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Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine.
Endoscopy. 2003 Aug; 35(8):683-7.E

Abstract

BACKGROUND AND STUDY AIMS

Patient-controlled sedation (PCS) using propofol and alfentanil provides effective sedation for colonoscopy, with the advantage of a shorter recovery time in comparison with diazepam and pethidine. However, most endoscopy units in the United Kingdom are currently using midazolam (a shorter-acting benzodiazepine) as a sedative agent. This study compares the efficacy of sedation and recovery times between PCS and a combination of midazolam and pethidine.

PATIENTS AND METHODS

Sixty-seven patients undergoing colonoscopy were randomly assigned prospectively to receive sedation with either PCS, using propofol and alfentanil, or a bolus of midazolam and pethidine. Sedation and pain scores were recorded during the procedure by one specialist nurse. Patients' recollection of pain was recorded after the procedure. Recovery was assessed using number connection tests. The impact on subsequent activities and the level of amnesia, as well as overall satisfaction, were established by telephone call after 24 h.

RESULTS

The sedation method had no impact on the success, difficulty, or duration of the colonoscopy. PCS could be set up by the specialist nurse without affecting the time between cases. Patients in the PCS group recovered significantly faster (median 5 min vs 35 min; P < 0.0001) and left the department more quickly (median 40 min vs 75 min; P < 0.0001). Patients in the PCS group had significantly higher pain scores and significantly more recall than those in the midazolam and pethidine group. All patients were satisfied with the sedation they received.

CONCLUSIONS

PCS provides an acceptable alternative to sedation with midazolam and pethidine with the advantage of significantly faster recovery times, which are of relevance in the outpatient setting.

Authors+Show Affiliations

Bright E
Dept. of Anaesthetics, Southampton General Hospital, Southampton, UK.
Roseveare C
No affiliation info available
Dalgleish D
No affiliation info available
Kimble J
No affiliation info available
Elliott J
No affiliation info available
Shepherd H
No affiliation info available

MeSH

Adjuvants, AnesthesiaAdultAgedAged, 80 and overAlfentanilAnalgesia, Patient-ControlledAnesthetics, IntravenousColonoscopyDrug Therapy, CombinationFemaleHumansHypnotics and SedativesIntraoperative ComplicationsMaleMeperidineMidazolamMiddle AgedPainPhysiciansPropofolProspective Studies

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

12929065

Citation

Bright, E, et al. "Patient-controlled Sedation for Colonoscopy: a Randomized Trial Comparing Patient-controlled Administration of Propofol and Alfentanil With Physician-administered Midazolam and Pethidine." Endoscopy, vol. 35, no. 8, 2003, pp. 683-7.
Bright E, Roseveare C, Dalgleish D, et al. Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine. Endoscopy. 2003;35(8):683-7.
Bright, E., Roseveare, C., Dalgleish, D., Kimble, J., Elliott, J., & Shepherd, H. (2003). Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine. Endoscopy, 35(8), 683-7.
Bright E, et al. Patient-controlled Sedation for Colonoscopy: a Randomized Trial Comparing Patient-controlled Administration of Propofol and Alfentanil With Physician-administered Midazolam and Pethidine. Endoscopy. 2003;35(8):683-7. PubMed PMID: 12929065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine. AU - Bright,E, AU - Roseveare,C, AU - Dalgleish,D, AU - Kimble,J, AU - Elliott,J, AU - Shepherd,H, PY - 2003/8/21/pubmed PY - 2003/12/6/medline PY - 2003/8/21/entrez SP - 683 EP - 7 JF - Endoscopy JO - Endoscopy VL - 35 IS - 8 N2 - BACKGROUND AND STUDY AIMS: Patient-controlled sedation (PCS) using propofol and alfentanil provides effective sedation for colonoscopy, with the advantage of a shorter recovery time in comparison with diazepam and pethidine. However, most endoscopy units in the United Kingdom are currently using midazolam (a shorter-acting benzodiazepine) as a sedative agent. This study compares the efficacy of sedation and recovery times between PCS and a combination of midazolam and pethidine. PATIENTS AND METHODS: Sixty-seven patients undergoing colonoscopy were randomly assigned prospectively to receive sedation with either PCS, using propofol and alfentanil, or a bolus of midazolam and pethidine. Sedation and pain scores were recorded during the procedure by one specialist nurse. Patients' recollection of pain was recorded after the procedure. Recovery was assessed using number connection tests. The impact on subsequent activities and the level of amnesia, as well as overall satisfaction, were established by telephone call after 24 h. RESULTS: The sedation method had no impact on the success, difficulty, or duration of the colonoscopy. PCS could be set up by the specialist nurse without affecting the time between cases. Patients in the PCS group recovered significantly faster (median 5 min vs 35 min; P < 0.0001) and left the department more quickly (median 40 min vs 75 min; P < 0.0001). Patients in the PCS group had significantly higher pain scores and significantly more recall than those in the midazolam and pethidine group. All patients were satisfied with the sedation they received. CONCLUSIONS: PCS provides an acceptable alternative to sedation with midazolam and pethidine with the advantage of significantly faster recovery times, which are of relevance in the outpatient setting. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/12929065/Patient_controlled_sedation_for_colonoscopy:_a_randomized_trial_comparing_patient_controlled_administration_of_propofol_and_alfentanil_with_physician_administered_midazolam_and_pethidine_ DB - PRIME DP - Unbound Medicine ER -