Title: An Observational Study to Compare Propofol with Midazolam plus Fentanyl Combination for Sedation in Gastrointestinal Endoscopies at Tertiary care Hospital in Katihar, Bihar
Authors: Dr Rakesh Ranjan Singh, Dr Ashmita Kiran
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.35
Abstract
Objective & Aim: In gastrointestinal (GI) endoscopy, Propofol has revolutionised sedation practices as it can be easily titrated and has a rapid recovery profile. This observational real-world study was initiated specially in patients who were undergoing GI endoscopy sedation to compare efficacy and safety of propofol with midazolam and fentanyl combination.
Methods: 80 patients who are admired at Katihar medical College and hospital and scheduled for gastrointestinal endoscopy process were recruited for this real word observational study. Patients was divided in two groups which contains either Group A (propofol alone) or Group B (combination of midazolam plus fentanyl). Efficacy was measured by the parameters like depth of sedation (Ramsays sedation scale), time of onset of sedation, amnesia and early recovery of sedation (Modified Aldrete Score). Cardiovascular and respiratory parameters were used to evaluate safety parameters. Adverse events like hypotension, hypoxia and bradycardia were recorded. For statistical analysis, PSPP software was used.
Result: With a mean RSS of 4.9, A group patients were more deeply sedated compared to 3.2 of the B group. At ten minutes after the end of the procedure, full recovery (Aldrete score 10) was seen in 73.33% of the patients of the A group compared to 50% of the B group which was insignificant. Significant haemodynamic changes (hypotension) had observed in A group as compared to B group. Few statistically non-significant respiratory complications were seen in both the groups.
Conclusion: Both the groups present with almost same efficacy and safe.
Keywords: Propofol, Midazolam plus Fentanyl Combination, GI endoscopy sedation.
References
- Trummel J. Sedation for gastrointestinal endoscopy: the changing landscape. Current Opinion in Anesthesiology. 2007;20:359-64.
- Garewal D, Powell S, Milan SJ, Nordmeyer J, Waikar P. Sedative techniques for endoscopic retrograde cholangiopancreatography. The Cochrane Library. 2012 Jun 13.
- Bo LL, Bai Y, Bian JJ, Wen PS, Li JB, Deng XM. Propofol vs traditional sedative agents for endoscopic retrograde cholangiopancreatography: a meta-analysis. World J Gastroenterol. 2011;17:3538-43.
- Newson C, Joshi GP, Victory R, White PF. Comparison of propofol administration techniques for sedation during monitored anesthesia care. Anesthesia and Analgesia. 1995;81:486-91.
- Shin S, Oh TG, Chung MJ, Park JY, Park SW, Chung JB, Song SY, Cho J, Park SH, Yoo YC, Bang S. Conventional versus Analgesia-Oriented Combination Sedation on Recovery Profiles and Satisfaction after ERCP: A Randomized Trial. PloS one. 2015;10:e0138422.
- Cohen LB, Hightower CD, Wood DA, Miller KM, Aisenberg J. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/ fentanyl, and midazolam. Gastrointestinal endoscopy. 2004;59:795-803.
- Mandel JE, Tanner JW, Lichtenstein GR, Metz DC, Katzka DA, Ginsberg GG, Kochman ML. A randomized, controlled, double-blind trial of patient-controlled sedation with propofol/remifentanil versus midazolam/fentanyl for colonoscopy. Anesthesia and Analgesia. 2008;106:434-9.
- Patterson KW, Casey PB, Murray JP, O'boyle CA, Cunningham AJ. Propofol sedation for outpatient upper gastrointestinal endoscopy: comparison with midazolam. British journal of anaesthesia. 1991;67:108-11.
- Sipe BW, Rex DK, Latinovich D, Overley C, Kinser K, Bratcher L, Kareken D. Propofol versus midazolam/ meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointestinal endoscopy. 2002;55:815-25.
- Wehrmann T, Kokabpick S, Lembcke B, Caspary WF, Seifert H. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointestinal endoscopy. 1999;49:677-83.
- Szegô E, Iványi Z, László A, Gál J. Impact of anesthesia on patient and endoscopist satisfaction after colonoscopy—A pilot study. Interventional Medicine and Applied Science. 2011;3:203-6.