Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy

• Published in: The American journal of gastroenterology Vol. 95; no. 6; pp. 1476 - 1479
• Main Authors: KOSHY, G, NAIR, S, NORKUS, E. P, HERTAN, H. I, PITCHUMONI, C. S
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01-06-2000; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Aged; Biological and medical sciences; Conscious Sedation; Digestive System - pathology; Endoscopy; Female; Gastroenterology; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Hypnotics. Sedatives; Male; Medical sciences; Meperidine - adverse effects; Meperidine - therapeutic use; Midazolam - adverse effects; Midazolam - therapeutic use; Middle Aged; Narcotics - adverse effects; Narcotics - therapeutic use; Neuropharmacology; Pharmacology. Drug treatments; Propofol - adverse effects; Propofol - therapeutic use; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Treatment Outcome; Human; Chemotherapy; Digestive system; Anesthesia; Endoscopy; Midazolam; Propofol; Sedation; Comparative study
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2000.02080.x

Propofol (2,6-diisopropyl phenol) is a relatively new intravenous sedative hypnotic with an ideal pharmacokinetic profile for conscious sedation. In this study, we compared the safety and efficacy of propofol versus the conventional regimen of midazolam and meperidine for conscious sedation in GI endoscopy.
In this prospective study, 274 patients that included many elderly patients with multiple comorbid conditions underwent GI endoscopic procedures at our hospital. A total of 150 patients received propofol (20-120 mg) and fentanyl (0.25-1.5 mg). The control group of 124 patients was given midazolam (2-6 mg) and meperidine (25-75 mg). The dose of medication was titrated according to patient need and the duration of the procedure. A "comfort score" on a scale of 1-4 assessed the efficacy of the drugs based on pain or discomfort to the patient and ease of endoscopy. A "sedation score" was used to assess the degree of sedation on a scale of 1-5. The Aldrete score was used to measure recovery from anesthesia at 5 and 10 min after the procedure.
After controlling for age, American Society of Anesthesiologists' Physical Status Classification (ASA grade), and type and duration of procedure, logistic regression analysis determined that propofol resulted in 2.04 times better patient comfort (p = 0.033, 95% CI = 1.058-3.923). Propofol was 1.84 times more likely to produce deeper sedation than the regimen of midazolam and meperidine (p = 0.027, 95% CI = 1.071-3.083). The recovery from sedation was faster in patients receiving propofol, although this did not reach statistical significance. The safety parameters between the two groups were comparable.
Propofol was associated with a statistically significant improvement in comfort and sedation score when compared to midazolam and meperidine.