Original article
A Prospective Safety Study of a Low-Dose Propofol Sedation Protocol for Colonoscopy

https://doi.org/10.1016/j.cgh.2007.01.013Get rights and content

Background & Aims: Propofol has been shown to be an effective method for endoscopic sedation but there are few studies of low-dose propofol protocols for gastrointestinal endoscopy. Methods: One hundred patients (American Society of Anesthesiology classes I–III) undergoing outpatient colonoscopy were enrolled prospectively in a multidrug propofol regimen that consisted of propofol, midazolam, and meperidine. Study outcome measures evaluated the level of sedation, length of procedure, sedation/recovery time, patient satisfaction, and adverse events. Results: The mean dose of propofol was 90 ± 40 mg. The mean times for induction of sedation, reaching the cecum, and total procedure time were 3 ± 1 minutes, 5 ± 3 minutes, and 17 ± 4 minutes, respectively. Deep sedation was observed in only 0.3% of observations. Postprocedure, the mean times to stand at the bedside without assistance, completion of all discharge criteria, and actual discharge were 10 ± 8 minutes, 20 ± 20 minutes, and 37 ± 23 minutes, respectively. Patient satisfaction ratings were high on a 10-point scale, with mean total procedure and sedation satisfaction scores of 9.4 ± 0.8 and 9.4 ± 1.1. In 99% of patients, no supplemental oxygen was required. No serious adverse events occurred. Conclusions: This protocol for propofol administration is safe and effective for patients undergoing elective colonoscopy. The level of sedation was titrated readily to a moderate level of sedation while preserving a high degree of patient satisfaction.

Section snippets

Methods

This study protocol was reviewed and approved by the institutional review board at St. Vincent’s Hospitals. The trial was a prospective study of 100 patients undergoing elective colonoscopy at either St. Vincent’s Carmel Hospital (Carmel, IN) or St. Vincent’s Hospital (Indianapolis, IN). All patients were referred through an open-access scheduling system. Patients were eligible to enter the study if they were between the ages of 18 to 75 years and were in American Society of Anesthesiology risk

Results

A total of 100 patients were enrolled in the study. Baseline characteristics of the study group are summarized in Table 2. In a questionnaire completed before the procedure, patients estimated that they would be discharged from the hospital an average of 66 ± 38 minutes after completion of the examination and they anticipated that the residual effects of sedation would persist for an average of 3.8 ± 4.8 hours.

Ninety-six patients received meperidine 50 mg and midazolam 1 mg, and the remaining 4

Discussion

The primary outcome measures in this study were designed to document the safety of the propofol protocol designed by Cohen et al7 for outpatient colonoscopy. Our secondary objectives were to document timely measures of efficiency, patient satisfaction, and adverse effects. The results of this study showed safe institution of this propofol-based protocol for colonoscopy. There were no serious adverse events such as bag mask ventilation, intubation, or hospitalization that occurred in this study.

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    First, it allowed for precise titration of propofol, with a smaller bolus of doses to maintain the target level of sedation. Several prospective studies of BPS also have shown that the level of sedation is titrated readily to a moderate level of sedation, so that the actual incidence of deep sedation is quite low.17-20 Second, specific antagonists of benzodiazepines (flumazenil) and/or opioids (naloxone) are available.

  • Sedation: Not Quite That Simple

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    Such statements obviously confirm that these investigators, who are supposed to be experts on sedation in the emergency unit, lack the understanding of risks associated with propofol use. Similarly, a recent article on nurse-administered propofol sedation for gastrointestinal endoscopic procedures13 states that “when using a multidrug protocol with propofol, the clinician may be able to exploit the therapeutic actions of the individual agents while reducing the possibility of sedation dose-related complications.” This standpoint is contrary to the established principles of polypharmacy emphasizing that the risk of hypoxia, hypercarbia, and airway compromise are actually worsened when propofol is combined with benzodiazepines and/or opioids.

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Submitted in part to American College of Gastroenterology Conference in October 2006 as an abstract.

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