Intravenous Midazolam Combined With Fentanyl And Propofol For Sedation During Gastrointestinal Endoscopy

ObjectiveThe objective was to study the feasibility and safety of sedation with midazolam combined with fentanyl and propofol in patients undergoing gastrointestinal endoscopy.MethodsIn this prospective,randamised,double-blined study,one hundred and twenty patients scheduled for upper gastrointestinal endoscopy were randomly assigned to group Gm or G₀,and eighty patients scheduled for colonoscopy were randomly assigned to group Cm or C₀.Patients in group Gm and Cm received intravenous midazolam(0.02 mg/kg).One minute after the midazolam dose was given,fentanyl (1ug/kg) was administered,one minute later,propofol(1.2mg/kg) was administered titrated to achieve the level of deep sedation.Instead of midazolam,patients in group G₀ and C₀ received saline(2 mL),and then introvenous fentanyl and propofol with the same methodology and sedation end point.During the procedure propofol(0.5mg/kg) was given according to body movement to keep a level of deep sedation.Blood pressure,heart rate and oximetry were monitored,and SBP,DBP,MAP,HR and SpO₂ of T1(before medication),T2(one minute after medication),T3(before examination), T4(one minute after beginning of examination),T5(five minute after beginning of examination) and T6(when recovery) were recorded.Parameters such as dosage of midazolam,fentanyl and propofol,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 except cancellation of examination for one patient in group Cm and one patient in group C₀ because of poor preprocedure preparation,and one patient in group Gm was excluded because of data confusion.In all the four groups,compared with that of T1,SBP,DBP and MAP at T2 to T6 decreased by less than 20%(P＜0.01),HR at some point decreased by less than 15% (P＜0.05),SpO₂ at some point decreased with a mean of more than 97%(P＜0.05).In group Gm,MAP at T3 was lower(75±14 vs 81±12,P＜0.05)and HR at T3 and T4 was higher(74±9 vs 70±10 and 73±9 vs 69±9,P＜0.05)than that in group G₀;in group Cm, HR at T4 was higher than that in group C₀(73±10 vs 68±9,P＜0.05).There was no difference in other hemodynamic parameters between experimental group and control group,including incidence of hypotension,bradycardia and hypoxemia(P＞0.05). Time for induction(second) in group Gm and Cm was shorter than that in group G₀ and C₀ respectively(112±23 vs 136±37 and 109±19 vs 139±41,P＜0.01),and time for discharge(minute) in group Gm and Cm was longer than that in group G₀ and C₀ respectively(27.7±9.6 vs 23.3±8.1 and 26.2±11.5 vs 20.6±10.8,P＜0.05),while time for examination and recovery were similar(P＞0.05).Dosage of propofol(mg) was lower in group Gm than that in group G₀(116.6±39.9 vs 134.0±42.4,P＜0.05),while similar in group Cm and C₀(160.2±65.9 vs 179.5±76.2,P＞0.05).Incidence of post-procedure complications was similar(P＞0.05).Incidence of awareness was similar in group Gm and G₀(P＞0.05),while lower in group Cm than that in group C₀(0%vs 43.6%,P＜0.01) ConclusionsIn gastrointestinal endoscopy,sedation with midazolam combined with fentanyl and propofol is feasible and safe,because of steady hemodynamics,lower dose of propofol,lower incidence of awareness,and faster induction without prolonged recovery.