Efficacy and safety of adjunctive midazolam with propofol-based TCI for sedated colonoscopy

Abstract

Objective : To study the efficacy and safety of Midazolam in reducing the dose of Propofol used for anesthesia during colonoscopy to mitigate intraoperative hypotension.

Methods : This study was a randomized controlled trial (RCT). All patients received Propofol target-controlled infusion (TCI) for anesthesia during treatment. They were randomly divided into two groups: the M Group received Midazolam 0.03 milligrams/kilogram + Fentanyl 1 microgram/kilogram followed by Propofol  TCI : Ce starting at 1.5 micrograms/milliliter and increasing Ce by 0.5 micrograms/milliliter until Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score ≤ 2, and the P Group received Fentanyl 1 microgram/kilogram + Propofol TCI : Ce starting at 1.5 micrograms/milliliter and increasing Ce 0.5 micrograms/milliliter at a time until MOAA/S score ≤ 2.

Results : When comparing between Groups, it was found that the mean total Propofol (milligrams) in Group M was 150.4±73.3 and in Group P was 198.2±97.5, and this difference was statistically significant (p=<0.01), indicating that Midazolam helped reduce the dose of Propofol used for anesthesia during colonoscopy. However, when comparing hypotension resulting from Propofol, Group M had 27 cases (58.7%), and Group P had 26 cases (57.8%). There was no statistically significant difference (p=0.92). Additionally, when comparing the results of side effects from drug use, it was found that Group M had 12 airway maneuvers (26.1%), and group P had 9 cases (20.0%). There was no statistically significant difference (p=0.49). Discharge from the recovery room was not delayed for any patient from either Group.

Conclusion : Midazolam has demonstrated efficacy in reducing the dose of Propofol during colonoscopy. Moreover, our findings indicate no significant difference between the Groups in intraoperative hypotension and other complications.