Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: a prospective study.
BACKGROUND
Many pediatric endoscopists are adopting propofol in their practices, with the expectation that propofol will increase their overall efficiency.


OBJECTIVE
To compare the efficiency of propofol versus midazolam and fentanyl by measuring elapsed times between initial intravenous administration and patient discharge at a pediatric teaching hospital.


METHODS
Endoscopy times were prospectively collected for consecutive patients who were undergoing either anesthesiologist-administered propofol or endoscopist-administered midazolam and fentanyl. The effect of the type of sedation on these times was assessed by using multiple linear regression by adjusting for other candidate predictors, including concomitant use of other sedatives, endotracheal intubation by anesthesiologists, and the presence of fellow trainees.


METHODS
Time to onset of sedation (time sedation started to scope in), procedure time (endoscope in to endoscope out), discharge time (endoscope out to hospital discharge), and total time (sedation started to hospital discharge).


RESULTS
The times for 134 children (mean age 12 +/- 5 years) to receive propofol sedation were compared with those of 195 children (13 +/- 5 years) who received midazolam and fentanyl. Midazolam and fentanyl cases disproportionately included EGDs (P < .001) and patients who were classified as American Society of Anesthesiologists I (P < .03). Patients who received propofol had shorter times until sedated, similar procedure times, longer discharge times, and comparable total times. Multivariate analyses confirmed that fellow participation prolonged the procedure times (P < .0001), and endotracheal intubation prolonged propofol times (P <. 01), but adjusting for these did not change the comparison results.


CONCLUSIONS
Anesthesiologist-administered propofol sedation in a pediatric teaching endoscopy unit may not lead to faster hospital times when compared with endoscopist-administered midazolam and fentanyl. These results are not explained by controlling for patient characteristics, the presence of a trainee, the sedative doses, or endotracheal intubation for airway management.
Lightdale
Jenifer R
JR
Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Valim
Clarissa
C
Newburg
Adrienne R
AR
Mahoney
Lisa B
LB
Zgleszewski
Steven
S
Fox
Victor L
VL
D000293:Adolescent; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002648:Child; D016292:Procedural Sedation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006784:Hospitals, Teaching; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D015999:Multivariate Analysis; D011336:Probability; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors
D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol