Abstract
Aim:To compare the effects of propofol/remifentanil and meperidine/midazolam on postprocedure cognitive function.Materials and methods:A total of 100 American Society of Anesthesiologists (ASA) score I to III patients undergoing elective colonoscopy were taken into the study and divided into two groups. Exclusion criteria were patient refusal, mini mental test (MMT) <26, The Amsterdam Preoperative Anxiety and Information Scale (APAIS) >10, advanced cardiopulmonary or psychiatric disease, chronic alcohol abuse, morbid obesity, and known allergy to study drugs. In group MM, 2 mg midazolam and 20 mg meperidine was given intravenously and additional 1 to 2 mg midazolam and 20 mg meperidine (with a maximum total of 5 mg midazolam and 50 mg meperidine) was given when bispectral index (BIS) was >80. In group RP, 100 μg/kg/minute propofol infusion and 1 μg/kg remifentanil bolus was administered and additional 0.5 μg/kg remifentanil bolus was given when BIS was >80. Observer’s Assessment of Alertness/Sedation scale (OAA/S) and Facial Pain Score (FPS) values were recorded. Cognitive function was measured by Trieger Dot Test (TDT) and Digit Symbol Substitution Test (DSST).Results:The study was concluded with 100 patients. Heart rate was slower and BIS values were lower in group RP throughout the procedure. Blood pressure was lower in group RP without clinical significance. There was no difference concerning recovery time and visual analog scores (VASs). In group MM, TDT scores were higher and DSST scores were lower. Satisfaction was higher in group RP.Conclusion:Propofol/remifentanil combination is better than meperidine/midazolam combination concerning cognitive function in sedation for colonoscopy.Clinical significance:The addition of BIS monitorization to evaluate the depth of sedation and the negative effects of midazolam meperidine combination on postprocedural cognitive function.How to cite this article: Ekmekci P, Erkan G, Yilmaz H, Kazbek BK, Koksoy UC, Doganay G, Tüzüner F. Effect of Different Sedation Regimes on Cognitive Functions in Colonoscopy. Euroasian J Hepato-Gastroenterol 2017;7(2):158-162.
Highlights
Sedation for lower gastrointestinal system is becoming more frequent and while agents with a fast onset, short half-life, and high safety profiles are chosen, the effects on cognitive functions are frequently disregarded
Heart rate was slower and bispectral index (BIS) values were lower in group RP throughout the procedure
Propofol/remifentanil combination is better than meperidine/midazolam combination concerning cognitive function in sedation for colonoscopy
Summary
Sedation for lower gastrointestinal system is becoming more frequent and while agents with a fast onset, short half-life, and high safety profiles are chosen, the effects on cognitive functions are frequently disregarded. Cognitive deterioration may become more pronounced in deeper levels of sedation and may have a significant impact on return to daily life. The ideal agent for sedation should cause minimal cognitive dysfunction in the early postprocedure period and allow rapid return to daily life. Midazolam, which is widely used for sedation in endoscopic procedures, is known to cause cognitive dysfunction.[8] Propofol alone, on the contrary, has been shown to cause less cognitive deterioration,[9] propofol alone for sedation causes higher costs, deeper sedation, and adverse effects as a result. The primary endpoint of this result was to compare the effect of sedation techniques of anesthesiologists and endoscopists on cognitive function, while the secondary endpoint was the comparison of adverse effect incidence and patient and endoscopist satisfaction
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