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Randomized controlled trial of patient-controlled sedation for colonoscopy: Entonox vs modified patient-maintained target-controlled propofol

Maslekar, S.; Balaji, P.; Gardiner, Anji; Culbert, B.; Monson, J. R.T.; Duthie, G. S.

Authors

S. Maslekar

P. Balaji

Anji Gardiner

B. Culbert

J. R.T. Monson

G. S. Duthie



Abstract

Aim Propofol sedation is often associated with deep sedation and decreased manoeuvrability. Patient-maintained sedation has been used in such patients with minimal side-effects. We aimed to compare novel modified patient-maintained target-controlled infusion (TCI) of propofol with patient-controlled Entonox inhalation for colonoscopy in terms of analgesic efficacy (primary outcome), depth of sedation, manoeuvrability and patient and endoscopist satisfaction (secondary outcomes). Method One hundred patients undergoing elective colonoscopy were randomized to receive either TCI propofol or Entonox. Patients in the propofol group were administered propofol initially to achieve a target concentration of 1.2 μ g/ml and then allowed to self-administer a bolus of propofol (200 μ g/kg/ml) using a patient-controlled analgesia pump with a handset. Entonox group patients inhaled the gas through a mouthpiece until caecum was reached and then as required. Sedation was initially given by an anaesthetist to achieve a score of 4 (Modified Observer's Assessment of Alertness and Sedation Scale), and colonoscopy was then started. Patients completed an anxiety score (Hospital Anxiety and Depression questionnaire), a baseline letter cancellation test and a pain score on a 100-mm visual analogue scale before and after the procedure. All patients completed a satisfaction survey at discharge and 24 h postprocedure. Results The median dose of propofol was 174 mg, and the median number of propofol boluses was four. There was no difference between the two groups in terms of pain recorded (95% confidence interval of the difference -0.809, 5.02) and patient/endoscopist satisfaction. There was no difference between the two groups in either depth of sedation or manoeuvrability. Conclusion Both Entonox and the modified TCI propofol provide equally effective sedation and pain relief, simultaneously allowing patients to be easily manoeuvred during the procedures. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.

Citation

Maslekar, S., Balaji, P., Gardiner, A., Culbert, B., Monson, J. R., & Duthie, G. S. (2011). Randomized controlled trial of patient-controlled sedation for colonoscopy: Entonox vs modified patient-maintained target-controlled propofol. Colorectal Disease, 13(1), 48-57. https://doi.org/10.1111/j.1463-1318.2009.01988.x

Journal Article Type Article
Acceptance Date May 16, 2009
Online Publication Date Jul 3, 2009
Publication Date 2011-01
Deposit Date Nov 13, 2014
Publicly Available Date Mar 29, 2024
Journal Colorectal Disease
Print ISSN 1462-8910
Electronic ISSN 1463-1318
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 13
Issue 1
Pages 48-57
DOI https://doi.org/10.1111/j.1463-1318.2009.01988.x
Keywords Propofol; Entonox; Sedation; Colonoscopy
Public URL https://hull-repository.worktribe.com/output/462645
Publisher URL https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1463-1318.2009.01988.x

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