Patients Prefer Propofol to Midazolam Plus Fentanyl for Sedation for Colonoscopy

Schroeder, Caleb; Kaoutzanis, Christodoulos; Tocco-Bradley, Rosalie; Obear, Janet; Welch, Kathleen B.; Winter, Sidney G.; Cleary, Robert K.

doi:10.1097/dcr.0000000000000512

Cited by 23 publications

(18 citation statements)

References 13 publications

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“…They occurred in 5.3% of cases and were mild in nature. These results are comparable with others, placing their frequency at 4.4 to 26% (11,22,23). The reason percentages vary depends mainly on whether low blood pressure, either symptomatic or not, is included or not among the side effects.…”

Section: Discussionsupporting

confidence: 88%

“…This was perhaps caused by initiating sedation with lower doses of midazolam and meperidine (26). The cecum was successfully reached in 86.7% of the cases, which is comparable to other studies (23,26). When the cases in which the exploration could not be completed for reasons unrelated to sedation were excluded, this figure exceeded 90%, complying with the minimum standard recommended by the ESGE (27).…”

Section: Discussionsupporting

confidence: 83%

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Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation

Grilo-Bensusan¹,

Martín²,

Jiménez-Mesa

et al. 2018

Rev Esp Enferm Dig

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 83%

Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation

Grilo-Bensusan¹,

Martín²,

Jiménez-Mesa

et al. 2018

Rev Esp Enferm Dig

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“…We performed full-text reviews of 333 articles and identified 9 studies that met all inclusion criteria. [18][19][20][21][22][23][24][25][26] Because our original search was designed to be inclusive of studies of both upper and lower endoscopy and any sedative used, the most frequent reasons for exclusion at the full-text stage were for studies of only upper/advanced endoscopic procedures (n Z 181) or studies that did not compare propofol (AE short-acting opioids) with midazolam (AE short-acting opioids) (n Z 104).…”

Section: Study Selectionmentioning

confidence: 99%

Propofol versus midazolam with or without short-acting opioids for sedation in colonoscopy: a systematic review and meta-analysis of safety, satisfaction, and efficiency outcomes

Dossa

Medeiros

Keng

et al. 2020

Gastrointestinal Endoscopy

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Background and Aims: Propofol is increasingly being used for sedation in colonoscopy; however, its benefits over midazolam (AE short-acting opioids) are not well quantified. The objective of this study was to compare safety, satisfaction, and efficiency outcomes of propofol versus midazolam (AE short-acting opioids) in patients undergoing colonoscopy. Methods: We systematically searched Medline, Embase, and the Cochrane library (to July 30, 2018) for randomized controlled trials of colonoscopies performed with propofol versus midazolam (AE short-acting opioids). We pooled odds ratios for cardiorespiratory outcomes using mixed-effects conditional logistic models. We pooled standardized mean differences (SMDs) for patient and endoscopist satisfaction and efficiency outcomes using random-effects models. Results: Nine studies of 1427 patients met the inclusion criteria. There were no significant differences in cardiorespiratory outcomes (hypotension, hypoxia, bradycardia) between sedative groups. Patient satisfaction was high in both groups, with most patients reporting willingness to undergo a future colonoscopy with the same sedative regimen. In the meta-analysis, patients sedated with propofol had greater satisfaction than those sedated with midazolam (AE short-acting opioids) (SMD, .54; 95% confidence interval [CI], .30-.79); however, there was considerable heterogeneity. Procedure time was similar between groups (SMD, .15; 95% CI, .04-.27), but recovery time was shorter in the propofol group (SMD, .41; 95% CI, .08-.74). The median difference in recovery time was 3 minutes, 6 seconds shorter in patients sedated with propofol. Conclusions: Both propofol and midazolam (AE short-acting opioids) result in high patient satisfaction and appear to be safe for use in colonoscopy. The marginal benefits to propofol are small improvements in satisfaction and recovery time. (Gastrointest Endosc 2020;91:1015-26.) Sedation used in colonoscopy can improve the experience for both patients and endoscopists. Globally, there is considerable variation in sedative practices. 1 In Europe, sedative use varies substantially by country and by region. 2 In some areas almost all patients receive sedation for colonoscopy, whereas in other areas Abbreviations: ASA,

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“…Sedation can suppress patient consciousness and cause anterograde amnesia during endoscopy as well as decrease patient anxiety and pain at the time of examination [ 1 ]. This improves patient satisfaction with endoscopy and increases their willingness to undergo the next examination [ 2 , 3 ]. However, unintentional deep sedation can lead to various complications, including hypoxia, hypotension, and arrhythmia [ 2 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Oxygenation before Endoscopic Sedation Reduces the Hypoxic Event during Endoscopy in Elderly Patients: A Randomized Controlled Trial

Kim

Hyun

Lee

et al. 2020

JCM

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Background: Sedation endoscopy increases patient and examiner satisfaction but involves complications. The most serious complication is hypoxia, the risk factors for which are old age, obesity, and American Society of Anesthesiologists physical status of 3 or greater. However, clear evidence of oxygenation during sedation endoscopy for elderly people is lacking in US, European, and Korean guidelines. Method: This study was conducted for 1 year starting in August 2018 to evaluate whether pre-oxygenation use 1 min before sedation endoscopy could reduce the incidence of hypoxia in patients older than 65 years of age. A total of 70 patients were divided into the non-oxygenated group (n = 35; control group) and oxygen-treated group (n = 35; experimental group) during endoscopy. Result: The incidence of hypoxia was 28 (80%) in the control group versus 0 (0%) in the pre-oxygenated group. Factors related to hypoxia in the non-oxygenated group were a relatively high dose of midazolam and concomitant injection with narcotic analgesics such as pethidine. Conclusion: The incidence of hypoxia during sedation endoscopy is high in patients over 65 years, but oxygenation during endoscopic sedation in elderly people can significantly reduce the incidence of intraprocedural hypoxic events.

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Patients Prefer Propofol to Midazolam Plus Fentanyl for Sedation for Colonoscopy

Abstract: The use of propofol for conscious sedation during colonoscopy is associated with greater patient satisfaction and less pain when compared with midazolam/fentanyl, as perceived by the patient and endoscopist.

Cited by 23 publications

References 13 publications

Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation

Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation

Propofol versus midazolam with or without short-acting opioids for sedation in colonoscopy: a systematic review and meta-analysis of safety, satisfaction, and efficiency outcomes

Oxygenation before Endoscopic Sedation Reduces the Hypoxic Event during Endoscopy in Elderly Patients: A Randomized Controlled Trial

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