[Propofol sedation in endoscopic manometry of Oddi's sphincter].
Endoscopic manometry of the sphincter Oddi (SO) is a sophisticated method which requires a cooperative patient. Therefore, during endoscopic manometry sufficient i.v. sedation is crucial, and additionally must no affect SO-motility. In a pilot trial SO-motility was determined in ten patients with suspected SO-dysfunction (SOD) under initial sedation with 4.8 +/- 1 mg midazolam (baseline), and 3 min after an i.v. bolus of 50 mg of propofol. In addition, endoscopic manometry was performed in 57 consecutive patients with suspected SOD from 10/94-9/95 under sedation with midazolam (6.2 +/- 1.6 mg), and from 10/95-9/96 with propofol (268 +/- 111 mg). Sedation was always performed by an independent physician according to a standardized protocol. Neither the SO-baseline pressure nor the parameters of phasic SO-motility were significantly altered by propofol (including two patients with proven SOD). Propofol causes a more rapid onset of sedation, and the time interval to obtain successful biliary cannulation was shorter than under midazolam (p < 0.05). Successful manometric recordings could be obtained in 82% of the patients under midazolam but in 96% of the patients under propofol-sedation (p < 0.05), respectively. The patient cooperation was significantly better rated (by the endoscopist) in the propofol group than in the midazolam group (p < 0.01). The blood pressure and the heart rate were not significantly affected in both groups, however, propofol caused a significant decrease of the oxygen saturation (p < 0.05). Accordingly, an apnea episode had to be mastered by mask ventilation via ambu bag in one patient under propofol-sedation (uneventful recovery). In the midazolam group flumazenil-administration was necessary in four patients. The post-procedure recovery was faster after propofol--than after midazolam-sedation (p < 0.05). In conclusion, propofol is suitable for i.v. sedation during endoscopic manometry of the spincter of Oddi.
Schmitt
T
T
Medizinische Klinik II, J.-W.-Goethe-Universität, Frankfurt am Main.
Seifert
H
H
Dietrich
C F
CF
Caspary
W E
WE
Wehrmann
T
T
D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D003137:Common Bile Duct Diseases / Q000175:diagnosis* / Q000503:physiopathology; D016292:Procedural Sedation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D020698:Duodenoscopes; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation; D007262:Infusions, Intravenous; D008297:Male; D008365:Manometry / Q000295:instrumentation; D008874:Midazolam; D008875:Middle Aged; D010865:Pilot Projects; D017562:Postcholecystectomy Syndrome / Q000175:diagnosis / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D015742:Propofol; D009803:Sphincter of Oddi / Q000187:drug effects / Q000503:physiopathology
D008874:Midazolam; D015742:Propofol