A research team, from Hong Kong, China, used a prospective randomized trial to assess the safety, effectiveness, and patient acceptance of patient-controlled sedation and intravenous sedation for colonoscopy.
The team recruited 100 patients (over 65 years).
These patients were randomized to patient-controlled sedation (mean age 72) or intravenous sedation (mean age 74) groups.
In the patient-controlled sedation group, a mixture of propofol and alfentanil was delivered by means of a patient-controlled pump (each bolus delivered 4.8 mg propofol and 12 µg alfentanil).
No loading dose was used and the lockout time was set at 0.
|Occurrence of hypotension:|
- Patient-controlled group = 4%
- Intravenous group = 28%
For the intravenous sedation group, fixed doses of diazemuls (0.1 mg/kg) and meperidine (0.5 mg/kg) were given, with further increases in dosages administered at the discretion of the endoscopist.
The team assessed outcome measures, including cardiopulmonary complications, recovery time, pain score, and satisfaction score.
The researchers discovered the mean dose of propofol consumed in the patient-controlled sedation group was 0.79 mg/kg.
Whereas, the mean doses of diazemuls and meperidine consumed in intravenous sedation group were, respectively, 5.8 mg and 30.1 mg.
Hypotension occurred in 4% of patients in the patient-controlled sedation group and 28% in the intravenous sedation group.
Oxygen desaturation was recorded for 8% of patients in the intravenous sedation group.
In addition, the median recovery time was significantly shorter in the patient-controlled sedation group, compared with the intravenous sedation group.
However, the team identified no statistically significant differences between groups for pain and satisfaction scores.
Dr Danny Lee's team concluded, "Patient-controlled sedation appears to be safer than intravenous sedation, with comparable effectiveness and acceptance, in elderly patients undergoing elective outpatient colonoscopy".