Anestesia e Pesquisa Clínica
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Abstrato

Safety and Effectiveness of Propofol Sedation during Endoscopic Retrograde Cholangiopancreatography

Minami T, Sasaki T, Serikawa M, Ishigaki T, Ishii Y, Mouri T, Yoshimi S, Shimizu A, Tsuboi T, Kurihara K, Tasugawa Y, Miyaki E, Nakamura R and Chayama K

Objectives: Evidence of the safety and usefulness of propofol sedation during endoscopic retrograde cholangiopancreatography is presently insufficient; our study aimed to add such information.

Methods: Patients were sedated using propofol or midazolam during endoscopic retrograde cholangiopancreatography. The safety and utility of the sedatives were compared. Safety parameters included examination cancellation rate, circulatory depression, and respiratory depression. Utility parameters included pain level, sedation tolerability rate, and bispectral index sedation level.

Results: The propofol and midazolam groups contained 30 and 27 patients, respectively. No patient had an examination cancelled for sedation-related reasons. Blood pressure reduction (mmHg) was 24.1 ± 19.7 and 28.1 ± 20.7 in the midazolam and propofol groups, respectively, showing no significant difference. Pulse rate decrease (beats/min) was 2.4 ± 5.6 and 1.7 ± 4.5 in the propofol and midazolam groups, respectively, with no significant difference. Arterial carbon dioxide tension (mmHg) increased by 10.2 ± 6.5 and 10.8 ± 7.2 in the propofol and midazolam groups, respectively, showing no significant difference. Arterial oxygen saturation reduced by 2.9 ± 2.2% and 1.5±1.7% in the midazolam and propofol groups, respectively. The percentage of patients with <92% oxygen saturation showed no significant difference. The pain level was 0.9 ± 1.3 in the propofol group, and significantly lower than 2.4 ± 2.7 in the midazolam group. The sedation tolerability rate was 93.3% for propofol, and significantly higher than 74.1% for midazolam. The bispectral index (mean value/minimum value) was 75.1 ± 10.6/63.9 ± 12.1 for propofol, and significantly lower than 80.5 ± 4.2/72.0 ± 5.0 for midazolam.

Conclusions: Propofol sedation had similar safety and superior efficacy to midazolam. Stepwise adjustments of propofol dosage likely result in safer sedation.