556 A Pilot Study on the Recovery Rate in Patients Who Receive Propofol Sedation During Upper Endoscopy (EGD)

Abstract

INTRODUCTION: Procedural sedation for gastrointestinal endoscopy has shifted towards the use of propofol instead of moderate sedation. While medications used for moderate sedation produce delayed psychomotor recovery, patients receiving propofol often report a subjective return to baseline by the time they leave the recovery area following brief endoscopic procedures. Patients are advised to take the day off of work, abstain from major decisions and have an adult accompany them home. This comes at a societal cost as both the patient and caregiver must miss a full day of work. Willey et al. previously studied the rate of recovery for patients receiving moderate sedation with fentanyl and midazolam for upper endoscopy (EGD) finding that average psychomotor recovery was only 64.4 ± 4.4% of baseline and that the letter cancellation test (LCT) and manual dexterity test (MDT) were the most powerful predictors of recovery. We hypothesize that patients receiving propofol sedation will experience a discrete period of psychomotor depression, followed by rapid improvement. METHODS: IRB approval was obtained and 30 outpatients undergoing EGD (divided into three equal age groups) were enrolled (Table 1). To determine normal score variability within each age group the LCT and the MDT were given twice in the pre-procedure period to each patient. Each patient also took the tests upon awakening in recovery and a follow up 30 minutes post-procedure. A patient's recovery status was defined as a 30 minute post-procedure test score within 2 standard deviations of the average score for their age cohort. RESULTS: Overall and within each age group, patients experienced a decrease in performance in the immediate post-procedure period on both the LCT and the MDT. Figure 1 All groups showed improvement on the 30 minute post-procedure test, although full recovery was only achieved 40.0 to 90.0% of the time (overall average of 73.3%) with the LCT and 90.0 – 100% of the time (overall average 90%) for the MDT (Table 2). CONCLUSION: In comparison to previously published results of moderate sedation, propofol sedation demonstrates an improved psychomotor recovery profile. The two tests utilized for this pilot study cannot be considered to provide a full evaluation of psychomotor recovery. We hope that this prospective data may ultimately be used to develop an easily accessible, inexpensive tool to assess psychomotor recovery at the bedside.