Brief Article
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World J Gastroenterol. Jun 14, 2013; 19(22): 3439-3446
Published online Jun 14, 2013. doi: 10.3748/wjg.v19.i22.3439
Deep sedation during gastrointestinal endoscopy: Propofol-fentanyl and midazolam-fentanyl regimens
Marcos Eduardo Lera dos Santos, Fauze Maluf-Filho, Dalton Marques Chaves, Sergio Eiji Matuguma, Edson Ide, Gustavo de Oliveira Luz, Thiago Ferreira de Souza, Fernanda C Simões Pessorrusso, Eduardo Guimarães Hourneaux de Moura, Paulo Sakai
Marcos Eduardo Lera dos Santos, Fauze Maluf-Filho, Dalton Marques Chaves, Sergio Eiji Matuguma, Edson Ide, Gustavo de Oliveira Luz, Thiago Ferreira de Souza, Fernanda C Simões Pessorrusso, Eduardo Guimarães Hourneaux de Moura, Paulo Sakai, Department of Gastroenterology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, CEP 05403-900, Brazil
Sergio Eiji Matuguma, Fauze Maluf-Filho, Cancer Institute of Sao Paulo State, Sao Paulo, CEP 01246-000, Brazil
Author contributions: Lera dos Santos ME performed the majority of the experiments; Maluf-Filho F designed the study, revised the article, and approved the final version to be published; Chaves DM and Matuguma SE provided analytical tools and were also involved in editing the manuscript; Ide E, Luz GO, and Pessorrusso FCS performed data acquisition; de Souza TF performed data analysis and interpretation; Maluf-Filho F, de Moura EGH, and Sakai P revised the article and approved the final version to be published.
Correspondence to: Dr. Marcos Eduardo Lera dos Santos, Assistant of the Endoscopy Division, Department of Gastroenterology, Hospital das Clínicas, University of Sao Paulo Medical School, Av. Angelica, 2163 Cj76, Sao Paulo, CEP 05403-900, Brazil. marcoslera@gmail.com
Telephone: +55-11-23681507 Fax: +55-11-23681507
Received: November 3, 2012
Revised: December 22, 2012
Accepted: January 11, 2013
Published online: June 14, 2013
Abstract

AIM: To compare deep sedation with propofol-fentanyl and midazolam-fentanyl regimens during upper gastrointestinal endoscopy.

METHODS: After obtaining approval of the research ethics committee and informed consent, 200 patients were evaluated and referred for upper gastrointestinal endoscopy. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group). We assessed the level of sedation using the observer’s assessment of alertness/sedation (OAA/S) score and bispectral index (BIS). We evaluated patient and physician satisfaction, as well as the recovery time and complication rates. The statistical analysis was performed using SPSS statistical software and included the Mann-Whitney test, χ2 test, measurement of analysis of variance, and the κ statistic.

RESULTS: The times to induction of sedation, recovery, and discharge were shorter in the propofol-fentanyl group than the midazolam-fentanyl group. According to the OAA/S score, deep sedation events occurred in 25% of the propofol-fentanyl group and 11% of the midazolam-fentanyl group (P = 0.014). Additionally, deep sedation events occurred in 19% of the propofol-fentanyl group and 7% of the midazolam-fentanyl group according to the BIS scale (P = 0.039). There was good concordance between the OAA/S score and BIS for both groups (κ = 0.71 and κ = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group and 26% of the midazolam-fentanyl group (P = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofol-fentanyl and midazolam-fentanyl groups, respectively (P < 0.001). There were no severe complications in either group. Although patients were equally satisfied with both drug combinations, physicians were more satisfied with the propofol-fentanyl combination.

CONCLUSION: Deep sedation occurred with propofol-fentanyl and midazolam-fentanyl, but was more frequent in the former. Recovery was faster in the propofol-fentanyl group.

Keywords: Endoscopy, Deep sedation, Anesthetic administration, Anesthetic dose, Adverse effects