Propofol target‐controlled infusion for sedated gastrointestinal endoscopy: A comparison of propofol alone versus propofol–fentanyl–midazolam

Abstract

Gastrointestinal (GI) endoscopy is the major technique for diagnosis of GI disease and treatment. Various sedation and analgesia regimens such as midazolam, fentanyl, and propofol can be used during GI endoscopy. The purpose of the study was to compare propofol alone and propofol combination with midazolam and fentanyl in moderate sedation for GI endoscopy. One hundred patients undergoing GI endoscopy were enrolled in this study. All patients received a propofol target-controlled infusion (TCI) to maintain sedation during the procedure. Patients were randomly allocated into either Group P (propofol TCI alone) or Group C (combination of propofol TCI plus midazolam and fentanyl). Dermographic data, anesthetic parameters (sedation regimen, blood pressure, heart rate, and oxygen saturation), procedure parameters (procedure time, colonoscopy, or panendoscopy), propofol consumption, and adverse events (hypoxia, hypotension, and bradycardia) were all recorded. Postprocedural records included recovery time, postoperative adverse events (nausea, vomiting, dizziness, recall, and pain) and satisfaction. The average propofol consumption was 251 ± 83 mg in Group P and 159 ± 73 mg in Group C (p < 0.001). The incidence of transient hypotension was higher in Group P (p = 0.009). The recovery time and discharge time were both shorter in Group C (p < 0.001 and p = 0.006 respectively). Overall, postprocedural adverse events were similar in both groups. The postanesthetic satisfaction was comparable in both groups. TCI of propofol combined with midazolam and fentanyl achieved sedation with fewer hypotension episodes and shorter recovery and discharge time than propofol TCI alone in patients undergoing GI endoscopy.

Recovery characteristics in patients undergoing short Gynaecological day care procedures under sedation with Dexmedetomidine vs Propofol infusion : Double blind Randomized controlled trial

“…Previous studies have shown that propofol has early awakening and recovery compared to thiopentone, midazolam. 6,9,10 In our study also, both groups achieved preoperative finger tapping score and visual-spatial memory by 2 hr. Young et al and Shukry et al, showed that intraoperative dexmedetomidine effectively reduced the incidence and intensity of emergence agitation without prolonging recovery and discharge time.…”

Comparison of propofol monotherapy and propofol combination therapy for sedation during gastrointestinal endoscopy: A systematic review and meta‐analysis

“…Of 10 studies that compared arrhythmia rates, four studies reported the rate of bradycardia . The combined results showed no evidence for a difference (RR, 1.59; 95% CI, 0.75 to 3.35; P chi 2 = 0.042; I 2 = 44.59%; NNTH = 386.3; 95% CI, NNTH 25.6 to ∞ to NNTB 29.5).…”

The Effectiveness of Low-dose Dexmedetomidine Infusion in Sedative Flexible Bronchoscopy: A Retrospective Analysis

“…A retrospective analysis showed that a triple sedation regimen (midazolam + fentanyl + propofol) provided safety and reduced dosage of sedatives [6]. Our previous study in sedative gastrointestinal endoscopy also revealed less recovery time in patients who received the triple regimen (midazolam+ fentanyl+ propofol) [12].…”

“…One systemic review study suggested dexmedetomidine exerts potential benefits over midazolam in procedural sedation [10]. However, these sedatives alone often provide insufficient sedative or analgesic effects as well as delayed recovery [11][12][13], for which previous studies suggest a combined sedative/analgesic regimen improve efficacy and safety during endoscopic examination [14][15][16].…”