title: Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists.
abstract: BACKGROUND
  Propofol is under evaluation as a sedative for endoscopic procedures.
  
  
  METHODS
  Eighty outpatients (ASA Class I or II) undergoing colonoscopy were randomized to receive either propofol or midazolam plus meperidine, administered by a nurse and supervised by an endoscopist. Endpoints were patient satisfaction, procedure and recovery times, neuropsychological function, and complications.
  
  
  RESULTS
  The mean dose of propofol administered was 218 mg; mean doses of midazolam and meperidine were, respectively, 4.7 mg and 89.7 mg. Mean time to sedation was faster in the propofol patients (2.1 min vs. 7.0 min; p < 0.0001), and depth of sedation was greater (p < 0.0001). On average, after the procedure, the propofol patients could stand at the bedside sooner (14.2 vs. 30.2 min), reached full recovery faster (14.4 vs. 33.0 min), and were discharged sooner (40.5 vs. 71.1 min) (all p < 0.0001). Patients who received propofol also expressed greater overall mean satisfaction on a 10-point visual analog scale (9.3 vs. 8.6; p < 0.05). At discharge, the propofol group had better scores on tests reflective of learning, memory, working memory span, and mental speed. Four patients in the midazolam/meperidine group developed minor complications (1 hypotension and bradycardia, 2 hypotension alone, and 1 tachycardia) and 1 patient in the propofol group had oxygen desaturation develop during an episode of epistaxis.
  
  
  CONCLUSIONS
  For outpatient colonoscopy, propofol administered by nurses and supervised by endoscopists has several advantages over midazolam plus meperidine and deserves additional investigation.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis 46202, USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Sipe
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
authors.forename: Danielle
authors.initials: D
authors.lastname: Latinovich
authors.forename: Chris
authors.initials: C
authors.lastname: Overley
authors.forename: Karen
authors.initials: K
authors.lastname: Kinser
authors.forename: Lisa
authors.initials: L
authors.lastname: Bratcher
authors.forename: David
authors.initials: D
authors.lastname: Kareken
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000762:Anesthesia Recovery Period; D003108:Colonic Diseases / Q000473:pathology*; D003113:Colonoscopy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009739:Nursing Services; D009934:Organization and Administration; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D020127:Recovery of Function / Q000187:drug effects; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives; D008614:Meperidine; D008874:Midazolam; D015742:Propofol