Propofol versus midazolam and meperidine for conscious sedation in gi endoscopy

Gita Koshy, Satheesh Nair, Edward P. Norkus, Hilary I. Hertan, C. S. Pitchumoni

Research output: Contribution to journalArticle

195 Citations (Scopus)

Abstract

OBJECTIVE: Propofol (2,6-diisopropyl phenol) is a relatively new intravenous sedative hypnotic with an ideal pharmacokinetic profile for conscious sedation. In this study, we compared the safety and efficacy of propofol versus the conventional regimen of midazolam and meperidine for conscious sedation in GI endoscopy. METHODS: In this prospective study, 274 patients that included many elderly patients with multiple comorbid conditions underwent GI endoscopic procedures at our hospital. A total of 150 patients received propofol (20-120 mg) and fentanyl (0.25-1.5 mg). The control group of 124 patients was given midazolam (2-6 mg) and meperidine (25-75 mg). The dose of medication was titrated according to patient need and the duration of the procedure. A 'comfort score' on a scale of 1-4 assessed the efficacy of the drugs based on pain or discomfort to the patient and ease of endoscopy A 'sedation score' was used to assess the degree of sedation on a scale of 1-5. The Aldrete score was used to measure recovery from anesthesia at 5 and 10 min after the procedure. RESULTS: After controlling for age, American Society of Anesthesiologists' Physical Status Classification (ASA grade), and type and duration of procedure, logistic regression analysis determined that propofol resulted in 2.04 times better patient comfort (p = 0.033, 95% CI = 1.058-3.923). Propofol was 1.84 times more likely to produce deeper sedation than the regimen of midazolam and meperidine (p = 0.027, 95% CI = 1.071-3.083). The recovery from sedation was faster in patients receiving propofol, although this did not reach statistical significance. The safety parameters between the two groups were comparable. CONCLUSION: Propofol was associated with a statistically significant improvement in comfort and sedation score when compared to midazolam and meperidine (C) 2000 Am. Coll. of Gastroenterology.

Original languageEnglish (US)
Pages (from-to)1476-1479
Number of pages4
JournalAmerican Journal of Gastroenterology
Volume95
Issue number6
DOIs
StatePublished - Jun 2000
Externally publishedYes

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Conscious Sedation
Meperidine
Midazolam
Propofol
Endoscopy
Deep Sedation
Safety
Fentanyl
Gastroenterology
Phenol
Hypnotics and Sedatives
Anesthesia
Pharmacokinetics
Logistic Models
Regression Analysis
Prospective Studies
Pain
Control Groups
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Propofol versus midazolam and meperidine for conscious sedation in gi endoscopy. / Koshy, Gita; Nair, Satheesh; Norkus, Edward P.; Hertan, Hilary I.; Pitchumoni, C. S.

In: American Journal of Gastroenterology, Vol. 95, No. 6, 06.2000, p. 1476-1479.

Research output: Contribution to journalArticle

Koshy, Gita ; Nair, Satheesh ; Norkus, Edward P. ; Hertan, Hilary I. ; Pitchumoni, C. S. / Propofol versus midazolam and meperidine for conscious sedation in gi endoscopy. In: American Journal of Gastroenterology. 2000 ; Vol. 95, No. 6. pp. 1476-1479.
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abstract = "OBJECTIVE: Propofol (2,6-diisopropyl phenol) is a relatively new intravenous sedative hypnotic with an ideal pharmacokinetic profile for conscious sedation. In this study, we compared the safety and efficacy of propofol versus the conventional regimen of midazolam and meperidine for conscious sedation in GI endoscopy. METHODS: In this prospective study, 274 patients that included many elderly patients with multiple comorbid conditions underwent GI endoscopic procedures at our hospital. A total of 150 patients received propofol (20-120 mg) and fentanyl (0.25-1.5 mg). The control group of 124 patients was given midazolam (2-6 mg) and meperidine (25-75 mg). The dose of medication was titrated according to patient need and the duration of the procedure. A 'comfort score' on a scale of 1-4 assessed the efficacy of the drugs based on pain or discomfort to the patient and ease of endoscopy A 'sedation score' was used to assess the degree of sedation on a scale of 1-5. The Aldrete score was used to measure recovery from anesthesia at 5 and 10 min after the procedure. RESULTS: After controlling for age, American Society of Anesthesiologists' Physical Status Classification (ASA grade), and type and duration of procedure, logistic regression analysis determined that propofol resulted in 2.04 times better patient comfort (p = 0.033, 95{\%} CI = 1.058-3.923). Propofol was 1.84 times more likely to produce deeper sedation than the regimen of midazolam and meperidine (p = 0.027, 95{\%} CI = 1.071-3.083). The recovery from sedation was faster in patients receiving propofol, although this did not reach statistical significance. The safety parameters between the two groups were comparable. CONCLUSION: Propofol was associated with a statistically significant improvement in comfort and sedation score when compared to midazolam and meperidine (C) 2000 Am. Coll. of Gastroenterology.",
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AU - Koshy, Gita

AU - Nair, Satheesh

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AU - Pitchumoni, C. S.

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