The dawning of a new sedative: propofol in gastrointestinal endoscopy.
BACKGROUND
Using gentler endoscopes and improved sedation, great strides have been made in enhancing patients' comfort and acceptance of endoscopic procedures. Because morbidity and mortality have been associated with benzodiazepines in endoscopic sedation, safer alternatives were sought. Propofol (2,6-diisopropylphenol), a rapid and short-acting anesthetic, initially used in the 1980's for general anesthesia induction and maintenance, is a promising candidate.


METHODS
This review article examines experiences and literature references of propofol's use in endoscopic procedures. Three critical questions are posed: What are the major advantages and potential risks of propofol? When should propofol be used? Who should administer propofol, how should it be administered, and what type of monitoring is required?


RESULTS
With considerable inter-patient variability, the propofol dose must be carefully titrated according to the individual patient's response. Factors influencing dosage include age, ASA class, patient's height and procedure duration. Propofol's primary risk is its narrow therapeutic range which necessitates careful patient monitoring.


CONCLUSIONS
Propofol's advantages over benzodiazepines and narcotics include a more rapid onset of action, full relief of discomfort and rapid recovery to alertness without residual sedative effects or anterograde amnesia, thereby making this drug a cost-effective and, with proper monitoring, safe choice.
Heuss
Ludwig T
LT
Department of Gastroenterology, University Hospital, Basel, Switzerland. lheuss@uhbs.ch
Inauen
Werner
W
D016292:Procedural Sedation / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008991:Monitoring, Physiologic; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D018579:Patient Selection; D015742:Propofol / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D012307:Risk Factors
D006993:Hypnotics and Sedatives; D015742:Propofol