Abstract
BackgroundPropofol provides a prominent sedation effect in colonoscopy. However, anesthesia and sedation induced with propofol in the elderly might result in cardiopulmonary complications, especially when it is combined with opoids in the regimen. This study aimed to test the hypothesis that the addition of intravenous lidocaine to propofol-based sedation could decrease the overall propofol requirement in elderly patients during colonoscopy while the procedural sedation satisfaction and the hemodynamic stability were not compromised.MethodsNinety-two patients undergoing colonoscopy were randomly enrolled into lidocaine+propofol (L + P) group or normal saline+propofol (NS + P) groups. Subjects received intravenous bolus of 1.5 mg/kg lidocaine followed by 4 mg kg− 1 h− 1 lidocaine continuous infusion in L + P group or equivalent volumes of normal saline for boluses and infusion in NS + P group. Anesthesia was induced with 2.5 μg sufentanil followed by injection of 1.2 mg kg− 1 propofol in all patients. A single supplemental bolus of 0.6 mg kg− 1 propofol was administered whenever MOAA/S score > 1 or had body movement during the colonoscopy. The recorded primary endpoints included: the total amount of propofol administered during entire procedure, the supplemental amount of propofol after induction, and the frequencies of boluses of supplemental propofol.ResultsA total of 79 patients were included in the final analysis. Compared with NS + P group, the total amounts of propofol (induction plus supplemental) were no significant differences in L + P group; however, the required supplemental propofol was less (69.9 ± 39.2 mg vs. 51.5 ± 38.6 mg) (P = 0.039); the average frequencies of boluses of supplemental propofol given after induction were lower (2.1 ± 1.1 vs. 1.4 ± 0.9) (P = 0.003); the calculated “unit propofol” infusion rate was lower (0.18 ± 0.05 vs. 0.14 ± 0.04 mg kg− 1 min− 1) (P = 0.002).ConclusionsThe addition of intravenous lidocaine to propofol-based sedation resulted in a remarked reduction of supplemental propofol in the elderly during colonoscopy.Trial registrationThe present clinical trial was registered at http://www.chictr.org.cn on 11th March 2019 (registration No. ChiCTR1900021818).
Highlights
Propofol provides a prominent sedation effect in colonoscopy
Propofol alone as a sedative in colonoscopy may require a larger dose to maintain a sufficient depth of anesthesia and supplement with low-dose opioids could reduce the stimulation on autonomic nerves system caused by colonoscopy [15], and make the patient recovery faster
In terms of hemodynamic profiles, MAP and SpO2 did not have significant differences between the two groups; within the group, compared with baseline, MAP was lower at various time points after the anesthesia, while there was no significant difference in SpO2 at different time points (Table 2). 2 patients suffered from brief apnea in L + P group and none in NS + P group, but there was no statistical difference between the two groups (P = 0.15)
Summary
Propofol provides a prominent sedation effect in colonoscopy. anesthesia and sedation induced with propofol in the elderly might result in cardiopulmonary complications, especially when it is combined with opoids in the regimen. Propofol has been getting more popular as sedative during colonoscopy for its advantages of fast onset and offset, quick recovery and less perception of procedure pain and discomfort during the colonoscopy with higher patient’s satisfaction [12, 13]. Propofol alone as a sedative in colonoscopy may require a larger dose to maintain a sufficient depth of anesthesia and supplement with low-dose opioids could reduce the stimulation on autonomic nerves system caused by colonoscopy [15], and make the patient recovery faster. The increased sensitivity to propofol in some individuals, especially in elderly patients could lead to the development of profound hypotension and prolonged apnea when propofol is used as a sedative during colonoscopy
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