TCI Versus Boluses Of Propofol Combined With Fentanyl, Sufentanil And Remifentanil In Sedation For Colonoscopy

ObjectiveThe objetive was to study the feasibility and safety of sedation with fentanyl, sufentanil and remifentanil, combined with target controlled infusion(TCI) or boluses of propofol in patients undergoing intestinal endoscopy.MethodsIn this prospective and randamised study,120 patients scheduled for intestinal endoscopy were randomly assigned to group GP+F, GP+F/T, GP+s and GP+R. Patients in group GP+F received intravenous fentanyl (lug/kg).1-2 minutes after the fentanyl dose was given, propofol (1～2mg/kg) was administered titrated to achieve the level of deep sedation. Patients in group GP+F/T, GP+S and GP+R all received target controlled infused propofol, and the opioids before which were intravenous fentanyl (1ug/kg), target controlled sufentanil and remifentanil respectively. The initial concentration of propofol was 1.5ug/ml, and the increasing interval was 0.3ug/ml. The procedure would begin with the OAA/S of 1～2. During the procedure additional propofol was given according to body movement to keep a level of deep sedation, with the dose of which was 0.5mg/kg for group GP+F and an increasing interval of 0.3ug/ml for the others. Blood pressure, heart rate, oximetry and BIS were monitored, and SBP, DBP, MAP, HR, SpO2, OAA/S score and BIS of T (before medication), Tsi(sigmoid), Tv(valve), Tb(biopsy) and To(procedure completed) were recorded. Parameters such as dosage of the drugs, time for induction, examination, recovery and discharge, complications of sedation such as hypotension, tachycardia and hypoxemia, awareness, and postoperative complications were recorded.ResultsAll patients were adequately sedated. Time for induction in group GP+F was shorter than that in other groups(P<0.01), and time for recovery in group GP+R was shorter than that in others(P<0.05), while time for examination and discharge were similar (P>0.05).In all the four groups, compared with that of T, HR and MAP decreased(P<0.01), the incidence of hypotension in group GP+F was higher than that in other groups(P<0.01). There was no difference in other parameters between the four groups, including incidence of bradycardia, hypoxemia, abdominal rigidity, awareness and agitation (P>0.05). Dosage of propofol for induction in group GP+F was higher than that in other groups(P<0.05), while the total dosage of propofol was lower in group GP+R than in group GP+F(P<0.05).ConclusionsFor patients undergoing intestinal endoscopy, sedation with fentanyl, sufentanil or remifentanil combined with propofol by both boluses and target controlled infusion is feasible and safe. It is more excellent for the boluses group at faster induction, for the TCI group at more steady hemodynamics, and for the remifentanil group at shorter discharge time.