Propofol by nonanesthesiologists is controversial because the drug is commonly used to produce deep sedation or general anesthesia.
Propofol in combination with opioids and/or benzodiazepines can be titrated to moderate sedation, which might be safer.
Drs Megan VanNatta and Douglas Rex from Indiana assessed propofol alone titrated to deep sedation and in combination therapy with opioids and/or benzodiazepines.
The research team compared recovery time, patient satisfaction, and other end points.
The team designed a randomized controlled clinical trial of propofol use in 200 outpatients undergoing colonoscopy.
|Patients on combination regimens were discharged more quickly|
|American Journal of Gastroenterology|
Patients in Group 1 received propofol alone titrated to deep sedation, and those in Group 2 had fentanyl plus propofol.
The team randomized patients in Group 3 to midazolam plus propofol.
Patients in Group 4 received fentanyl plus midazolam plus propofol.
Patients receiving propofol alone received higher doses of propofol and had deeper sedation scores compared with combination therapy.
The researchers found that patients receiving combination regimens were discharged more quickly than those receiving propofol alone.
There were no differences in vital signs or oxygen saturations among the study arms.
The team observed no significant differences in pain or satisfaction among the study arms in the recovery area.
At a follow-up phone call, patients receiving fentanyl and propofol remembered more of the procedure than those in the other regimens.
In addition, the team noted that with fentanyl and propofol patients remembered more pain than those receiving propofol alone.
Dr VanNatta and colleagues conclude, “Propofol in combination with fentanyl and/or midazolam can be titrated to moderate levels of sedation without substantial loss of satisfaction.”
“The moderate combination therapy is also shows shorter recovery times compared with propofol titrated to deep sedation throughout the procedure.”