Quality of Psychomotor Recovery After Propofol Sedation for Routine Endoscopy: A Randomized, Controlled Study

Abstract

Background: Propofol sedation for endoscopy is increasingly used in the outpatient setting. Because of its short action, current recommendations to refrain from traffic participation for 24 hours may be too strict. Therefore we assessed psychomotor recovery and driving skills before and after sedation. Methods: 100 patients undergoing routine upper or lower GI-endoscopy were randomly sedated with propofol alone or midazolam plus pethidine. Recovery time and quality of recovery were assessed. Psychomotor recovery was evaluated by the number connection test (NCT) and a driving simulator test one hour before and two hours after the endoscopic procedure. Results: 96 patients completed the 2-hour post-sedation run. Vital signs were recorded with no clinically relevant complications. Mean recovery time and quality of recovery were significantly better after propofol sedation (14 vs. 25 min. and 8.3 vs. 6.1 points) (p < 0.01). Psychomotor and driving skills after propofol sedation were similar to the baseline results, while in the midazolam/pethidine group patients showed significantly more lane deviations (1.1 vs.1.6), time over the speed limit (0.3 vs. 0.6), events of missing the red light (0.05 vs. 0.11), as well as a slower reaction time for unexpected events (1.11 vs. 1.39 s.) (p < 0.01). Time needed to complete the NCT after sedation did not differ in both groups (32.1 vs. 33.4 s. for propofol; 31.5 vs. 34.6 s. for midazolam/pethidin). Conclusion: Current recommendations to refrain from driving and unescorted participation in public traffic for 24 hours after sedation could be reconsidered in those patients who undergo propofol sedation.