Nonanesthesiologist-Administered Propofol Versus Midazolam and Propofol, Titrated to Moderate Sedation, for Colonoscopy: A Randomized Controlled Trial

Molina–Infante, Javier; Dueñas-Sadornil, Carmen; Mateos-Rodríguez, José María; Perez-Gallardo, Belen; Vinagre-Rodríguez, Gema; Hernández-Alonso, Moisés; Fernandez-Bermejo, Miguel; González-Húix, Ferrán

doi:10.1007/s10620-012-2222-4

Cited by 37 publications

(31 citation statements)

References 25 publications

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“…The present study shows that NAAP using single-agent propofol can be safely and effectively used for endoscopic procedures requiring moderate sedation, in accordance with our previous results (16), with high rates of satisfaction and willingness to undergo repeat procedure. Despite overwhelming evidence demonstrating the safety and efficacy of NAAP for endoscopic procedures, it has been recently shown to be used only in one third of settings in an European survey (17).…”

Section: Discussionsupporting

confidence: 92%

Intermittent boluses versus pump continuous infusion for endoscopist-directed propofol administration in colonoscopy

González-Santiago

Martín-Noguerol

Vinagre-Rodríguez

et al. 2013

Rev. esp. enferm. dig.

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Background: non-anesthesiologist administration of propofol (NAAP) using continuous infusion systems may achieve a more sustained sedative action.Aim: to compare intermittent boluses (IB) with pump continuous infusion (PCI) for NAAP, targeted to moderate sedation, for colonoscopy.Methods: 192 consecutive outpatients were randomized to receive IB (20 mg propofol boluses on demand) or PCI (3 mg/ kg/h plus 20 mg boluses on demand). Sedation could be stopped at cecal intubation at the discretion of the endoscopist. Satisfaction rates of the patient, nurses and endoscopist, propofol doses, depth of sedation (at the beginning, at cecal intubation and at the end), recovery times, complications and were collected.Results: there were no differences between groups regarding patient, nurse or endoscopist satisfaction rates with procedural sedation. Propofol doses (mg) were significantly higher during the induction phase (86 [30-172] vs. 78 [30-160], p 0.03) and overall (185 [72-400] vs. 157 [60-460], p = 0.003) for PCI group. 81 % of assessments of the depth of sedation were moderate. The level of sedation (O/AAS scale) was borderline significantly deeper at cecal intubation (2.38 vs. 2.72; p = 0.056) and at the end of the procedure (4.13 vs. 4.45; p = 0.05) for PCI group, prolonging thus early recovery time (6.3 vs. 5.1 minutes, p = 0.008), but not discharge time. Complications, all of them in minors, were non-significantly more frequent in the PCI group (9 vs. 7 %, p = 0.07).Conclusions: NAAP for colonoscopy was safely administered with comparable satisfaction and complication rates with either IB or PCI.

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Section: Discussionsupporting

confidence: 92%

Intermittent boluses versus pump continuous infusion for endoscopist-directed propofol administration in colonoscopy

González-Santiago

Martín-Noguerol

Vinagre-Rodríguez

et al. 2013

Rev. esp. enferm. dig.

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“…Propofol usage for endoscopy has increased over the last decade. Balanced propofol sedation (BPS), which combines propofol with small doses of a benzodiazepine, was developed to reduce the total dose of propofol administered (1). Compared with the use of propofol alone, propofol sedation combined with a benzodiazepine provides superior patient satisfaction and more rapid recovery after endoscopy (2).…”

Section: Introductionmentioning

confidence: 99%

Effects of balanced propofol sedation on QT, corrected QT, and P-wave dispersion on upper endoscopy

Bolat

Celıkbılek²,

Sarıkaya³

et al. 2015

Anatol J Cardiol

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Objective:Combined sedation with propofol and benzodiazepines, known as balanced propofol sedation (BPS), was developed to increase patient comfort during endoscopy. However, the effects of BPS on P-wave dispersion (Pwd), QT interval, and corrected QT (QTc) interval after endoscopy have not been investigated.Methods:The study population consisted of 40 patients with BPS and 42 without sedation who were scheduled to undergo upper endoscopy in this cross-sectional prospective study. Patients with hypertension, diabetes mellitus, renal failure, chronic obstructive pulmonary disease, coronary artery disease, or valvular heart disease and those on medications that interfere with cardiac conduction times were excluded. Electrocardiograms (ECGs) was recorded in all patients pre-endoscopy and 10 min post-endoscopy. QT, QT dispersion (QTd), and Pwd were defined from 12-lead ECG. The QTc interval was calculated using Bazett’s formula. All analyses were performed using SPSS 15.0.Results:Post-endoscopy P max duration and Pwd were prolonged compared with baseline values (86±13 ms vs. 92±10 ms and 29±12 ms vs. 33±12 ms, respectively; p<0.05). Post-endoscopy QTc and QTd were decreased compared with baseline values, but these decreases were not statistically significant (431±25 ms vs. 416±30 ms and 62±28 ms vs. 43±22 ms, respectively; p>0.05).Conclusion:The present study showed that P-wave duration and Pwd values increased after endoscopy with a combination of midazolam and propofol sedation. Physicians should be made aware of the potential effects of BPS in terms on P-wave duration and Pwd values.

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“…We considered these reasonable targets based on our previous experience, informal surveys of practicing pulmonologists' attitudes toward procedure sedation, and available endoscopy sedation data. 19,25,31,32 Sedation Administration All sedation was administered and adjusted by an advanced cardiac life support-certified sedation registered nurse, under the direction of the bronchoscopist. No anesthetist or anesthesiologist was present.…”

Section: Designmentioning

confidence: 99%

“…Furthermore, propofol has been safely administered by nonanesthesiologists. [17][18][19][20][21][22][23][24][25] To our knowledge, however, no dedicated literature exists assessing propofol's performance with targeting moderate sedation during EBUS bronchoscopy. In addition, most studies that have examined its use with bronchoscopy have done so for quick, mostly routine procedures, and while utilizing bolus-dose regimens.…”

mentioning

confidence: 99%

Bronchoscopist-directed Continuous Propofol Infusion for Targeting Moderate Sedation During Endobronchial Ultrasound Bronchoscopy

Chrissian

Bedi

2015

Journal of Bronchology &Amp; Interventional Pulmonology

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Nonanesthesiologist-Administered Propofol Versus Midazolam and Propofol, Titrated to Moderate Sedation, for Colonoscopy: A Randomized Controlled Trial

Abstract: Moderate sedation was feasible with both NAAP regimens. Drug synergy in the midazolam plus propofol sedation regimen promotes a deeper and longer moderate sedation, improving patient satisfaction rates but prolonging early recovery time (Clinical Trials gov NCT01428882).

Cited by 37 publications

References 25 publications

Intermittent boluses versus pump continuous infusion for endoscopist-directed propofol administration in colonoscopy

Intermittent boluses versus pump continuous infusion for endoscopist-directed propofol administration in colonoscopy

Effects of balanced propofol sedation on QT, corrected QT, and P-wave dispersion on upper endoscopy

Bronchoscopist-directed Continuous Propofol Infusion for Targeting Moderate Sedation During Endobronchial Ultrasound Bronchoscopy

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