Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study

• Published in: Gastrointestinal endoscopy 1999-06, Vol.49 (6), p.677-683
• Main Authors: Wehrmann, Till, Kokabpick, Sepideh, Lembcke, Bernhard, Caspary, Wolfgang F., Seifert, Hans
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde; Conscious Sedation - methods; Female; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Infusions, Intravenous; Male; Medical sciences; Midazolam - administration & dosage; Middle Aged; Propofol - administration & dosage; Prospective Studies; Statistics, Nonparametric; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(99)70281-6

Background: Adequate patient sedation is mandatory for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The short-acting anesthetic propofol offers certain potential advantages for endoscopic procedures, but controlled studies proving its superiority over benzodiazepines for ERCP are lacking. Methods: During a 6-month period 198 consecutive patients undergoing routine ERCP randomly received either midazolam (n = 98) or propofol (n = 99) for sedation. Vital signs (heart rate, blood pressure, oxygen saturation) were continuously monitored and procedure-related parameters, the recovery time and quality (recovery score) as well as the patient ́s cooperation and tolerance of the procedure (visual analog scales) were prospectively assessed. Results: Patients receiving propofol or midazolam were well matched with respect to demographic and clinical data, ERCP findings, and the performance of associated procedures. Propofol caused a more rapid onset of sedation than midazolam ( p < 0.01). Clinically relevant changes in vital signs were observed at comparable frequencies with temporary oxygen desaturation occurring (< 85 %) in 6 patients in the propofol group and 4 patients receiving midazolam (not significant). However, an episode of apnea had to be managed by mask ventilation via an ambu bag (lasting 8 minutes) in one of the patients receiving propofol sedation. Mean recovery times as well as the recovery scores were significantly shorter with propofol ( p < 0.01). Propofol provided significantly better patient cooperation than midazolam ( p < 0.01), but procedure tolerability was rated the same by both groups of patients (not significant). Conclusions: Intravenous sedation with propofol for ERCP is (1) more effective than sedation with midazolam, (2) safe under adequate patient monitoring, and (3) associated with a faster postprocedure recovery. (Gastrointest Endosc 1999;49:677-83.)