Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Abstract

BackgroundThere is increasing interest in balanced propofol sedation (BPS) titrated to moderate sedation (conscious sedation) for endoscopic procedures. However, few controlled studies on BPS targeted to deep sedation for diagnostic endoscopy were found. Alfentanil, a rapid and short-acting synthetic analog of fentanyl, appears to offer clinically significant advantages over fentanyl during outpatient anesthesia.It is reasonable to hypothesize that low dose of alfentanil used in BPS might also result in more rapid recovery as compared with fentanyl.MethodsA prospective, randomized and double-blinded clinical trial of alfentanil, midazolam and propofol versus fentanyl, midazolam and propofol in 272 outpatients undergoing diagnostic esophagogastroduodenal endoscopy (EGD) and colonoscopy for health examination were enrolled. Randomization was achieved by using the computer-generated random sequence. Each combination regimen was titrated to deep sedation. The recovery time, patient satisfaction, safety and the efficacy and cost benefit between groups were compared.Results260 participants were analyzed, 129 in alfentanil group and 131 in fentanyl group. There is no significant difference in sex, age, body weight, BMI and ASA distribution between two groups. Also, there is no significant difference in recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between two groups. Though deep sedation was targeted, all cardiopulmonary complications were minor and transient (10.8%, 28/260). No serious adverse events including the use of flumazenil, assisted ventilation, permanent injury or death, and temporary or permanent interruption of procedure were found in both groups. However, fentanyl is New Taiwan Dollar (NT$) 103 (approximate US$ 4) cheaper than alfentanil, leading to a significant difference in total cost between two groups.ConclusionsThis randomized, double-blinded clinical trial showed that there is no significant difference in the recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between the two most common sedation regimens for EGD and colonoscopy in our hospital. However, fentanyl is NT$103 (US$ 4) cheaper than alfentanil in each case.Trial registrationInstitutional Review Board of Buddhist Tzu Chi General Hospital (IRB097-18) and Chinese Clinical Trial Registry (ChiCTR-TRC-12002575)

Addition of low-dose ketamine to midazolam-fentanyl-propofol–based sedation for colonoscopy: a randomized, double-blind, controlled trial

“…Toklu et al [7] compared remifentanil + propofol and remifentanil + etomidate in patients who underwent colonoscopy under sedation and reported that the mean discharge times were 32.8 and 24.6 minutes, respectively. The mean discharge time in our study was approximately 15 minutes (15.1 vs 15.7 minutes) in both groups, which was similar to the studies that showed that the mean discharge times were around 15 minutes using moderate sedation for colonoscopy [8][9][10].…”

“…It is believed that pain, distension of colon, stretching of the mesentery, and sedation regimen provoke these symptoms [1][2][3][4][5][6][7][8][9][10]. In our study, no vasovagal reactions were observed in any patients.…”

“…Although several trials have been performed using different anesthetic agents, the optimal combination has not yet been established [3][4][5][6][7][8][9]. In addition, some patients may require much deeper sedation with higher doses leading to cardiorespiratory depression, loss of protective reflexes, and delayed discharge [10,11].…”

An evaluation of a target‐controlled infusion of propofol or propofol–alfentanil admixture for sedation in dogs

“…1992, Engelhard et al . 1999 ).This so-called "admixture" is commonly used in humans for sedation (Ho et al . 2012 ), although it is not free of complications and may cause respiratory depression (Yoon et al .…”

Synergistic antinociceptive interactions between fospropofol and alfentanil in mice

“…These advantages make it an attractive analgesic supplement for short ambulatory surgical procedures [13,14]. Clinically, analgesia with propofol-alfentanil combination has been widely used in short surgical procedures [15][16][17] such as arthroscopy, bunionectomy, esophagogastroduodenoscopy, lithotripsy and ureteroscopy. Fospropofol produces a predictable pharmacokinetic and pharmacodynamic profile by delivering controlled sedation in an outpatient setting.…”