Background and study aims: Sedation with propofol is associated with a high acceptance rate in upper gastrointestinal
endoscopy. So far, however, there are no valid data on whether the use of propofol
can increase the general quality of the endoscopic examination.
Patients and methods: A total of 60 patients referred for upper gastrointestinal endoscopy were randomized
to receive sedation with either midazolam (n = 30) or propofol (n = 30). The maximum
dosages permitted were 5 mg of midazolam and 500 mg of propofol. The examinations
were recorded on videotapes, and the quality of upper endoscopy was assessed by videotape
analysis by three experienced endoscopists who were all blinded to patient data and
the medications used for sedation. A score sheet was used with 18 assessment items
that each represented a step of upper gastrointestinal endoscopy and a global score
for the entire examination. A scale ranging from 1 (excellent) to 6 (very poor) was
used. Data were analyzed on an intention-to-investigate basis: inability to perform
the procedure because of a patient’s intolerance of the procedure, for example, was
scored as 6 (i. e. very poor).
Results: Patients in the two groups were well matched with respect to demographic and clinical
data. Four patients in the midazolam group could not be adequately examined. The median
dosage used for sedation was 5 mg midazolam (range 2 - 5 mg) and 160 mg propofol (range
70 - 320 mg). When assessments by all three blinded examiners were added together,
propofol sedation was found to result in significantly better scores for all parameters
except for the assessments of “Z-line/cardia”, “duodenal bulb”, and “duodenal folds”
(all P < 0.05, Mann-Whitney U test).
Conclusion: Sedation with propofol might increase the quality of upper endoscopy. This finding
may have a significant impact on the selection of the type of sedation, not only in
terms of increasing patients’ acceptance of the procedure, but also for improving
the diagnostic accuracy of upper gastrointestinal endoscopy.
References
Available from: http://www.dgvs.de/media/1.2.Sedierung-ueberwachung.pdf
alexander.meining@lrz.tum.de
