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Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: a prospective study.
Gastrointest Endosc. 2008 Jun; 67(7):1067-75.GE

Abstract

BACKGROUND

Many pediatric endoscopists are adopting propofol in their practices, with the expectation that propofol will increase their overall efficiency.

OBJECTIVE AND SETTING

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.

DESIGN

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.

MAIN OUTCOME MEASUREMENTS

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.

Authors+Show Affiliations

Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18367187

Citation

Lightdale, Jenifer R., et al. "Efficiency of Propofol Versus Midazolam and Fentanyl Sedation at a Pediatric Teaching Hospital: a Prospective Study." Gastrointestinal Endoscopy, vol. 67, no. 7, 2008, pp. 1067-75.
Lightdale JR, Valim C, Newburg AR, et al. Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: a prospective study. Gastrointest Endosc. 2008;67(7):1067-75.
Lightdale, J. R., Valim, C., Newburg, A. R., Mahoney, L. B., Zgleszewski, S., & Fox, V. L. (2008). Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: a prospective study. Gastrointestinal Endoscopy, 67(7), 1067-75. https://doi.org/10.1016/j.gie.2007.11.038
Lightdale JR, et al. Efficiency of Propofol Versus Midazolam and Fentanyl Sedation at a Pediatric Teaching Hospital: a Prospective Study. Gastrointest Endosc. 2008;67(7):1067-75. PubMed PMID: 18367187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: a prospective study. AU - Lightdale,Jenifer R, AU - Valim,Clarissa, AU - Newburg,Adrienne R, AU - Mahoney,Lisa B, AU - Zgleszewski,Steven, AU - Fox,Victor L, Y1 - 2008/03/26/ PY - 2007/04/01/received PY - 2007/11/12/accepted PY - 2008/3/28/pubmed PY - 2008/8/30/medline PY - 2008/3/28/entrez SP - 1067 EP - 75 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 67 IS - 7 N2 - BACKGROUND: Many pediatric endoscopists are adopting propofol in their practices, with the expectation that propofol will increase their overall efficiency. OBJECTIVE AND SETTING: 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. DESIGN: 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. MAIN OUTCOME MEASUREMENTS: 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. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/18367187/Efficiency_of_propofol_versus_midazolam_and_fentanyl_sedation_at_a_pediatric_teaching_hospital:_a_prospective_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(07)03116-1 DB - PRIME DP - Unbound Medicine ER -