Introduction. There is an increasing interest in balanced propofol sedation
(BPS) for colonoscopy in outpatient settings. Propofol is a potent anesthetic
agent for this purpose and has a narrow therapeutic range, which increases a
risk of cardiovascular and respiratory complications in case of improper
administration. Objective. The aim of this study was to compare patients?
safety and comfort of endoscopists in two methods of BPS targeting deep
sedation - propofol target-controlled infusion (TCI) and manual intravenous
titration technique (MT) - during colonoscopy. Methods. This prospective
randomized controlled trial included 90 patients (class I or II of the
American Society of Anesthesiologists) deeply sedated with propofol,
coadministered with small doses of midazolam and fentanyl. Propofol was given
by MT technique (45 patients) or by TCI (45 patients). The following adverse
effects were recorded: hypotension, hypertension, bradycardia, tachycardia,
hypoxemia, bradypnea, apnea, hiccupping, and coughing, as well as
endoscopist?s comfort during colonoscopy by means of a questionnaire.
Results. The MT group compared to the TCI group had a lower mean arterial
pressure in the 10th minute after the beginning (p = 0.017), and at the end
of colonoscopy (p = 0.006), higher oxygen saturation in the fifth minute (p =
0.033), and in the 15th minute (p = 0.008) after the beginning of
colonoscopy, and lower heart rate at the beginning of the procedure (p =
0.001). There were no statistically significant differences in adverse
events. Endoscopist?s comfort during colonoscopy was high 95.6% in the TCI
group vs. 88.9% in the MT group (p = 0.069). Conclusion. MT is clinically as
stable as TCI of propofol for deep sedation during colonoscopy, and
endoscopists experienced the same comfort during colonoscopy in both groups.
Thus, both combinations are suitable for deep sedation during diagnostic
colonoscopy.
The effect of bispectral index monitoring on cognitive performance following sedation for outpatient colonoscopy: a randomized controlled trial
