Patient-Controlled Sedation with Propofol and Alfentanil During Colonoscopy: A Pilot Study

Roseveare, C.; Seavell, C. R.; Patel, Payal; Criswell, J.; Shepherd, H. A.

doi:10.1055/s-2007-1001312

Endoscopy

1998

DOI: 10.1055/s-2007-1001312

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Patient-Controlled Sedation with Propofol and Alfentanil During Colonoscopy: A Pilot Study

C. Roseveare¹,

C. R. Seavell²,

Payal Patel³

et al.

Abstract: PCS with propofol and alfentanil is an effective, short-acting form of sedation for patients undergoing colonoscopy and may be an alternative to benzodiazepines.

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Cited by 31 publications

(17 citation statements)

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“…2 It provides faster onset of sedation and rapid recovery of cognitive function. 3,4 Propofol can be given alone 3,5,6 or in combination with an opioid [7][8][9][10][11] or a benzodiazepine. 4,12,13 Compared with propofol alone, the combined regimens can reduce doses of propofol in most studies.…”

mentioning

confidence: 99%

Propofol Alone Versus Propofol in Combination With Meperidine for Sedation During Colonoscopy

Hsieh

Chou²,

Lai

et al. 2009

Journal of Clinical Gastroenterology

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mentioning

confidence: 99%

Propofol Alone Versus Propofol in Combination With Meperidine for Sedation During Colonoscopy

Hsieh

Chou²,

Lai

et al. 2009

Journal of Clinical Gastroenterology

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“…Time from start of sedation to start of procedure; min 8.9 (4.8)[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Duration of procedure; min 15.6 (7.9) [1-39] Time from start of sedation to discharge; min 39.5 (9.6) [20-63] Time from end of procedure to discharge; min15Histogram showing the lowest recorded oxygen saturations.…”

mentioning

confidence: 99%

Evaluation of a new effect‐site controlled, patient‐maintained sedation system in dental patients*

Chapman¹,

Anderson

Green

et al. 2006

Anaesthesia

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SummaryWe have designed a new effect-site controlled, patient-maintained sedation system for delivering propofol. In the previous systems we developed, the patients retained the use of the handset throughout the procedure and were able to increase the level of sedation. However, it was found that this could potentially lead to oversedation. In the present system, the patients were able to increase their level of sedation until a level was reached that was judged by the patients as being adequate to allow them to tolerate the injection of dental local anaesthetic. The handset was then taken from the patients and the effect site concentration of propofol was maintained at that level for the remainder of the procedure. To assess its safety and efficacy, the system was used to sedate 40 patients presenting for dental procedures under sedation. The system was used successfully and treatment was completed in 39 patients. The system was found to be safe. Both surgeon and patient approval scores were high. Although this study demonstrates the efficacy of effect-site controlled, patient-maintained propofol sedation in this group of patients, further work is required to confirm its safety. At present, patients receiving conscious sedation in the UK for dental procedures usually receive incremental doses of midazolam administered by an operatorsedationist. The safety of this regimen has been questioned in a variety of clinical situations [1][2][3][4], and an alternative propofol-based sedation system has been developed recently [5][6][7][8]. The majority of targetcontrolled propofol infusion systems in clinical use are plasma level controlled. It is known that the clinical effect of propofol lags behind changes in its plasma concentration, which reflects the time taken for propofol to move from the plasma compartment to its site of action for sedation or hypnosis in the brain. It is assumed that when the clinical effect of propofol has reached a plateau, the plasma and brain concentrations have equilibrated. The effect-site concentration is a mathematically derived term that corresponds with the clinical effect of propofol [9]. Patient-maintained sedation (PMS) involves the patient controlling a target-controlled infusion of propofol by operating a patient-controlled handset, and has been assessed in a number of surgical models [5][6][7][8]. This has recently been changed from controlling the target plasma concentration of propofol, to controlling the effect-site concentration (C e ) [10].Ultimately, it is hoped that the system will be safe for use in the absence of an anaesthetist. However, in the previous pilot studies the patients retained the use of the handset throughout the procedure and were able to

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“…Remifentanil and propofol have similar pharmacokinetic profiles, making them the most suitable drugs for use in a PCS system. PCS without background infusion has been assessed to be successful using propofol alone or mixed with alfentanil during colonoscopy and cataract surgery (5–7). Blair et al (8) demonstrated that auto‐administered boluses of remifentanil without background infusion may safely provide worthwhile labour analgesia, and that adding a continuous infusion to the auto‐administered boluses did not result in any further significant reduction in pain scores.…”

mentioning

confidence: 99%

Can continuous infusion be a better choice than patient‐controlled sedation for colonoscopy during monitored anaesthesia care?

Bouvet¹,

Chassard²,

Boselli³

2006

Acta Anaesthesiol Scand

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Patient-Controlled Sedation with Propofol and Alfentanil During Colonoscopy: A Pilot Study

Abstract: PCS with propofol and alfentanil is an effective, short-acting form of sedation for patients undergoing colonoscopy and may be an alternative to benzodiazepines.

Cited by 31 publications

References 0 publications

Propofol Alone Versus Propofol in Combination With Meperidine for Sedation During Colonoscopy

Propofol Alone Versus Propofol in Combination With Meperidine for Sedation During Colonoscopy

Evaluation of a new effect‐site controlled, patient‐maintained sedation system in dental patients*

Can continuous infusion be a better choice than patient‐controlled sedation for colonoscopy during monitored anaesthesia care?

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