Propofol versus traditional sedative methods for colonoscopy in a low-resource setting

Abstract

Our data suggest that PRO sedation is safe when used for outpatient diagnostic colonoscopy in low-resource settings with better patients and physician satisfaction. The synergistic sedative effect of midazolam and/or opioids combined with PRO help reducing the dose of PRO used with better recovery.

Comparison of the effects and side-effects of sedation with propofol versus midazolam plus pethidine in patients undergoing endoscopy in Imam Khomeini Hospital, Ahvaz

“…The results of the upper level showed more comfort and satisfaction of patients and a shorter recovery time in the propofol-midazolam group. These results are in agreement with the findings of previous studies, in which it was stated that propofol in combination with other sedatives is an appropriate option for achieving sedation with proper depth, and high tolerance for the patient, and is free of the side effects associated with injection of high doses of propofol, such as increasing the recovery time [ 8 , 15 – 17 ].…”

“…Previous studies also showed that the age of patients was an independent risk factor for significant reduction in O 2 saturation [ 16 ]. However, the study conducted by Alatise et al [ 17 ] did not confirm this. Nonetheless, it is recommended that the intranasal oxygen and blood pressure be monitored during the endoscopy and colonoscopy regardless of the used sedation regime.…”

“…Studies have shown that, despite the effectiveness of sedation by propofol, there is still a risk of cardio respiratory side effects such as hypoxia, hypotension, arrhythmias, and respiratory distress in the case of use of propofol, which requires cardiopulmonary support [ 18 ]. In the study of Alatise et al [ 17 ] hypotension was similar in the three protocols of sedation by propofol-midazolam, opioid-midazolam, and propofol alone, but the cause of this similarity was unknown. However, the emergence of hypoxaemia in a group with propofol (100% of patients in the group of sedation with propofol and 97.5% of patients in the propofol-midazolam group) was significantly higher than in the opioid-midazolam (30%) group.…”

“…Because in the study of Alatise et al [ 17 ] hypoxaemia was observed in a significant number of patients under opioid-midazolam sedation, they emphasised that careful monitoring of patients is vital without considering the sedation. In the study of Lera dos Santos et al [ 8 ] there were no serious side effects in both groups of sedation: with propofol-fentanyl and midazolam-fentanyl.…”

“…In the study conducted by Hosseini et al [ 22 ], recovery time in the propofol-fentanyl group was significantly lower than that of the meperidine-midazolam group. In the study of Alatise et al , the recovery time in patients who underwent diagnostic colonoscopy in the propofol-midazolam group (5.8 min) was significantly lower than the that of the opioid-midazolam group (13.4 min) and propofol alone (7.9 min) [ 17 ]. In another study, Padmanabhan et al [ 23 ] showed that endoscopy could be carried out using a combination of low-dosage propofol with a narcotic and/or benzodiazepine agent at moderate sedation levels, and a combination of small doses of propofol with a narcotic agent and midazolam does not prolong the patients’ recovery time.…”