Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists.
OBJECTIVE
Propofol is under evaluation as a sedative for endoscopic procedures. We compared nurse-administered propofol to midazolam plus fentanyl for outpatient colonoscopy.


METHODS
One hundred outpatients undergoing colonoscopy were randomized to receive propofol or midazolam plus fentanyl, administered by a registered nurse and supervised only by an endoscopist. Endpoints were patient satisfaction, procedure and recovery times, neuropsychologic function, and complications.


RESULTS
The mean dose of propofol administered was 277 mg; mean doses of midazolam and fentanyl were 7.2 mg and 117 microg, respectively. Mean time to sedation was faster with propofol (2.1 vs. 6.1 min; P<0.0001), and depth of sedation was greater (P<0.0001). Patients receiving propofol reached full recovery sooner (16.5 vs. 27.5 min; P=0.0001) and were discharged sooner (36.5 vs. 46.1 min; P=0.01). After recovery, the propofol group scored better on tests reflective of learning, memory, working memory span, and mental speed. Six minor complications occurred in the propofol group: 4 episodes of hypotension, 1 episode of bradycardia, and 1 rash. Five complications occurred with the use of midazolam and fentanyl: one episode of oxygen desaturation requiring mask ventilation and 4 episodes of hypotension. Patients in the propofol vs. midazolam and fentanyl groups reported similar degrees of overall satisfaction using a 10-cm visual analog scale (9.3 vs. 9.4, P>0.5).


CONCLUSIONS
Nurse-administered propofol resulted in several advantages for outpatient colonoscopy compared with midazolam plus fentanyl, but did not improve patient satisfaction.
Ulmer
Brian J
BJ
Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Hospital, Indianapolis 46202, USA.
Hansen
Jonathan J
JJ
Overley
Christine A
CA
Symms
Michelle R
MR
Chadalawada
Vidyasree
V
Liangpunsakul
Suthat
S
Strahl
Eloise
E
Mendel
April M
AM
Rex
Douglas K
DK
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000762:Anesthesia Recovery Period; D001288:Attention / Q000187:drug effects; D001309:Auditory Threshold / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D003071:Cognition / Q000187:drug effects; D003113:Colonoscopy; D016292:Procedural Sedation / Q000451:nursing; D003971:Diastole / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D009745:Nursing, Supervisory; D010100:Oxygen / Q000097:blood; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects; D011787:Quality of Health Care; D012720:Severity of Illness Index; D013599:Systole / Q000187:drug effects; D013997:Time Factors
D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl; D015742:Propofol