David C.; Ginsberg, Gregory G.; Kochman, Michael L.

doi:10.1016/j.gie.2010.01.031

Cited by 30 publications

(16 citation statements)

References 16 publications

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“…Mild respiratory impairment and the need for supplemental oxygen were expected in some of the cases, as reported previously, with only propofol (healthy volunteers) [83] and propofol/remifentanil (colonoscopy) [51]. Although some respiratory impairment was expected, apnoea in five cases was not.…”

Section: Cardiorespiratory Functions and Interventionssupporting

confidence: 65%

Patient-controlled sedation in procedural care

Nilsson¹

2015

Linköping University Medical Dissertations

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Section: Cardiorespiratory Functions and Interventionssupporting

confidence: 65%

Patient-controlled sedation in procedural care

Nilsson¹

2015

Linköping University Medical Dissertations

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“…4,16,18 Some studies reported that patients receiving combined sedation were discharged more quickly and reported greater satisfaction. 4,20,21 Our results showed that patients who did not receive midazolam (Group II) had a higher frequency of reaction to the colonoscope introduction (Table 1). We believe that the addition of midazolam to propofol and fentanyl, at the doses used in the research (minimum recommended doses), provides a more adequate level of sedation to the device introduction.…”

Section: Discussionmentioning

confidence: 75%

“…This finding is consistent with the literature, in which the reduced propofol dose is associated with the combined use of opioids and benzodiazepines. 4,6,9,21 The combination of propofol and fentanyl and/or midazolam reduces the consumption of propofol and decreases the risk of deep sedation, without prolonging the recovery. 22 A smaller consumption of propofol is usually expected in combined sedation.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam

Neves

Araújo²,

Araújo

et al. 2016

Brazilian Journal of Anesthesiology (English Edition)

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Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction.

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“…8 Adding opioids seem to contribute to effectiveness and ease of treatment, with minor or no need for interventions. 15,16 The use of alfentanil in our study was based on reported respiratory depression with remifentanil, 9 in combination with concurrent local anaesthesia infiltration. Combinations of sedative and opioids for PCS are possibly required for uncomfortable procedures where the painful stimulus is constant.…”

Section: Discussionmentioning

confidence: 99%

“…8 Usually surveys describe a preset loading dose that is infused before the patient uses the PCS. Loading doses that have been used have been calculated from pharmacokinetic modelling that estimated the effect of concentrations of propofol at the site, 16 from weight, 20 or from undefined preset calculations 10 . We prefer that the patients themselves are responsible for induction, as they get feedback from pressing on the delivery button.…”

Section: Discussionmentioning

confidence: 99%

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Nilsson

Ustaal

et al. 2012

Acta Anaesthesiol Scand

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BackgroundWidespread use of patient‐controlled sedation (PCS) demands simplicity and a predictable outcome. We evaluated patients’ safety and ease of use of PCS for gynaecological outpatient procedures.MethodsIn a prospective double‐blind study, 165 patients were randomized to use propofol or propofol with alfentanil as PCS combined with local anaesthetic for pain control. Data on cardiopulmonary function, consciousness, and need for interventions were collected at baseline and every fifth minute. The surgeons’ evaluation of the ease and the duration of the procedure were recorded.ResultsOne hundred and fifty‐five patients used PCS for the entire procedure, 76 patients propofol, and 79 patients propofol/alfentanil. Fifteen procedures in the propofol group were limited or could not be done, compared with four in the propofol/alfentanil group (P = 0.02). The duration of surgery was not affected. The addition of alfentanil affected respiratory function compared with the propofol group: five patients compared with none were manually ventilated (P = 0.03), and two thirds, compared with a quarter, were given supplementary oxygen as their saturation decreased below 90% (P < 0.001). Overall cardiovascular stability was maintained. The propofol group had deeper conscious sedation as measured by the bispectral index (P = 0.03), but all patients could be roused. In the propofol/alfentanil group, five patients became apnoeic and could not be roused.ConclusionsPCS using propofol alone supports patients’ safety, as the addition of alfentanil increased the need for specific interventions to maintain respiratory stability. However, alfentanil increases the feasibility of the procedure, as complementary doses of propofol were not required.

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A prospective, randomized, comparative trial evaluating respiratory depression during patient-controlled versus anesthesiologist-administered propofol-remifentanil sedation for elective colonoscopy

Cited by 30 publications

References 16 publications

Patient-controlled sedation in procedural care

Patient-controlled sedation in procedural care

Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

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