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

Samita  Pirotesak; Somchai  Amornyotin; Sithee  Chumthong; Wilaiporn  Supan

Authors

Samita Pirotesak Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Somchai Amornyotin Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Sithee Chumthong Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Wilaiporn Supan Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

Keywords:

colonoscopy, deep sedation, ephedrine, hemodynamic parameters, propofol

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.

References

Amornyotin S. Sedation and monitoring for

gastrointestinal endoscopy. World J Gastrointest Endosc. 2013;5:47-55.

Amornyotin S. Sedative and analgesic drugs for gastrointestinal endoscopic procedure. J Gastroenterol Hepatol Res. 2014;3:1133-44.

Amornyotin S. Sedation-related complications in gastrointestinal endoscopy. World J Gastrointest Endosc. 2013;5:527-33.

Sneyd JR, Absalom AR, Barends CRM, Jones JB. Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis. Brit J Anaesth. 2022;128:610-22.

National Center for Biotechnology Information (2024). PubChem Compound Summary for CID 9294, Ephedrine. Retrieved October 7, 2024 from https://pubchem.ncbi.nlm.nih.gov/compound/Ephedrine.

Ejaimi G, Saab A, Ahmed S, Ahmed A,

Abujamilah H, Satyanarayana B. Small dose of ephedrine for prevention of hypotension following propofol and fentanyl administration during induction of general anesthesia. Ann Afr Med Res. 2020;3:126.

Austin JD, Parke TJ. Admixture of ephedrine to offset side effects of propofol: a randomized controlled trial. J Clin Anesth. 2009;21:44-9.

Khezri MB, Kayalha H. The effect of combined ephedrine and lidocaine pretreatment on pain and hemodynamic changes due to propofol injection. Acta Anesthesiol Taiwan. 2011;49:54-8.

Masjedi M, Zand F, Kazemi AP, Hoseinipour A. Prophylactic effect of ephedrine to reduce hemodynamic changes associated with anesthesia induction with propofol and remifentanil. J Anesthesiol Clin Pharmacol. 2014;30:217-21.

Amornyotin S, Srikureja W, Pausawasdi N, Prakanrattana U, Kachintorn U. Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand. Asian Biomed. 2011;5:485-91.

Amornyotin S, Songarj P, Kongphlay S. Deep sedation with propofol and pethidine versus moderate sedation with midazolam and fentanyl in colonoscopic procedure. J Gastroenterol Hepatol Res. 2013;2:885-90.

Amornyotin S, Kongphlay S. Complication rate of propofol-based deep sedation for colonoscopy in marked obesity patients. J Gastroenterol Hepatol Res. 2015;4:1734-8.

Amornyotin S, Kongphlay S. Clinical efficacy of combination of propofol and ketamine (ketofol) for deep sedation in colonoscopic procedure. J Gastroenterol Hepatol Res. 2015;4:1689-93.

Gamlin F, Vucevic M, Winslow L, Berridge J. The hemodynamic effects of propofol in combination with ephedrine. Anaesthesia. 1996;51:488-91.

Gamlin F, Freeman J, Winslow L, Berridge J, Vucevic M. The hemodynamic effects of propofol in combination with ephedrine in elderly patients (ASA groups 3 and 4). Anaesth Intensive Care. 1999;27:477-80.

Chow MY, Sim KM, Sia AT, Chan YW. Hemodynamic effects of adding ephedrine to propofol and alfentanil. Can J Anaesth. 1998;45:597-8. .