Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam

Jose Francisco Nunes Pereira das Neves; Mariana Moraes Pereira das Neves Araújo; Fernando de Paiva Araújo; Clarice Martins Ferreira; Fabiana Baeta Neves Duarte; Fabio Heleno Pace; Laura Cotta Ornellas; Todd H. Baron; Lincoln Eduardo Villela Vieira de Castro Ferreira

doi:10.1016/j.bjane.2014.09.014

Scientific Article

Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam

Sedação para colonoscopia: ensaio clínico comparando propofol e fentanil associado ou não ao midazolam

Jose Francisco Nunes Pereira das Neves; Mariana Moraes Pereira das Neves Araújo; Fernando de Paiva Araújo; Clarice Martins Ferreira; Fabiana Baeta Neves Duarte; Fabio Heleno Pace; Laura Cotta Ornellas; Todd H. Baron; Lincoln Eduardo Villela Vieira de Castro Ferreira

http://dx.doi.org/10.1016/j.bjane.2014.09.014 Braz J Anesthesiol, vol.66, n3, p.231-236, 2016

PDF

Downloads: 0

Abstract

ABSTRACT Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5 min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction.

Keywords

Sedation, Colonoscopy, Propofol, Fentanil, Midazolam

Resumo

RESUMO A colonoscopia é um dos procedimentos mais feitos. Sedação e analgesia diminuem a ansiedade e o desconforto e minimizam riscos. Em razão disso, os pacientes preferem que o exame seja feito sob anestesia, embora não tenha sido determinada a melhor combinação de fármacos. A associação de benzodiazepínicos com opioides é usada para aliviar a dor e o desconforto do paciente. Mais recentemente, o propofol assumiu posição de destaque. Este estudo, prospectivo e randomizado, é único na literatura médica e especificamente comparou o uso do propofol e fentanil associado ou não ao midazolam na sedação para colonoscopia feita por anestesiologistas. Os objetivos do estudo foram avaliar os efeitos colaterais da sedação, as condições de alta, a qualidade da sedação e o consumo de propofol durante a colonoscopia, com ou sem o midazolam como pré-anestésico. Envolveu 140 pacientes submetidos à colonoscopia, no Hospital Universitário da Universidade Federal de Juiz de Fora. Os pacientes foram divididos em dois grupos. O Grupo I recebeu, por via endovenosa, midazolam como pré-anestésico, cinco minutos antes da sedação, seguido do fentanil e propofol. O Grupo II recebeu, por via endovenosa, anestesia com fentanil e propofol. Os pacientes do Grupo II apresentaram maior incidência de reação (motora ou verbal) à introdução do colonoscópio, bradicardia, hipotensão arterial e maior consumo de propofol. A satisfação dos pacientes foi maior no Grupo I. De acordo com a metodologia empregada, a associação de midazolam ao propofol e fentanil para sedação em colonoscopia reduz o consumo de propofol e cursa com maior satisfação do paciente.

Palavras-chave

Sedação, Colonoscopia, Propofol, Fentanil, Midazolam

References

De Villiers WJ. Anesthesiology and gastroenterology. Anesthe- siol Clin. 2009;27:57-70.

Goulson DT, Fragneto RY. Anesthesia for gastrointesti- nal endoscopic procedures. Anesthesiol Clin. 2009;27:71-85.

Greilich PE, Virella CD, Rich JM. Remifentanil versus meperidine for monitored anesthesia care a comparison study in older patients undergoing ambulatory colonoscopy. Anesth Analg. 2001;92:80-4.

Hsieh YH, Chou AL, Lai YY. Propofol alone versus propofol in combination with meperidine for sedation during colonoscopy. J Clin Gastroenterol. 2009;43:753-7.

Jalowiecki P, Rudner R, Gonciarz M. Sole use ofdexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology. 2005;103:269-73.

Lazaraki G, Kountouras J, Metallidis S. Single useof fentanyl in colonoscopy is safe and effective and significantly shortens recovery time. Surg Endosc. 2007;21:1631-6.

Singh H, Poluha W, Cheung M. Propofol for sedation during colonoscopy. Cochrane Database Syst Rev. 2008:CD006268.

Dumonceau JM, Riphaus A, Aparicio JR. European Society of Gas- troenterology and Endoscopy Nurses and Associates; European Society of Anaesthesiology Guideline non-anesthesiologist administration of propofol for GI endoscopy. Endoscopy. 2010;42:960-74.

Padmanabhan U, Leslie K, Eer AS. Early cognitive impairment after sedation for colonoscopy the effect of adding midazolam and/or fentanyl to propofol. Anesth Analg. 2009;109:1448-55.

Edwards JK, Norris TE. Colonoscopy in rural communities can family physicians perform the procedure with safe and effica- cious results?. J Am Board Fam Pract. 2004;17:353-8.

Hartle A, Malhotra S. The safety of propofol. BMJ. 2009;339:b4024.

VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodi- azepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol. 2006;101:2209-17.

Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesthesia. 1995;7:89-91.

Ahmadi A, Polyak S, Draganov PV. Colorectal cancer surveillance in inflammatory bowel disease the search continues. World J Gastroenterol. 2009;15:61-6.

Cappell MS. Reducing the incidence and mortality of colon cancer mass screening and colonoscopic polypectomy. Gas- troenterol Clin North Am. 2008;37:129-60.

Gasparovic S, Rustemovic N, Opacic M. Comparison of colonoscopies performed under sedation with propofol or with midazolam or without sedation. Acta Med Austriaca. 2003;30(1):13-6.

Agostoni M, Fanti L, Gemma M. Adverse events during monitored anesthesia care for GI endoscopy an 8-year experi- ence. Gastrointest Endosc. 2011;74:266-75.

Vargo JJ, Bramley T, Meyer K. Practice efficiency and economics the case for rapid recovery sedation agents for colonoscopy in a screening population. J Clin Gastroenterol. 2007;41:591-8.

Qadeer MA, Vargo JJ, Khandwala F. Propofol versus traditional sedative agents for gastrointestinal endoscopy a meta-analysis. Clin Gastroenterol Hepatol. 2005;3:1049-56.

Luginbuhl M, Vuilleumier P, Schumacher P. Anesthesia or sedation for gastroenterologic endoscopies. Curr Opin Anaes- thesiol. 2009;22:524-31.

Mandel JE, Lichtenstein GR, Metz DC. A prospective, ran- domized, comparative trial evaluating respiratory depression during patient-controlled versus anesthesiologist-administered propofol-remifentanil sedation for elective colonoscopy. Gas- trointest Endosc. 2010;72:112-7.

Cohen LB, Hightower CD, Wood DA. Moderate levelsedation during endoscopy a prospective study using low-dosepropofol, meperidine/fentanyl, and midazolam. GastrointestEndosc. 2004;59:795-803.

Aguero Pena RE, Pascuzzo-Lima C, Granado Duque AE. Propofol-induced myocardial depression possible role of atrialmuscarinic cholinergic receptors. Rev Esp Anestesiol Reanim. 2008;55:81-5.

Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam

Sedação para colonoscopia: ensaio clínico comparando propofol e fentanil associado ou não ao midazolam

Jose Francisco Nunes Pereira das Neves; Mariana Moraes Pereira das Neves Araújo; Fernando de Paiva Araújo; Clarice Martins Ferreira; Fabiana Baeta Neves Duarte; Fabio Heleno Pace; Laura Cotta Ornellas; Todd H. Baron; Lincoln Eduardo Villela Vieira de Castro Ferreira

Abstract

Keywords

Resumo

Palavras-chave

References

Links

Share

Braz J Anesthesiol