Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study☆,☆☆
Section snippets
PATIENTS AND METHODS
Two hundred consecutive adult patients admitted for routine diagnostic and therapeutic ERCP were randomly assigned by a computer-generated list for sedation with either propofol (mean age 63.6 ± 23.3 years, range 30 to 88 years, 58 women, 42 men) or midazolam (mean age 61.2 ± 20.5 years, range 28 to 80 years; 60 women, 40 men). According to the American Society of Anaesthesiology (ASA) physical status classification, the majority of the patients of both study groups (midazolam group, n = 67,
RESULTS
In the midazolam group, two patients were excluded after randomization, one because it was impossible to cannulate the papilla because of infiltration by pancreatic carcinoma and the other due to the unexpected finding of an esophagogastric carcinoma that hindered the passage of the endoscope. In the propofol group, one patient was excluded because of obstruction of the duodenal bulb by extramural compression due to a large carcinoma of the pancreatic head that rendered passage of the
DISCUSSION
This first prospective randomized study demonstrates that intravenous propofol is more effective than midazolam for sedation during ERCP and does not increase the risk for clinically relevant side effects if patient monitoring is adequate.
ERCP and its related procedures were traditionally performed under conscious sedation. The need for proper sedation during ERCP is particularly obvious if technically demanding procedures such as sphincterotomy or transpapillary stent placement are performed.
Acknowledgements
We thank B. Braden, MD, and C. F. Dietrich, MD, who carried out the intravenous sedation during the examinations.
References (28)
- et al.
Sedation and analgesia for colonoscopy: patient tolerance, pain, and cardiorespiratory parameters
Gastrointest Endosc
(1997) - et al.
Flumazenil reversal of psychomotor impairment due to midazolam or diazepam for conscious sedation for upper endoscopy
Gastrointest Endosc
(1996) - et al.
Endoscopic sphincterotomy complications and their management: an attempt at consensus
Gastrointest Endosc
(1991) - et al.
Midazolam acts synergistically with fentanyl for induction of anaesthesia
Br J Anaesth
(1990) - et al.
Midazolam versus diazepam in lipid emulsion as conscious sedation for colonoscopy with or without reversal of sedation with flumazenil
Gastrointest Endosc
(1998) - et al.
Opioid drugs cause bile duct obstruction during hepatobiliary scans
Am J Surg
(1984) - et al.
Meperidine need not be proscribed during sphincter of Oddi manometry
Gastrointest Endosc
(1994) - et al.
Synergistic interaction between midazolam and propofol
Br J Anaesth
(1992) - et al.
Propofol and midazolam act synergistically in combination
Br J Anaesth
(1991) - et al.
Co-induction of sedation: the rationale
Eur J Anaesth
(1995)
Propofol versus propofol with midazolam for laryngeal mask insertion
Eur J Anaesth
Use of propofol for sedation during gastrointestinal endoscopies
Anesthesia
Infusion of propofol as sedative technique for colonoscopies
Postgrad Med J
Sedation for colonoscopy: a double-blind comparison of diazepam/meperidine, midazolam/fentanyl and propofol/fentanyl combinations
Can J Gastroenterol
Cited by (0)
- ☆
Reprint requests: Till Wehrmann, MD, Department of Internal Medicine II, J.W. Goethe University Hospital, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany.
- ☆☆
37/1/96358