A team from Cleveland, Ohio, USA, evaluated gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy.
A total of 75 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) were included in the study.
They were randomized to either gastroenterologist-administered propofol (n = 38) or meperidine/midazolam (n = 37) for the procedures.
Monitoring with capnography allowed for rapid titration of propofol at the earliest signs of respiratory depression.
Visual analogue scales were used to measure tolerance and satisfaction.
The return to baseline for both activity and food intake 24 hours after the procedure were measured.
The groups had similar physiological outcomes and satisfaction.
Patients receiving propofol had shorter recovery times. They also had a higher recovery of both baseline activity level and dietary intake 24 hours after the procedure.
An incremental cost-effectiveness analysis was conducted using these figures.
| Gastroenterologist-administered propofol cost an additional $403 per patient.
| Gastroenterology |
The authors found that gastroenterologist-administered propofol cost an additional $403 per additional patient, when compared with standard sedation and analgesia. This was for when patients were fully recovered, with respect to activity level and food intake.
Sensitivity analysis indicated that the only model in which propofol administration would become the dominant strategy was with its administration by a registered nurse.
John J. Vargo, of the Cleveland Clinic Foundation, said on behalf his colleagues, "Gastroenterologist-administered propofol, using monitoring with capnography, is similar to meperidine/midazolam for both physiological outcomes and patient/endoscopist satisfaction."
"Propofol leads to significantly improved recovery of baseline activity and food intake 24 hours after the procedure," he added.
"Our model suggests that propofol would be more cost-effective than meperidine and midazolam for ERCP and EUS if registered nurse administration were possible," he concluded.
In an accompanying Editorial, authors Michael F. Byrne and John Baillie, of Duke University Medical Center, Durham, North Carolina, USA, comment, "The study suggests that gastroenterologist-administered propofol is safe and effective, but expensive.
"We expect that it will stimulate further controlled studies evaluating the safety of propofol administered by both physicians and nurses with appropriate training.
"However, the jury is still out regarding the place of propofol in modern gastrointestinal endoscopy."