title: Balanced propofol sedation administered by nonanesthesiologists: The first Italian experience.
abstract: OBJECTIVE
  To assess the efficacy and safety of a balanced approach using midazolam in combination with propofol, administered by non-anesthesiologists, in a large series of diagnostic colonoscopies.
  
  
  METHODS
  Consecutive patients undergoing diagnostic colonoscopy were sedated with a single dose of midazolam (0.05 mg/kg) and low-dose propofol (starter bolus of 0.5 mg/kg and repeated boluses of 10 to 20 mg). Induction time and deepest level of sedation, adverse and serious adverse events, as well as recovery times, were prospectively assessed. Cecal intubation and adenoma detection rates were also collected.
  
  
  RESULTS
  Overall, 1593 eligible patients were included. The median dose of propofol administered was 70 mg (range: 40-120 mg), and the median dose of midazolam was 2.3 mg (range: 2-4 mg). Median induction time of sedation was 3 min (range: 1-4 min), and median recovery time was 23 min (range: 10-40 min). A moderate level of sedation was achieved in 1561 (98%) patients, whilst a deep sedation occurred in 32 (2%) cases. Transient oxygen desaturation requiring further oxygen supplementation occurred in 8 (0.46%; 95% CI: 0.2%-0.8%) patients. No serious adverse event was observed. Cecal intubation and adenoma detection rates were 93.5% and 23.4% (27.8% for male and 18.5% for female, subjects), respectively.
  
  
  CONCLUSIONS
  A balanced sedation protocol provided a minimalization of the dose of propofol needed to target a moderate sedation for colonoscopy, resulting in a high safety profile for non-anesthesiologist propofol sedation.
authors: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Via Manzoni 56 20089 Rozzano, Milan, Italy. alessandro.repici@humanitas.it
authors: Alessandro
authors: A
authors: Repici
authors: Nico
authors: N
authors: Pagano
authors: Cesare
authors: C
authors: Hassan
authors: Alessandra
authors: A
authors: Carlino
authors: Giacomo
authors: G
authors: Rando
authors: Giuseppe
authors: G
authors: Strangio
authors: Fabio
authors: F
authors: Romeo
authors: Angelo
authors: A
authors: Zullo
authors: Elisa
authors: E
authors: Ferrara
authors: Eva
authors: E
authors: Vitetta
authors: Daniel de Paula Pessoa
authors: Dde P
authors: Ferreira
authors: Silvio
authors: S
authors: Danese
authors: Massimo
authors: M
authors: Arosio
authors: Alberto
authors: A
authors: Malesci
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D003113:Colonoscopy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000627:therapeutic use; D007558:Italy; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol