title: Patient-controlled versus nurse-administered sedation with propofol during colonoscopy. A prospective randomized trial.
abstract: OBJECTIVE
  Patient-controlled sedation (PCS) with propofol, is well tolerated and reduces recovery time and staff required during endoscopic interventions. "Who" administers the drug proves economically crucial. With the aim of maintaining safety, medical quality, and patient satisfaction, this study investigates PCS versus nurse-administered propofol sedation (NAPS) in a cohort of consecutive patients.
  
  
  METHODS
  One hundred and fourteen patients, aged 22-90 yr, undergoing only colonoscopy participated in this prospective randomized trial. Patients were randomly assigned to either PCS or NAPS. If patients declined randomization for different reasons of reluctance to PCS they were assigned to a standard nurse-sedated control group. All patients received pethidine presedation for analgesia. Visual analogue scales followed patient anxiety level, tolerability, pain, and satisfaction, and endoscopist's assessment of the procedure.
  
  
  RESULTS
  Given the choice, 35% of the patients who were rather younger and more anxious declined randomization to PCS. The mean total dose of propofol needed in this group was higher, but the patients had a tendency to rate the global tolerance and the pain of the examination as less comfortable compared to the two randomized groups. Self-administration of propofol created a significantly different drug profile and higher medication costs. With regard to the safety parameters there was no difference between PCS and NAPS. In their global assessments, the patients and endoscopists tended to prefer NAPS.
  
  
  CONCLUSIONS
  Individual patient characteristics and attitudes toward self-control are crucial for PCS. While being a viable option for patients who are able and willing to handle, this technique is not applicable in a considerable portion of everyday patients.
authors.affiliation: Department of Gastroenterology, University Hospital Basel, Basel, Switzerland.
authors.forename: Ludwig T
authors.initials: LT
authors.lastname: Heuss
authors.forename: Juergen
authors.initials: J
authors.lastname: Drewe
authors.forename: Patrizia
authors.initials: P
authors.lastname: Schnieper
authors.forename: Claudia B
authors.initials: CB
authors.lastname: Tapparelli
authors.forename: Eric
authors.initials: E
authors.lastname: Pflimlin
authors.forename: Christoph
authors.initials: C
authors.lastname: Beglinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled; D003113:Colonoscopy / Q000009:adverse effects*; D016292:Procedural Sedation / Q000451:nursing*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol