Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2024; 16(1): 11-17
Published online Jan 16, 2024. doi: 10.4253/wjge.v16.i1.11
Propofol sedation in routine endoscopy: A case series comparing target controlled infusion vs manually controlled bolus concept
Riad Sarraj, Lorenz Theiler, Nima Vakilzadeh, Niklas Krupka, Reiner Wiest
Riad Sarraj, Niklas Krupka, Reiner Wiest, Department of Visceral Surgery and Medicine, Inselspital University Hospital, Bern 3010, Switzerland
Lorenz Theiler, Clinic for Anesthesia, Perioperative, Emergency & Intensive Care Medicine, Kantonsspital Aarau, Aarau 5001, Switzerland
Nima Vakilzadeh, Department of Nephrology and Hypertension, University Hospital Lausanne, Lausanne 1011, Switzerland
Author contributions: Sarraj R collected the dataset, wrote and designed the manuscript and figures; Vakilzadeh N provided support for the statistical analysis and figure design; Krupka N reviewed the manuscript and supported the submission; Theiler L and Wiest R designed the trial and implemented the TCI use in clinical practice and reviewed and the manuscript.
Institutional review board statement: The study was reviewed and approved by the Gesundheits-, Sozial-und Integrations direktion Kantonale Ethikkommission für die Forschung.
Conflict-of-interest statement: No conflict-of-internest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at riad.sarraj@insel.ch. patient consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Riad Sarraj, MD, Attending Doctor, Department of Visceral Surgery and Medicine, Inselspital University Hospital, Freiburgstrasse 18, Bern 3010, Switzerland. riad.sarraj@insel.ch
Received: August 17, 2023
Peer-review started: August 17, 2023
First decision: September 13, 2023
Revised: September 27, 2023
Accepted: December 6, 2023
Article in press: December 6, 2023
Published online: January 16, 2024
Processing time: 150 Days and 21.7 Hours
Abstract
BACKGROUND

Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation (NAPS) for gastrointestinal (GI) endoscopy Target controlled infusion (TCI) is claimed to provide an optimal sedation regimen by avoiding under- or oversedation.

AIM

To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.

METHODS

Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS. Patients were matched for age and endoscopic procedure. We recorded time of sedation and endoscopy, dosage of medication and adverse events.

RESULTS

There was a significant reduction in dose per time of propofol administered in the TCI group, compared to the NAPS group (8.2 ± 2.7 mg/min vs 9.3 ± 3.4 mg/min; P = 0.046). The time needed to provide adequate sedation levels was slightly but significantly lower in the control group (5.3 ± 2.7 min vs 7.7 ± 3.3 min; P < 0.001), nonetheless the total endoscopy time was similar in both groups. No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.

CONCLUSION

This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy. This may translate into less adverse events. However, further and randomized trials need to confirm this trend.

Keywords: Sedation; Endoscopy; Propofol; Target controlled infusion; Non-anaesthesiologist propofol sedation; Adverse event

Core Tip: First, target controlled infusion (TCI) is claimed to provide an optimal sedation regimen. Secondly, little is known about the differences of time of sedation and propofol dosage between nurse-administered intermittent bolus propofol sedation and TCI. Thirdly, sedation using TCI for gastrointestinal (GI) endoscopy reduces the dose of propofol necessary per minute of endoscopy (8.2 ± 2.7 mg/min vs 9.3 ± 3.4 mg/min; P = 0.046). Fourthly, sedation using TCI for GI endoscopy could have an impact on propofol total dosage on prolonged endoscopy procedures. Fifthly, this may translate into less adverse events and higher safety when using TCI in prolonged procedures.