Moderate-Level Sedation During Endoscopy Using Low-Dose Propofol, Midazolam and an Opioid

Abstract

Background: Propofol provides several benefits for endoscopic sedation compared to benzodiazepines and opioids, including faster recovery and improved patient satisfaction. However, concern about the risk of deep sedation with propofol has limited its use by gastroenterologists. This study was designed to evaluate the level of sedation during endoscopy performed using low-dose propofol, midazolam, and an opioid. Methods: We prospectively studied 100 patients undergoing outpatient endoscopy. Sedation was performed according to our established protocol (Gastrointest Endosc 2003;58:725). An independent observer assessed the level of sedation using the ASA scale at 2-minute intervals throughout each procedure. Recovery was evaluated using 3 neuropsychometric tests. Recovery was complete when at least 2 out of 3 test scores returned to baseline values. All patients completed a post-procedure satisfaction survey as well as a 24-hour follow-up questionnaire. Results: Details of the medication dosing and procedural times are shown below. There were 729 assessments of sedation, 628 during colonoscopy and 101 during EGD. The level of sedation was minimal, moderate and deep in 77%, 21%, and 2%, respectively. There were 13 episodes of deep sedation, 9 during colonoscopy (1%) and 4 during EGD (4%). Physiologic measures remained stable throughout these 13 events and no intervention was required. During colonoscopy, deep sedation was more likely in patients with lower BMI and longer procedure time (p<0.01 for both). An analysis of the 13 deep sedation events will be presented. Ninety-eight percent of patients were satisfied with their endoscopic sedation, and 71% of patients returned to their usual activities within 2 hours of discharge. Conclusions: Endoscopic sedation with low-dose propofol combined with an opioid and midazolam retains the beneficial effects of higher dose propofol, but in contrast, most patients are only moderately sedated.