[Propofol in combination with meperidine and midazolam in colonoscopy and upper endoscopy: first prospective study in private practice in Peru].
BACKGROUND
There is currently a vast experience reported in the literature with respect to Propofol utilization as a single agent and in combination with narcotics and/or benzodiazepines in endoscopic procedures, without the presence of an anesthesiologist in the endoscopy suite. Over 200 thousand reported procedures have demonstrated safety and excellent acceptance by patients.


OBJECTIVE
To report the experience in a private endoscopy center in Lima utilizing propofol in combination with Meperidine and Midazolam in colonoscopies and upper endoscopies, administered by a nurse supervised by a trained gastroenterologist without the presence of an anesthesiologist.


METHODS
We included adult patients with low or moderate risk for sedation, subjected to colonoscopy and / or upper endoscopy between November 2006 and September 2007 in the Gastroenterology Service at the Clinica Anglo Americana in Lima. Meperidine 25 mg IV was administered for colonoscopy and 50 mg IV for upper endoscopy and Midazolam 1.5 mg for both procedures as premedication. All the patients received Oxygen 2 L/min per nasal cannula throughout the procedure. After the above mentioned premedication, an initial bolus of propofol (10 - 30 mg) was administered, according to the general condition of the patient and the level of sedation achieved by the premedication, according to the judgement made by the gastroenterologist and the nurse. We registered the following variables: sex, age, average dose of propofol according to sex, age and procedure. We also registered adverse events such as desaturation < 90%, hypotension, bradycardia, need for assisted ventilation or hospitalization.


RESULTS
Four hundred procedures were performed, 315 colonoscopies (78.8%) and 85 upper endoscopies (21.3%). One hundred sixty one procedures (42.8%) were done in males and 229 (57.3%) in females. The average age was 60 years (22-91). The average propofol dose in general was 85.6 mg (10-330), 85.6, 87.7 mg in average for colonoscopies and 41.05 mg for upper endoscopies (p< 0.05). The average propofol dose for males was 78.4 mg and 91 mg for females (p<0.05). For patients younger than 70 years old (307) the average propofol dose was 91.6 mg and for patients older than 70 years old (93) it was 65.6 mg (p<0.05). We only registered one episode of oxygen desaturation to less than 90% (86%) responding to increase in the oxygen flow per nasal cannula and repositioning of the neck and chin. No patient required assisted ventilation or intubation, nor hospitalization for observation after the procedure. One hundred percent of the patients stated non having any discomfort whatsoever and expressed their satisfaction with the procedure.


CONCLUSIONS
Propofol combined with Meperine and Midazolam in endoscopic procedures is a safe agent administered by a trained gastroenterologist and nurse. Pacientes undergoing upper endoscopy, males and patients younger than 70 years old, required less doses of propofol compared with those subjected to colonoscopy, females and patients older than 70 years old respectively. We did not report complications or hospitalizations. Tolerance to endoscopic procedures with the above mentioned combination.
Tagle
Martín
M
Servicio de Gastroenterología, Clínica Anglo Americana, Lima, Perú.
Siu
Hugo
H
Ramos
María
M
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D003113:Colonoscopy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008614:Meperidine / Q000008:administration & dosage*; D008875:Middle Aged; D010568:Peru; D011331:Private Practice; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies
D000759:Adjuvants, Anesthesia; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D008614:Meperidine; D015742:Propofol