In a study reported on Monday (click here to view), researchers from the Indiana University School of Medicine, Indianapolis, Indiana, USA, discovered that propofol can be given safely by appropriately trained nurses under supervision by endoscopists.
A team from the same institution assessed propofol versus midazolam/meperidine, administered by nurses, for outpatient colonoscopy
A total of 80 outpatients (ASA Class I or II) undergoing colonoscopy were randomized to receive either propofol or midazolam plus meperidine.
The sedatives were administered by a nurse and supervised by an endoscopist.
Patient satisfaction, procedure and recovery times, neuropsychological function, and complications were all measured.
The mean dose of propofol administered was 218 mg; mean doses of midazolam and meperidine were, respectively, 4.7 mg and 89.7 mg.
Mean time to sedation was faster in the propofol patients (2 min vs 7 min). In addition, depth of sedation was greater.
|Advantages of propofol:|
- Faster recovery
- Greater patient satisfaction
- Fewer complications
| Gastrointestinal Endoscopy |
On average, after the procedure, the propofol patients could stand at the bedside sooner (14 vs 30 min), reached full recovery faster (14 vs 33 min), and were discharged sooner (41 vs 71 min).
The authors found that patients who received propofol also expressed greater overall mean satisfaction on a 10-point visual analog scale (9.3 vs 8.6).
At discharge, the propofol group had better scores on tests reflective of learning, memory, working memory span, and mental speed.
Some 4 patients in the midazolam/meperidine group developed minor complications (1 hypotension and bradycardia, 2 hypotension alone, and 1 tachycardia).
A further patient in the propofol group had oxygen desaturation develop, during an episode of epistaxis.
Dr Brian W. Sipe, of the Indiana University School of Medicine, said on behalf of his colleagues, "For outpatient colonoscopy, propofol administered by nurses and supervised by endoscopists has several advantages over midazolam plus meperidine, and deserves additional investigation."