Propofol infusion for sedated upper gastrointestinal endoscopic ultrasound: a comparison of propofol alone versus propofol-fentanyl or propofol-midazolam

Abstract

Background: Gastrointestinal (GI) endoscopic untrasound is the major technique for diagnosis of GI disease and treatment. Various sedation and analgesia regimens such as midazolam, fentanyl, and propofol can be used during GI endoscopy. The purpose of the study was to compare propofol alone and propofol combine with midazolam or fentanyl in moderate sedation for GI endoscopy. Objectives: To observe the efficiency comparison between propofol alone and propofol/fentanyl or propofol/midazolam on sedation during upper gastrointestinal endoscopic ultrasound. Methods: In a prospective, randomized clinical study, 90 patients were assigned to group 1 (n = 30; 1 mg/kg IV propofol) group 2 (n = 30; 1 mg IV midazolam intravenous followed 1 mg/kg IV propofol) or group 3 (n = 30; 50 μg fentanyl followed 1 mg/kg IV propofol). Each patient was administered 1 mg/kg propofol for induction. All of the patients were administered an additional dose of IV propofol infusion (5 mg/kg/h). This study was performed in Hue University of Medicine and Pharmacy Hospital, between January 2020 - 2021. Total propofol consumption, time to achieve, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Postprocedural records included recovery time, postoperative adverse events (nausea, vomiting, dizziness, recall, and pain) and satisfaction. Results: The average propofol consumption was 283.8 ± 113 mg in Group 1 and 230 ± 76.3 mg in Group 2 and 231.8 ± 76.3 mg in Group 3 (p < 0.05). The incidence of moving motor or verbal) was lower in Group 3 (p < 0.05). The physician satisfaction was higher significantly in Group 3 (p < 0.05). Total propofol consumption was higher in group 1 significantly. Time to onset of sedation was significantly higher in group 1 The physician satisfaction was higher significantly in Group 3. Overall, the other results were similar in 3 groups. Conclusion: Both propofol/fentanyl and propofol/midazolam combinations provided appropriate hypnosis and analgesia during upper gastrointestinal endoscopy. However, propofol consumption was significantly lower and greater endoscopist satisfaction in group using the propofol/ fentanyl combination. Key words: sedation, upper gastrointestinal endoscopy, propofol, fentanyl, midazolam