Propofol compared with bolus and titrated midazolam for sedation in outpatient colonoscopy: a prospective randomized double-blind study - 29/08/20

Doi : 10.1016/j.gie.2020.05.045

Dae Bum Kim, MD, PhD ¹, Joon Sung Kim, MD, PhD ^2,^⁎, Cheal Wung Huh, MD ², Dae Won Ma, MD ², Jeong-Seon Ji, MD, PhD ², Byung-Wook Kim, MD, PhD ², Hwang Choi, MD, PhD ²
¹ Division of Gastroenterology, Department of Internal Medicine, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
² Division of Gastroenterology, Department of Internal Medicine, Incheon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

^∗Reprint requests: Joon Sung Kim, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Incheon St Mary’s Hospital, the Catholic University of Korea, 665, Bupyeong-dong, Bupyeong-gu, Incheon 403-720, Republic of Korea.Division of GastroenterologyDepartment of Internal MedicineCollege of MedicineIncheon St Mary’s Hospitalthe Catholic University of Korea665Bupyeong-dongBupyeong-guIncheon403-720Republic of Korea

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 29 August 2020

Abstract

Background and Aims

The safest and most efficient method of sedation for outpatient colonoscopy remains unclear. This study aimed to compare the efficiency and safety of bolus administration of midazolam compared with titrated administration and propofol administration for patients undergoing outpatient colonoscopy.

Methods

We randomly divided patients undergoing colonoscopy into the propofol group, bolus midazolam group, and titrated midazolam group. We compared total procedure time, induction time, recovery time, and discharge time among the 3 groups. We also compared patient satisfaction and the incidence of adverse events.

Results

In total, 267 patients (89 in each study group) were enrolled during the study period. Patients in the propofol group had a shorter total procedure time (39.5 vs 59.4 vs 58.1 minutes; P < .001), induction time (4.6 vs 6.3 vs 7.6 minutes; P < .001), recovery time (11.5 vs 29.5 vs 29.2 minutes; P < .001), and discharge time (20.6 vs 34.9 vs 34.7 minutes; P < .001) than patients in the bolus midazolam group and titrated midazolam group. Patients in the propofol group reported higher degrees of satisfaction than patients in the bolus or titrated midazolam plus meperidine groups (9.9 vs 9.6 vs 9.6 [P = .007] and 4.9 vs 4.7 vs 4.8 [P = .008], respectively). Adverse events were not significantly different between groups.

Conclusions

In this randomized trial, propofol was superior to bolus or titrated midazolam in terms of endoscopy unit efficiency and patient satisfaction during outpatient colonoscopy. (Clinical trial registration number: KCT0002805.)

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