Abstract
Propofol is administered as intermittent boluses to achieve deep sedation to facilitate oesophagogastroduodenoscopy. Target controlled infusion (TCI) can be employed for this purpose. 176 adults were randomly allocated into two groups of 88 patients. Control group: Received an initial bolus of propofol 1mg/kg, with repeat boluses of 0.25mg/kg. Intervention group: Received an initial target effect-site concentration of 4mcg/ml, followed by maintenance target effect-site concentration of 2.5mcg/ml, titrated by 0.5mcg/ml from baseline infusion rate as needed. Oxygen saturation, blood pressure and heart rate were evaluated immediately before administering the sedative and at 2.50, 5.00, 7.50 and 10.00 minutes. Oxygen desaturation below 90% in both study groups was recorded. Sedation starting time, stopping time, waking up time and overall duration of time to recovery of participants in each study arm was recorded. More hypoxic episodes were observed in the intermittent bolus group with statistically significant association between control and the incidence of hypoxia: Chi square test, p=0.037. There were more hypotensive episodes in the TCI group but not achieving statistical significance: Chi square test for association X2(1) = 0.962, p=0.327.The time to recovery between the two groups was comparable, with 18.84 ± 10.76 minutes in the bolus group and 19.72 ± 9.27 minutes in the TCI group; no statistically significant difference was shown: Student's t-test, p=0.0564. TCI of propofol was associated with fewer episodes of hypoxia compared to intermittent bolus administration. Similar hemodynamic profiles and comparable time to recovery were demonstrated by these two sedation techniques.
Highlights
In recent years, there has been a notable increase in the number of patients requiring upper and lower gastrointestinal endoscopic studies as an essential part of the diagnostic and treatment strategy for gastrointestinal pathologies[1,2]
Propofol has secured a favorable position in procedural sedation as has been elaborated in guidelines published by the American Society of Anesthesiology (ASA) for the safe conduct of sedation for various diagnostic and therapeutic procedures including gastrointestinal endoscopy[8]
For the conduct of procedural sedation, propofol may be administered as intermittent boluses or via continuous infusion; the latter technique requiring the use of a drug infusion pump that requires one to either manually adjust the rate of infusion or, use a target controlled infusion system – which allows more accurate rapid titration of the dose of this agent
Summary
There has been a notable increase in the number of patients requiring upper and lower gastrointestinal endoscopic studies as an essential part of the diagnostic and treatment strategy for gastrointestinal pathologies[1,2]. For the conduct of procedural sedation, propofol may be administered as intermittent boluses or via continuous infusion; the latter technique requiring the use of a drug infusion pump that requires one to either manually adjust the rate of infusion or, use a target controlled infusion system – which allows more accurate rapid titration of the dose of this agent. Propofol is administered as intermittent boluses to achieve deep sedation to facilitate oesophagogastroduodenoscopy. Control group: Received an initial bolus of propofol 1mg/kg, with repeat boluses of 0.25mg/kg. Results: More hypoxic episodes were observed in the intermittent bolus group with statistically significant association between control and the incidence of hypoxia: Chi square test, p=0.037. Effect of target controlled propofol infusion versus intermittent boluses during oesophagogastroduodenoscopy: a randomized controlled trial.
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