Original Articles
Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam

https://doi.org/10.1016/S0016-5107(04)00349-9Get rights and content

Abstract

Background

Propofol provides several benefits over benzodiazepine and narcotic agents as a sedative medication for endoscopic procedures, including faster recovery and improved patient satisfaction. However, its use generally has been limited to anesthesiologists because of the risks associated with deep sedation.

Methods

One hundred patients undergoing colonoscopy or EGD were sedated with low-dose propofol, midazolam, and fentanyl (or meperidine). Depth of sedation was assessed at 2-minute intervals by an independent observer by using the American Society of Anesthesiologists criteria. Recovery time was determined by using paired neuropsychometric tests. A post-procedure satisfaction survey and 24-hour follow-up questionnaires were administered.

Results

For colonoscopy and EGD, respectively, the mean propofol dose was 98 mg and 79 mg, the mean midazolam dose was 0.9 mg and 0.8 mg, the mean fentanyl dose was 69 mcg and 63 mcg, and the mean meperidine dose was 42 mg (for both procedures). There were 628 assessments of the level of sedation performed during 74 colonoscopies and 101 assessments during 26 EGDs. The level of sedation was minimal in 77%, moderate in 21%, and deep in 2% of assessments. Nine of the 13 episodes of deep sedation were recorded during colonoscopy and 4 during EGD. In no instance was more than a single assessment of deep sedation recorded during one procedure. Ninety-eight percent of patients were satisfied with the sedation, and 71% returned to their usual activities within 2 hours of discharge. There was no serious adverse event.

Conclusions

Endoscopic sedation with low-dose propofol, a narcotic agent, and midazolam produces a moderate level of sedation. The quality of sedation and measures of recovery are comparable with the results reported with standard-dose propofol.

Section snippets

Patients and methods

Consecutive patients presenting for elective outpatient colonoscopy or EGD in two private practices (L.B.C., J.A.) were invited to enroll in the study (target 100 participants). It was anticipated that this number would permit detection of deep sedation episodes occurring at a frequency of at least 5%. Patients were excluded if one of two designated independent observers (see below) was not available to record data; if the patient was unable to perform the neuropsychometric testing because of

Patient analysis and endoscopic variables

One hundred patients (mean age 57 years; range 24 to 84 years) were enrolled. The majority were in excellent health (95% ASA I or II).

The analysis of the endoscopic procedures is detailed in Table 2. Colonoscopy accounted for the majority (74%). The mean time for induction, examination, recovery, and discharge for colonoscopy was, respectively, 3 (1) minutes, 18 (6) minutes, 14 (5) minutes, and 47 (11) minutes. The comparable mean times for EGD were, respectively, 4 (2), 8 (5), 16 (5), and 42

Discussion

To determine whether propofol can be administered safely and effectively without deep sedation, the level of sedation obtained during routine endoscopy in 100 consecutive patients receiving a combination of low-dose propofol, a narcotic agent, and midazolam was assessed in the present study. An independent observer, recording depth of sedation at 2-minute intervals, rated the level as minimal in 77% of determinations and moderate in 21%. Deep sedation was recorded in only 13 instances, less

Acknowledgements

The authors are indebted to Ms. Maya Voynarovska and Ms. Jennifer Page (endoscopy assistants) for their tireless efforts during this study, and Valerie Durkalski, PhD, MPH, for her helpful suggestions and statistical support.

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