Patient Satisfaction With Propofol for Outpatient Colonoscopy: A Prospective, Randomized, Double-Blind Study

Padmanabhan, Anantha; Frangopoulos, Christoforos; Shaffer, Lynn

doi:10.1097/dcr.0000000000000909

Cited by 41 publications

(29 citation statements)

References 9 publications

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“…combination of benzodiazepines and opioids, which allowed the patient to obtain a moderate level of sedation [6]. However, more recently, owning to its rapid onset of action and its favorable safety profile, propofol-based sedation, or PS, has been introduced as an alternative [6,20]. There are a number of benefits of utilizing propofol for sedation during colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis

et al. 2020

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Background and study aims Choice of sedation (propofol vs opioid/benzodiazepine) has been studied in the literature and has shown variable outcomes. The majority of recent studies have evaluated propofol sedation (PS) versus opioids, benzodiazepines, or a combination of both. We performed a systematic review and meta-analysis of studies comparing PS to other sedation methods to assess the impact on colonoscopy outcomes. Methods Multiple databases were searched and studies of interest were extracted. Primary outcome of the study was adenoma detection rate (ADR) and secondary outcomes included polyp detection rate (PDR), advanced adenoma detection rate (AADR), and cecal intubation rate (CIR). Results A total of 11 studies met the inclusion criteria with a total of 177,016 patients (148,753 and 28,263 in the opioids/benzodiazepine group and PS group, respectively). Overall, ADR (RR: 1.07, 95 % CI 0.99–1.15), PDR (RR: 1.01, 95 % CI 0.93–1.10), and AADR (RR: 1.17, 95 % CI 0.92–1.48) did not improve with the use of PS. The CIR was slightly higher for propofol sedation group (RR 1.02, 95 % CI 1.00–1.03). Conclusion Based on our analysis, PS and opioid/benzodiazepine sedation seem to have comparable ADR. Our results do not favor use of a particular sedation method and the choice of sedation should be individualized based on patient preference, risk factors and resource availability.

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Section: Discussionmentioning

confidence: 99%

Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis

et al. 2020

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“…Although patient satisfaction is important in its own right, it has also become increasingly important as an indicator of the quality of health care. Inevitably, it will also have an effect on reimbursements . However, the relative importance of aspects regarding sedation from the patient's perspective and from the clinical perspective can be questioned considering that patient safety cannot be deduced from the patient's experience and needs to be based on clinical parameters.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine vs propofol as sedation for implantation of neurostimulators: A single‐center single‐blinded randomized controlled trial

Bruggen

Ceuppens

Leliveld

et al. 2019

Acta Anaesthesiol Scand

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Background:During the lead implantation of most spinal cord neurostimulators, the patient has to be comfortable and without pain. However, the patient is expected to provide feedback during electrical mapping. Titrating sedatives and analgesics for this double goal can be challenging. In comparison with our standard sedative agent propofol, the pharmacological profile of dexmedetomidine is more conducive to produce arousable sedation. The latter, however, is associated with hemodynamic side effects. We investigated whether dexmedetomidine is preferable over propofol during neurostimulator implantation.Methods: This single-center single-blinded randomized controlled trial included 72 patients with an indication for a neurostimulator, randomized to sedation with either propofol (0.5 mg/kg for 10 minutes, followed by 2.0 mg/kg/h) or dexmedetomidine (1 μg/kg for 10 minutes, followed by 0.6 μg/kg/h). The primary outcome was patient satisfaction with the sedation. The secondary outcomes were patient's and operator's comfort, number of titration adjustments, standard intraoperative hemodynamic and respiratory parameters and side effects. Results: Data of 69 patients (dexmedetomidine n = 35; propofol n = 34) were analyzed. Those receiving dexmedetomidine were more satisfied with the sedation than those receiving propofol; i.e. with sedation delivery (median 100.0 vs 83.3, P < .01), procedural recall (median 95.8 vs 83.3, P = .03), and sedation side effects (median 90.0 vs 83.3, P = .01). Fewer changes in the dexmedetomidine titration were necessary to maintain arousable sedation. Over time, mean arterial pressure and heart rate were significantly lower in the dexmedetomidine group. Hemodynamic side effects were comparable across groups.Conclusions: Dexmedetomidine sedation resulted in higher patient satisfaction and allowed for better arousable sedation than sedation with propofol. Although differences in hemodynamic parameters were found between the groups, these differences were not regarded as clinically relevant. 1322 | ter BrUGGeN et al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: ter Bruggen FFJA, Ceuppens C, Leliveld L, Stronks DL, Huygen FJPM. Dexmedetomidine vs propofol as sedation for implantation of neurostimulators: A single-center single-blinded randomized controlled trial. Acta

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“…Fentanyl is also commonly used during endoscopic procedures but its utility for routine endoscopic procedures is a little more in question. Recent studies suggest that patients generally prefer sedation with propofol . Fentanyl is generally preferred over other opioids because of its onset of action leads to shorter cases .…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies suggest that patients generally prefer sedation with propofol. 23,24 Fentanyl is generally preferred over other opioids because of its onset of action leads to shorter cases. 25 There is even some suggestion that use of midazolam alone is sufficient for sedation.…”

Section: Discussionmentioning

confidence: 99%

Patient characteristics associated with easy and poor tolerance of moderate sedation during endoscopy

et al. 2019

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Summary Background Appropriate levels of sedation are paramount for optimising patient comfort, safety and technical success during endoscopy. The goal of this cross‐sectional study was to identify factors associated with patient tolerance of moderate sedation during esophagogastroduodenoscopy (EGD) and colonoscopy. Methods Endoscopic procedures performed under moderate sedation from 2004 to 2018 at the NIH were reviewed. Patients were categorised as “poorly tolerated,” based on the assessment of the performing endoscopist, or “easily sedated,” based on low levels of sedation (fentanyl 50 mcg and midazolam ≤2 mg). Epidemiologic and anthropometric data, type of procedure, inpatient/outpatient status and benzodiazepine/opiate use were analysed and compared between the two sedation groups. Results Over a 14‐year period, 7590 endoscopies were assessed (4442 EGDs and 3148 Colonoscopies). A total of 359 patients met criteria for inclusion; 242 were categorised as “easy to sedate” (162 EGDs and 80 colonoscopies) and 118 as “difficult to sedate” (62 EGDs and 56 colonoscopies). For EGDs, younger age, African American race and nonscreening indication were associated with difficult sedation. For colonoscopies, young age, low/normal weight and White/African American race were all associated with more difficult sedation. Conclusions Patients who are female, young and have a lower BMI are more likely to poorly tolerate procedures with moderate sedation. Persons of Hispanic/Asian descent appear to tolerate moderate sedation significantly better than other races. Clinicians should be aware of these factors when determining the type of sedation that will optimise success of endoscopy.

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Patient Satisfaction With Propofol for Outpatient Colonoscopy: A Prospective, Randomized, Double-Blind Study

Cited by 41 publications

References 9 publications

Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis

Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis

Dexmedetomidine vs propofol as sedation for implantation of neurostimulators: A single‐center single‐blinded randomized controlled trial

Patient characteristics associated with easy and poor tolerance of moderate sedation during endoscopy

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