title: Target-controlled infusion vs. manually controlled infusion of propofol with alfentanil for bidirectional endoscopy: a randomized controlled trial.
abstract: OBJECTIVE
  The best anesthesia methods for analgesia and sedation during gastrointestinal endoscopy are still debated. The aim of this study was to compare the recovery time, clinical presentations, and satisfaction between target-controlled infusion (TCI) and manually controlled infusion (MCI) in same-day bidirectional endoscopy (esophagogastroduodenoscopy followed by colonoscopy).
  
  
  METHODS
  A total of 220 patients with American Society of Anesthesiology physical status 1 or 2 were enrolled and randomized into the TCI or MCI groups. The clinical presentations, vasoactive drug demand, propofol consumption, and adverse events were recorded for both groups peri-procedurally. The concentrations of propofol in the plasma (Cp) and at the site of drug effect (Ce) by computerized simulation were also monitored in both groups. Finally, the satisfaction of patients, endoscopists, and nurse anesthetists was assessed by questionnaire after the examinations.
  
  
  RESULTS
  Compared with the MCI group, the TCI group had a faster recovery time (17.91 ± 7.72 minutes vs. 14.58 ± 8.55 minutes; P = 0.002), less moderate hypotension (7.37 ± 15.46 % vs. 1.82 ± 5.15 %; P < 0.001), and shorter period of bradypnea (13.81 ± 15.92 % vs. 9.18 ± 12.00 %; P = 0.013). In addition, the TCI group reduced the relative risk of moderate desaturation by 50 % compared with the MCI group (30.9 % vs. 15.5 %; 95 % confidence interval 1.191-3.360; P = 0.007).
  
  
  CONCLUSIONS
  The study demonstrated that TCI of propofol combined with alfentanil was associated with a faster recovery time, and better hemodynamic and respiratory stability than MCI in same-day bidirectional endoscopy.
  
  
  BACKGROUND
  CGMH IRB Identifier 97-0969B.
authors.affiliation: Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Min-Hsien
authors.initials: MH
authors.lastname: Chiang
authors.forename: Shao-Chun
authors.initials: SC
authors.lastname: Wu
authors.forename: Chia-Hsun
authors.initials: CH
authors.lastname: You
authors.forename: Keng-Liang
authors.initials: KL
authors.lastname: Wu
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chiu
authors.forename: Chao-Wei
authors.initials: CW
authors.lastname: Ma
authors.forename: Chin-Wei
authors.initials: CW
authors.lastname: Kao
authors.forename: Kun-Chen
authors.initials: KC
authors.lastname: Lin
authors.forename: Kuan-Hung
authors.initials: KH
authors.lastname: Chen
authors.forename: Peng-Chih
authors.initials: PC
authors.lastname: Wang
authors.forename: An-Kuo
authors.initials: AK
authors.lastname: Chou
mesh_terms: D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D003113:Colonoscopy; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage*; D011795:Surveys and Questionnaires
chemical_list: D018686:Anesthetics, Intravenous; D015760:Alfentanil; D015742:Propofol