Sedation Levels During Propofol Administration for Outpatient Colonoscopies

Abstract

The levels of sedation required for patients to comfortably undergo colonoscopy with propofol were examined. One hundred patients undergoing colonoscopy with propofol were enrolled. In addition to standard-of-care monitoring, sedation level was monitored with the Patient State Index (PSI) obtained from a brain function monitor, transcutaneous carbon dioxide (tcpCO2) was monitored with the TCM TOSCA monitor, and end-tidal carbon dioxide was monitored via nasal cannula. The Ramsay Sedation Score (RSS) was also assessed and recorded. After baseline data were obtained from the first 40 consecutive patients enrolled in the study, the remaining 60 patients were randomized into two groups. In one group the PSI value was blinded from the anesthesiologist and in the second group the PSI was visible and the impact of this information on the management of the sedation was analyzed. Overall 96% of patients reached levels of deep sedation and 89% reached levels of general anesthesia. When comparing the blinded to PSI versus unblinded groups, the blinded group had a significantly lower PSI and higher RSS and tcpCO2, indicating the blinded group was maintained at a deeper sedation level with more respiratory compromise than the unblinded group. Patients undergoing colonoscopy under propofol sedation delivered by a bolus technique are frequently taken to levels of general anesthesia and are at risk for respiratory depression, airway obstruction, and hemodynamic compromise.

Intravenous Sedation Techniques for Gastrointestinal Endoscopy

“…In addition, the blinded to PSI group was maintained at a deeper sedation level with more respiratory compromise than the unblinded group. This report demonstrated that propofol sedation delivered by a bolus technique was frequently taken to levels of general anesthesia [6] .…”

“…It is often taken to the level of general anesthesia and is at risk for respiratory depression and hemodynamic instability. The levels of sedation required for patients to comfortably undergo colonoscopy with propofol were assessed [6] . The sedation level was monitored with the Patient State Index (PSI), and end-tidal carbon dioxide was monitored via nasal cannula.…”

Modified sevoflurane-based sedation technique versus propofol sedation technique: A randomized-controlled study

“…This difference may be due that propofol lacks any analgesic activity and so a high dose is required to perform a painful procedure. [ 11 ] This usually results in a deep level of sedation, respiratory and cardiac depressions. [ 11 ] When propofol sedation is administered by nonanesthesia personnel, the incidence of occurrence of GA (or a deeper sedation level) may reach up to 88%.…”

“…[ 11 ] This usually results in a deep level of sedation, respiratory and cardiac depressions. [ 11 ] When propofol sedation is administered by nonanesthesia personnel, the incidence of occurrence of GA (or a deeper sedation level) may reach up to 88%. This increases the risk of respiratory depression, airway obstruction, and hemodynamic instability.…”

Patient-controlled sedation in procedural care

“…European guidelines recommend using fast-and short-acting drugs and monotherapy, and avoiding the use of IV-achieved pain relief [3]. Sedation from midazolam and opioids were earlier the standard, but for more than a decade and for a variety of procedures, the use of propofol has been welldocumented for endoscopy [4][5][6], dental treatment [7][8][9], renal stone therapy [10][11][12] and emergency care [13][14][15][16].…”