A comparison Between Propofol with and without Ephedrine on Hemodynamic Parameters in Propofol-Based Deep Sedation for Colonoscopy

Abstract

Introduction: Propofol is widely used for deep sedation in colonoscopic procedures due to its rapid onset and short duration of action. However, propofol can cause significant hemodynamic changes, including hypotension. The addition of ephedrine, a sympathomimetic agent, might mitigate these effects. We compare the effect of propofol with and without ephedrine on hemodynamic parameters including systolic and diastolic blood pressure, heart rate and oxygen saturation in propofol-based deep sedation for colonoscopy. The primary outcome variable is the alteration of systolic blood pressure. The secondary outcome variables are the alterations of diastolic blood pressure, heart rate and oxygen saturation. Methods: A double-blinded randomized controlled trial was conducted. A total of 122 patients with ASA physical status I-II were randomly allocated to two groups. Group PE received a combination of propofol and ephedrine (propofol 9.75 mg/ml and ephedrine 0.75 mg/ml). Group P received a combination of propofol and normal saline (propofol 9.75 mg/ml). A nasal cannula was used for oxygen supplementation. All patients received a bolus of 1 mcg/kg of fentanyl and 0.5-1 mg/kg of propofol. Continuous infusion of propofol with and without ephedrine was done during the procedure. All patients were sedated at a deep sedation level using the Observer’s Assessment of Alertness/Sedation Scale (0 or 1). Systolic and diastolic blood pressure, heart rate, and oxygen saturation were recorded. Results: The patients’ characteristics were not significantly different between the two groups. Alteration of hemodynamic parameters in group PE was substantially lower than in group P. Hypotension and bradycardia in group P were considerably greater than in group PE. However, the two groups had no significant differences in diastolic blood pressure and oxygen saturation. Conclusion: Co-administration of ephedrine with propofol for deep sedation in colonoscopy significantly stabilizes hemodynamic parameters and reduces the incidence of hypotension and bradycardia. This combination can be considered a better option for patients undergoing colonoscopy to ensure hemodynamic stability.