Improved Sedation in Diagnostic and Therapeutic ERCP: Propofol is an Alternative to Midazolam

Jung, Michael J.; Hofmann, Carsten; Kießlich, Ralf; Brackertz, A.

doi:10.1055/s-2000-96

Cited by 172 publications

(117 citation statements)

References 10 publications

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“…The safety and efficacy of propofol for other complex therapeutic endoscopic procedures, such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, has already been established by several studies. [9][10][11] Nevertheless, the most effective and safest sedative agent and sedation protocol for ESD has not yet been clearly established.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Deep Sedation with Propofol Alone or Combined with Midazolam Administrated by Nonanesthesiologist for Gastric Endoscopic Submucosal Dissection

Chun¹,

Kim²,

Park³

et al. 2012

Gut Liver

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Background/Aims: Endoscopic submucosal dissection (ESD) is accepted as a treatment for gastric neoplasms and usually requires deep sedation. The aim of this study was to evaluate the safety and efficacy profiles of deep sedation induced by continuous propofol infusion with or without midazolam during ESD. Methods: A total of 135 patients scheduled for ESDs between December 2008 and June 2010 were included in this prospective study and were randomly assigned to one of two groups: the propofol group or the combination group (propofol plus midazolam). Results: The propofol group reported only one case of severe hypoxemia with no need of mask ventilation or intubation. Additionally, 18 cases of mild hypotension were observed in the propofol group, and 11 cases were observed in the combination group. The combination group had a lower mean total propofol dose (378 mg vs 466 mg, p<0.012), a longer mean recovery time (10.5 minutes vs 7.9 minutes, p=0.027), and a lower frequency of overall adverse events (32.8% vs 17.6%, p=0.042). Conclusions: Deep sedation induced by continuous propofol infusion was shown to be safe during ESD. The combination of continuous propofol infusion and intermittent midazolam injection can decrease the total dose and infusion rate of propofol and the overall occurrence of adverse events. (Gut Liver 2012;6:464-470)

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Deep Sedation with Propofol Alone or Combined with Midazolam Administrated by Nonanesthesiologist for Gastric Endoscopic Submucosal Dissection

Chun¹,

Kim²,

Park³

et al. 2012

Gut Liver

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“…Patients must be administered agents to induce moderate-to-deep sedation to tolerate the ERCP procedure. The use of propofol for endoscopic sedation has increased markedly in recent years, mainly due to its favorable pharmacokinetic profile compared with "traditional" endoscopy sedation drugs, such as benzodiazepines and opioids [6][7][8][9][10] . When administered intravenously, propofol rapidly crosses the blood-brain barrier and activates aminobutyric acid to induce sedation, amnesia, and sleep.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of a patient-positioning device (EZ-FIX) for endoscopic retrograde cholangiopancreatography

Lee

Han

Lee

et al. 2015

WJG

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AIM:To assess the efficacy and safety of a patientpositioning device (EZ-FIX) for endoscopic retrograde cholangiopancreatography (ERCP). METHODS:A total of 105 patients were randomized to the EZ-FIX (n = 53) or non-EZ-FIX (n = 52) group in this prospective study. Midazolam and propofol, titrated to provide an adequate level of sedation during therapeutic ERCP, were administered by trained registered nurses under endoscopist supervision. Primary outcome measures were the total dose of propofol and sedative-related complications, including hypoxia and hypotension. Secondary outcome measures were recovery time and sedation satisfaction of the endoscopist, nurses, and patients. RESULTS:There was no significant difference in the rate of hypoxia, but there was a statistical trend (EX-FIX group; n = 4, 7.55%, control group; n = 6, 11.53%, P = 0.06). The mean total dose of propofol was lower in the EZ-FIX group than in the non-EZ-FIX group (89.43 ± 49.8 mg vs 112.4 ± 53.8 mg, P = 0.025).In addition, the EZ-FIX group had a shorter mean recovery time (11.23 ± 4.61 mg vs 14.96 ± 5.12 mg, P < 0.001). Sedation satisfaction of the endoscopist and nurses was higher in the EX-FIX group than in the non-EZ-FIX group. Technical success rates of the procedure were 96.23% and 96.15%, respectively (P = 0.856). Procedure-related complications did not differ by group (11.32% vs 13.46%, respectively, P = 0.735). CONCLUSION:Using EZ-FIX reduced the total dose of propofol and the recovery time, and increased the satisfaction of the endoscopist and nurses.

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“…Besides, when used alone, relatively large doses of propofol may be required to achieve adequate comfort which may result in doserelated side effects, such as hypotension or respiratory depression 16,17 . Drug combinations can decrease the adverse reactions by reducing the dosage of drugs 18 .…”

Section: Introductionmentioning

confidence: 99%

Comparing the pain of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy

2014

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Improved Sedation in Diagnostic and Therapeutic ERCP: Propofol is an Alternative to Midazolam

Abstract: Propofol proves to be an excellent sedative for ERCP and shows a shorter recovery time than midazolam. Because of the narrow therapeutic window, we recommend close patient monitoring.

Cited by 172 publications

References 10 publications

Safety and Efficacy of Deep Sedation with Propofol Alone or Combined with Midazolam Administrated by Nonanesthesiologist for Gastric Endoscopic Submucosal Dissection

Safety and Efficacy of Deep Sedation with Propofol Alone or Combined with Midazolam Administrated by Nonanesthesiologist for Gastric Endoscopic Submucosal Dissection

Efficacy and safety of a patient-positioning device (EZ-FIX) for endoscopic retrograde cholangiopancreatography

Comparing the pain of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy

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