title: Cocktail sedation containing propofol versus conventional sedation for ERCP: a prospective, randomized controlled study.
abstract: BACKGROUND
  ERCP practically requires moderate to deep sedation controlled by a combination of benzodiazepine and opiod. Propofol as a sole agent may cause oversedation. A combination (cocktail) of infused propofol, meperidine, and midazolam can reduce the dosage of propofol and we hypothesized that it might decrease the risk of oversedation. We prospectively compare the efficacy, recovery time, patient satisfactory, and side effects between cocktail and conventional sedations in patients undergoing ERCP.
  
  
  METHODS
  ERCP patients were randomized into 2 groups; the cocktail group (n = 103) and the controls (n = 102). For induction, a combination of 25 mg of meperidine and 2.5 mg of midazolam were administered in both groups. In the cocktail group, a bolus dose of propofol 1 mg/kg was administered and continuously infused. In the controls, 25 mg of meperidine or 2.5 mg/kg of midazolam were titrated to maintain the level of sedation.
  
  
  RESULTS
  In the cocktail group, the average administration rate of propofol was 6.2 mg/kg/hr. In the control group; average weight base dosage of meperidine and midazolam were 1.03 mg/kg and 0.12 mg/kg, respectively. Recovery times and patients' satisfaction scores in the cocktail and control groups were 9.67 minutes and 12.89 minutes (P = 0.045), 93.1and 87.6 (P <0.001), respectively. Desaturation rates in the cocktail and conventional groups were 58.3% and 31.4% (P <0.001), respectively. All desaturations were corrected with temporary oxygen supplementation without the need for scope removal.
  
  
  CONCLUSIONS
  Cocktail sedation containing propofol provides faster recovery time and better patients' satisfaction for patients undergoing ERCP. However, mild degree of desaturation may still develop.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT01540084.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10310, Thailand. rungsun@pol.net.
authors.forename: Phonthep
authors.initials: P
authors.lastname: Angsuwatcharakon
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr
authors.forename: Wiriyaporn
authors.initials: W
authors.lastname: Ridtitid
authors.forename: Pradermchai
authors.initials: P
authors.lastname: Kongkam
authors.forename: Sahadol
authors.initials: S
authors.lastname: Poonyathawon
authors.forename: Yuwadee
authors.initials: Y
authors.lastname: Ponauthai
authors.forename: Sakolkan
authors.initials: S
authors.lastname: Sumdin
authors.forename: Pinit
authors.initials: P
authors.lastname: Kullavanijaya