Effect‐site targeted patient‐controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy

Abstract

SummaryPatient-controlled sedation (PCS) allows patients to match their sedation requirement to perceived discomfort. The significant delay in onset of sedation may be overcome with effect-site steered target controlled infusion, but previously only trials in volunteers have been carried out. We therefore conducted a randomised, double-blind controlled trial comparing effect-site steered propofol PCS with anaesthetist-administered propofol sedation in 40 patients presenting for colonoscopy. The initial effect-site target in the PCS group was 0.8 lg.ml )1 , increment was 0.1 lg.ml )1 and lockout was 3 min. Patient and endoscopist satisfaction and operating conditions were similar between the two groups. PCS patients were sedated more slowly (13 [7.1] vs. 3 [1.1] min; p < 0.0001) and less deeply (minimum BIS value: 71 [16] vs. 58 [15]; p = 0.13) than anaesthetist-administered propofol sedation patients. More of the latter patients were hypotensive, but all patients had similar recollection of events during the procedure and similar quality of recovery.

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

“…Although the finding of less oversedation with PCS is not unique, there are several important differences between this study and that of Stonell et al 9 First, Stonell et al targeted the effect site concentration of a single agent, propofol, whereas this study targeted the mixed effect of 2 agents, propofol plus remifentanil. Stonell et al used PMS in the experimental arm and empirically dosed propofol in the control arm.…”

“…The primary study endpoint was oversedation, as assessed by the bispectral index (BIS) 8 and hypopnea. Power analysis was based on the study of Stonell et al, 9 who compared the number of episodes of oversedation during patient-maintained sedation (PMS) with AAS. Patients under AAS were observed to have a mean of 3.0 (SD ϭ 3.2) events compared with a mean of 0.8 (SD ϭ 1.4) events in those under PMS.…”

Propofol Infusion Platforms: Opportunities and Challenges

“…Patient-controlled and target-controlled infusion systems have been well described in the literature [2,3,4]. More recently, Mandel et al [5 ]published a study using patient-controlled sedation for colonoscopy, comparing propofol-remifentanil versus midazolam-fentanyl.…”

Computer-Assisted Propofol Administration

“…Patients in the TCI group were sedated more slowly and less deeply, and received a lower total dose of propofol than the anaesthesiologist-administered propofol group. Patient satisfaction and recovery times were comparable in the two groups [11]. The closed-loop system has also been tested.…”