Synergistic sedation with low-dose midazolam and propofol for colonoscopies.
OBJECTIVE
Patients undergoing colonoscopy are often sedated with benzodiazepines and long-acting opiates. Since low-dose midazolam also acts synergistically with short-acting propofol, we compared this synergistic sedation with a standard combination of midazolam and the opioid nalbuphine for colonoscopies.


METHODS
A total of 79 patients presenting for colonoscopies were randomly assigned to the following protocols. Patients in group I (n = 32) received a median dose of 9 mg midazolam (interquartile range [IQR] 6 to 12); 20 patients (59%) needed additional nalbuphine (median 20 mg, IQR 10 to 20). Patients in group II (n = 47) received 2 mg midazolam and repeated injections of propofol (median 100 mg, IQR 53 to 145) with a maximal bolus of 50 mg.


RESULTS
Patients treated with the synergistic sedation (group II) recovered remarkably sooner after the procedure compared with those in group I, with a median time to discharge of 17 minutes vs. 93 minutes (P<0.001). Of the patients treated with analgosedation (group I), 28 % were unable to take part in a reaction time measurement and attention awareness test 1 hour after the procedure. All patients treated with the synergistic sedation were able to participate (P=0.002), and performed better. Despite a lower proportion of complete amnesia, patients treated with synergistic sedation more often rated the procedure as comfortable (81% vs. 50 %). Quality of sedation from the point of view of the endoscopist, and cardiorespiratory parameters, were similar in both groups.


CONCLUSIONS
Low-dose midazolam combined with propofol is an effective and economic alternative to benzodiazepine-based analgosedation. It is associated with a high degree of patient comfort and rapid recovery times, and has a potential cost benefit concerning nursing care and bed facilities.
Reimann
F M
FM
Department of Internal Medicine I, University of Lübeck, Germany. reimann.f@t-online.de
Samson
U
U
Derad
I
I
Fuchs
M
M
Schiefer
B
B
Stange
E F
EF
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000762:Anesthesia Recovery Period; D003113:Colonoscopy; D016292:Procedural Sedation; D004357:Drug Synergism; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D009266:Nalbuphine / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009266:Nalbuphine; D008874:Midazolam; D015742:Propofol