Tu1092 OPTIMAL SEDATION FOR THE GASTROINTESTIINAL ENDOSCOPY WITH THE COMBINATION OF INTERMEDIATE - ACTION AND RAPID- ACTION AGENT

Abstract

Since 1989, we have performed the gastrointestinal endoscopy with sedation of 2 agents combination (diazepam/thiopental sodium). In 1997, we changed diazepam to midazolam in order to decrease the risk of respiratory depression. Since 2010, we have used propofol instead of thiopental sodium in order to decrease the risk of cough from sputum. Furthermore, recently, we have changed the ration of midazolam and propofol in order to decrease the awakening time. It was uncertain whether midazolam predominant/propofol or midazolam/propofol predominant is more effective and safer. To evaluate prospectively effectiveness and safety of midazolam predominant or propofol predominant (The plasma half time of diazepam, midazolam, thiopental sodium, and propofol are 28 - 35 hour, 120 minute, 2.8 minute, and 2.6minute, respectively.) In diagnostic endoscopy, 200 patients were randomly assigned to 2 groups (2015 October - 2016 March). No significant difference was observed between the two groups in patients characteristic. Both combination agents were given intravenously by the skilled nurse. Midazolam predominant method: Midazolam and propofol were administered intravenously at a stating dose of 0.12mg/Kg and 0.4mg/Kg of body weight, respectively. Sedation was maintained by administering a bolus of 10mg propofol every time the patient’s resistance was noted. Propofol predominant method: At a stating dose of 0.033mg/Kg and 1.0mg/Kg of body weight, respectively. Bolus: 10mg. The primary end-points were the relief rate of discomfort by questionnairing to 200 patients and the safety of sedation by using SPO2 pulse oximeter . Respiratory depression was defined as decrease in oxygen saturation < 90 % for > 20 sec. Severe respiratory depression was defined as the necessity of mask ventilation or the interruption of endoscopic procedure. The perfect relief rate of discomfort and anxiety were same (99% vs 100%). The respiratory depression rate were not significantly difference (23% vs 18%). Severe respiratory depression rate were not significantly difference (1% vs 0 %). However, the rate of cough from sputum significantly decreased (19% vs 9%). Furthermore, the awaking time were shorter in propofol predominant group (80.7min. vs 60.6min). The sedation with the combination of intermediate - action agent and rapid - action agent is very effective. Propofol predominant method is safer than Midazolam predominant method and has faster awaking time.