Endoscopy 2003; 35(8): 683-687
DOI: 10.1055/s-2003-41519
Original Article

© Georg Thieme Verlag Stuttgart · New York

Patient-Controlled Sedation for Colonoscopy: a Randomized Trial Comparing Patient-Controlled Administration of Propofol and Alfentanil with Physician-Administered Midazolam and Pethidine

E.  Bright 1 , C.  Roseveare 2 , D.  Dalgleish 1 , J.  Kimble 3 , J.  Elliott 3 , H.  Shepherd 3
  • 1 Dept. of Anaesthetics
  • 2 Dept. of Medicine, Southampton General Hospital, Southampton, UK
  • 3 Dept. of Medicine, Royal Hampshire County Hospital, Winchester, UK
Further Information

Publication History

Submitted 29 October 2002

Accepted after Revision after revision: 19 March 2003

Publication Date:
20 August 2003 (online)

Background and Study Aims: Patient-controlled sedation (PCS) using propofol and alfentanil provides effective sedation for colonoscopy, with the advantage of a shorter recovery time in comparison with diazepam and pethidine. However, most endoscopy units in the United Kingdom are currently using midazolam (a shorter-acting benzodiazepine) as a sedative agent. This study compares the efficacy of sedation and recovery times between PCS and a combination of midazolam and pethidine.
Patients and Methods: Sixty-seven patients undergoing colonoscopy were randomly assigned prospectively to receive sedation with either PCS, using propofol and alfentanil, or a bolus of midazolam and pethidine. Sedation and pain scores were recorded during the procedure by one specialist nurse. Patients' recollection of pain was recorded after the procedure. Recovery was assessed using number connection tests. The impact on subsequent activities and the level of amnesia, as well as overall satisfaction, were established by telephone call after 24 h.
Results: The sedation method had no impact on the success, difficulty, or duration of the colonoscopy. PCS could be set up by the specialist nurse without affecting the time between cases. Patients in the PCS group recovered significantly faster (median 5 min vs 35 min; P < 0.0001) and left the department more quickly (median 40 min vs 75 min; P < 0.0001). Patients in the PCS group had significantly higher pain scores and significantly more recall than those in the midazolam and pethidine group. All patients were satisfied with the sedation they received.
Conclusions: PCS provides an acceptable alternative to sedation with midazolam and pethidine with the advantage of significantly faster recovery times, which are of relevance in the outpatient setting.

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C. Roseveare, M.D.

Southampton General Hospital

Mail Point 47 · Tremona Road · Southampton SO16 6YD · United Kingdom

Fax: +44-23-8079-4585

Email: chris.roseveare@suht.swest.nhs.uk

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