Cardiopulmonary Safety of Propofol Versus Midazolam/Meperidine Sedation for Colonoscopy: A Prospective, Randomized, Double-Blinded Study

Gürbulak, Bünyamin; Uzman, Sinan; Gürbulak, Esin Kabul; Gül, Yaşar Gökhan; Toptaş, Mehmet; Baltalı, Sevim; Savaş, Osman Anıl

doi:10.5812/ircmj.19329

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…In this study, patients’ hemodynamic variables were monitored intraoperatively, and regarding the cardiovascular effects of opioids, no significant difference was observed between the study groups. Gurbulak et al ( 32 ) also found no association between incidence rates of cardiopulmonary events and the use of propofol or midazolam/meperidine. Respiratory depression is a rare side effect of intrathecal opioids caused by suppression of the respiratory centers in the brainstem ( 33 ).…”

Section: Discussionmentioning

confidence: 96%

Intravenous Midazolam as More Effective Than Propofol for Preventing Pruritus After Intrathecal Sufentanil in Surgical Patients: A Randomized Blinded Trial

et al. 2016

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BackgroundPruritus is a troublesome side effect of intrathecal opioids. Midazolam can reinforce GABA-mediated inhibition of the medullary dorsal horn neurons, and thus theoretically has potential to suppress opioid-induced pruritus.ObjectivesThis prospective double-blinded randomized trial aimed at comparing the effects of propofol, midazolam, and a combination of the two on the prevention of pruritus induced by intrathecal sufentanil.MethodsEighty-four patients undergoing spinal anesthesia with 3 mL hyperbaric bupivacaine 0.5% and 5 μg sufentanil (1 mL) were randomly allocated to one of the three study groups: Group 1, who were administered 20 mg intravenous (IV) propofol bolus, then 50 μg/kg/min IV infusion; Group 2, who were administered 0.03 mg/kg IV midazolam bolus, then 0.02 mg/kg/h IV infusion; and Group 3, who were administered 10 mg IV propofol and 0.015 mg/kg IV midazolam bolus, then 25 μg/kg/min propofol and 0.01 mg/kg/h midazolam IV infusion. The incidence rates and severity of pruritus were assessed intraoperatively and postoperatively for 24 hours.ResultsThe Ramsay Sedation Score was highest for the propofol group throughout the duration of the anesthetic process. Overall, 17 patients in the propofol group (60.7%), eight patients in the midazolam group (28.6%), and nine patients in the propofol-midazolam group (32.1%) developed pruritus (P = 0.027). Intraoperative pruritus was observed in seven patients in the propofol group (25%), two patients in the midazolam group (7.1%), and five patients in the midazolam-propofol group (17.9%) (P = 0.196). Postoperative pruritus developed in 12 patients in the propofol group (42.9%), six patients in the midazolam group (21.4%), and four patients in the midazolam-propofol group (14.3%) (P = 0.041). There was no significant difference between the groups with respect to the severity of pruritus (P > 0.05).ConclusionsThis study showed that in comparison with propofol, the administration of 0.03 mg/kg IV midazolam bolus followed by 0.02 mg/kg/h could be more effective in the prevention of intrathecal sufentanil-induced pruritus without increasing sedation and other side effects.

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Section: Discussionmentioning

confidence: 96%

Intravenous Midazolam as More Effective Than Propofol for Preventing Pruritus After Intrathecal Sufentanil in Surgical Patients: A Randomized Blinded Trial

et al. 2016

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“…Compared to other Turkish cohorts, the number of events observed during the baseline is lower than in previous publications reporting on propofol sedation. Gurbulak et al compared the safety of propofol with midazolam/medperidine sedation for colonoscopic procedures, reporting an 8.1% incidence of oxygen desaturation events in the propofol arm [ 16 ]. In our evaluation, if only colonoscopy is considered, only 4.03% of procedures were associated with any oxygen desaturation event (mild and severe desaturations).…”

Section: Discussionmentioning

confidence: 99%

“…In our evaluation, if only colonoscopy is considered, only 4.03% of procedures were associated with any oxygen desaturation event (mild and severe desaturations). In the same study, bradycardias also were registered, but none were found in the propofol arm [ 16 ]. This matches our analysis, as only a single adverse event of bradycardia was observed for the 264 patients receiving gastroscopy only.…”

Section: Discussionmentioning

confidence: 99%

Patient Safety during Propofol Sedation before and after Implementation of Capnography Monitoring

Baytaş,

Vural,

Özçelik

et al. 2023

JCM

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Endoscopic procedures are routinely applied to cancer screening programs and surveillance. The preferred technique is usually deep sedation with propofol being a convenient agent allowing for a quicker patient recovery while maintaining a similar safety profile compared to traditional agents. However, adverse events, including respiratory depression and consequent undesirable cardiovascular side effects, may occur. The goal of this work is to evaluate the patient safety impact of adding capnography during endoscopic procedures under deep propofol sedation. Data were retrospectively collected from patients undergoing deep, procedural sedation for gastrointestinal (GI) endoscopy in October 2019 to January 2021 in a single Turkish university hospital. Included in the analysis were all adult patients classified by the American Society of Anesthesiologists (ASA) as I–IV, who were scheduled for GI endoscopy utilizing propofol alone or in combination. Data on 1840 patients were collected, of whom 1610 (730 pre- and 880 post-capnography implemention) met inclusion criteria. The primary outcome was a change in the composite incidence of mild oxygen desaturation (SpO2 75–90% for <60 s), severe oxygen desaturation (SpO2 < 75% anytime or <90% for >60 s), bradycardia (<60 ppm), and tachycardia (>25% from baseline). Without capnography, on average, 7.5 events of the primary endpoint were observed per 100 procedures and 2.9 with additional capnography monitoring (p < 0.001). A significant reduction was observed for mild oxygen desaturation, with a resulting odds ratio of 0.25 (95% CI 0.14 to 0.46). ASA I patients had the highest difference in combined incidence of any oxygen desaturation of 5.85% in the pre-capnography group and 0.64% in the post-capnography group. Although procedural sedation using propofol is not associated with severe adverse events, the incidence of composite adverse events could be reduced with the addition of capnography monitoring.

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Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis

Sneyd

Absalom

Barends

et al. 2022

British Journal of Anaesthesia

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Background: Intraoperative and postoperative hypotension occur commonly and are associated with organ injury and poor outcomes. Changes in arterial blood pressure (BP) during procedural sedation are not well described. Methods: Individual patient data from five trials of propofol sedation for colonoscopy and a clinical database were pooled and explored with logistic and linear regression. A literature search and focused meta-analysis compared the incidence of hypotension with propofol and alternative forms of procedural sedation. Hypotensive episodes were characterised by the original authors' definitions (typically systolic BP <90 mm Hg). Results: In pooled individual patient data (n¼939), 36% of procedures were associated with episodes of hypotension. Longer periods of propofol sedation and larger propofol doses were associated with longer-lasting and more-profound hypotension. Amongst 380 patients for whom individual BP measurements were available, 107 (28%) experienced systolic BP <90 mm Hg for >5 min, and in 89 (23%) the episodes exceeded 10 min. Meta-analysis of 18 RCTs identified an increased risk ratio for the development of hypotension in procedures where propofol was used compared with the use of etomidate (two studies; n¼260; risk ratio [RR] 2.0 [95% confidence interval: 1.37e2.92]; P¼0.0003), remimazolam (one study; n¼384; RR 2.15 [1.61e2.87]; P¼0.0001), midazolam (14 studies; n¼2218; RR 1.46 [1.18e1.79]; P¼0.0004), or all benzodiazepines (15 studies; n¼2602; 1.67 [1.41e1.98]; P<0.00001). Hypotension was less likely with propofol than with dexmedetomidine (one study; n¼60; RR 0.24 [0.09e0.62]; P¼0.003). Conclusions: Hypotension is common during propofol sedation for colonoscopy and of a magnitude and duration associated with harm in surgical patients.

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Cardiopulmonary Safety of Propofol Versus Midazolam/Meperidine Sedation for Colonoscopy: A Prospective, Randomized, Double-Blinded Study

Cited by 5 publications

References 28 publications

Intravenous Midazolam as More Effective Than Propofol for Preventing Pruritus After Intrathecal Sufentanil in Surgical Patients: A Randomized Blinded Trial

Intravenous Midazolam as More Effective Than Propofol for Preventing Pruritus After Intrathecal Sufentanil in Surgical Patients: A Randomized Blinded Trial

Patient Safety during Propofol Sedation before and after Implementation of Capnography Monitoring

Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis

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