Sedation for Colonoscopy: A Double-Blind Comparison of Diazepam/Meperidine, Midazolam/Fentanyl and Propofol/Fentanyl Combinations

Abstract

Rate of recovery and incidence of complications were compared among three intravenous sedation techniques for colonoscopy. Sixty patients were randomized to receive diazepam and meperidine, midazolam and fentanyl, or propofol and fentanyl with a continuous infusion of propofol. Patients were sedated to a standard end-point using a double-blinded technique. There were no differences in rate of recovery or incidence of minor side effects among the three groups. The techniques were equally effective in providing sedation and analgesia for colonoscopy. All groups developed significant oxygen desaturation measured by continuous pulse oximetry. Over 20% of patients required supplemental oxygen due to persistent desaturation below 85% following administration of sedatives. The authors conclude that oxygen should be administered to all patients undergoing colonoscopy.

Conscious Sedation and Analgesia in Colonoscopy: Ketamine/Propofol Combination has Superior Patient Satisfaction Versus Fentanyl/Propofol

“…The mean of procedure duration was similar in patients of both groups (21 versus 23 minutes) in this study, similar to Sipe and Paspatis’studies (15, 16). The frequency of nausea in patients who were sedated with propofol plus narcotics in the Kostash et al study was 26 %, (range 16-40%) while it was much less (12.5%) in our study (18). The combination of ketamine and propofol for performing procedural sedation theoretically may be advantageous as using lower doses of each agent may result in a reduction of the adverse drug effects while maintaining an acceptable condition for colonoscopy.…”

Sedation with propofol plus midazolam versus propofol alone for interventional endoscopic procedures: a prospective, randomized study

“…Propofol is a potent hypnotic agent with an unclear mechanism of action, a rapid onset and offset of sedation but marked cardio‐respiratory depressant properties 10 –12 , . 20 However, several empirical statements and reports have favoured the use of propofol for sedation during upper and lower gastrointestinal‐endoscopy 13 –16 . Two recent prospective randomized studies proved a higher sedation efficacy and a shorter patient recovery during endoscopic retrograde cholangio‐pancreaticography‐procedures when performed under sedation with propofol than with the traditionally used midazolam 19 , .…”

“…Favourable results have been reported for propofol sedation during various gastrointestinal endoscopic procedures 13 –19 . However, propofol is relatively expensive and may lead to respiratory arrest when used in higher doses 12 , .…”

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

“…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).…”