Continuous Upper and Lower Gastrointestinal Endoscopy Under Sedation: A Randomized Double-Blind Comparative Study Using Propofol Alone Versus Propofol Combined Midazolam

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Background/Aims: Adequate patient sedation is mandatory for most endoscopic procedures. Recent studies indicate that propofol and midazolam act synergistically in combination and therefore may be superior to sedation with propofol alone in terms of sedating efficacy and costs. We investigated the effect and safety of propofol alone and combined use of propofol and midazolam for continuous upper and lower gastrointestinal endoscopy. Methods: The double blind, randomized controlled trial was carried out to compare patients' and endoscopists' assessments in both groups of patients: P (propofol alone) group (n = 152) received propofol alone and MP (midazolam/propofol) group (n = 150) received propofol plus midazolam (3 mg). Propofol was infused by 2~2.5 ml/kg/hr according to the patient's response and vital sign. Upper gastrointestinal endoscopy was performed at first, and then followed by lower gastrointestinal endoscopy. Propofol infusion was discontinued while the endoscopic fiber was passing through the hepatic flexure. We compared followings in both groups; 1) induction and total propofol dosage 2) induction time 3) recovery time 4) satisfactions of patients 5) adverse effects. Results: Induction (9 vs. 12 ml) and total (18 vs. 36 ml) propofol dosage were lower in MP group than P group (p < 0.05). Induction time was shorter in MP group than P group (p < 0.05). There was no significant difference of recovery time and satisfaction of patients. In both groups, significant difference was not observed in decreased of blood pressure, heart rate, respiration rate, and peripheral blood oxygen saturation rate. Fatal adverse effect was not found in both groups. Conclusions: Continuous upper and lower gastrointestinal endoscopy using continuous propofol infusion is safe. Combined use of propofol and midazolam is more efficient sedative method than use of propofol alone because of rapid induction and low propofol dosage without increasing adverse effects.