Patient-controlled sedation for endoscopic ultrasound matches current standard

Patient-controlled sedation and analgesia with a combination of propofol and fentanyl worked just as well as the standard gastroenterologist-administered midazolam and pethidine for upper gastrointestinal tract endoscopic ultrasound exams. Patients and endoscopists were equally satisfied with each method.

Dr. Massimo Agostoni and colleagues in the anesthesiology department at the San Raffaele Del Monte Tabor Foundation in Milan, Italy, published their study in the October issue of Digestive and Liver Disease.

They studied 54 consecutive patients needing endoscopic ultrasonography. Half received the standard drugs for sedation and analgesia, midazolam and pethidine. The other half were given a mixture of propofol and fentanyl. The researchers' primary measure of success was the Observer's Assessment of Alertness/Sedation Score, patient satisfaction, and patient cooperation.

The 27 patients receiving the standard regimen received 0.7 mg/kg of pethidine and 0.04 mg/kg of midazolam prior to their endoscopic ultrasound exam. Additional boluses of the same drugs were administered to patients during the exam if sedation was insufficient. They were also given a sham patient-controlled sedation analgesia pump. The mean final dosage for this group of patients was 88.6 mg of pethidine and 5 mg of midazolam.

The other 27 patients received 17 mg of propofol and 15 μg of fentanyl prior to their endoscopic ultrasound exam. They were also given a patient-controlled sedation analgesia pump containing 170 mg of propofol and 150 μg of fentanyl. Every time a patient pressed the button he or she was injected with 0.5 ml of the mixture. There was no patient "lock out" but if sedation was insufficient, patients were given an additional 1 ml of the mixture. The mean dosage for this group was 119.7 mg of propofol and 106 μg of fentanyl.

Endoscopists gave both groups similar ratings for difficulty of procedure and procedures lasted a similar length of time. The grade of sedation according to the Observer's Assessment of Alertness/Sedation Score was also similar across the two groups. Finally, patient satisfaction as reported by the patients and cooperation of the patients as reported by the endoscopists were also similar. The only difference between the two groups was the extra boluses administered with the sedation analgesia pump during the procedure.

The researchers concluded that patient-controlled sedation with propofol and fentanyl is an effective and safe technique for providing a satisfactory experience for both patients and operators during upper gastrointestinal tract endoscopic ultrasonography.