Clinical Endoscopy

Original Articles

Comparison of bispectral index-guided endoscopic ultrasonography with continuous vs. intermittent infusion of propofol: a retrospective study in Japan: Ayana Okamoto, Ken Kamata, Tomohiro Yamazaki, Shunsuke Omoto, Kosuke Minaga, Mamoru Takenaka, Masatoshi Kudo; Clin Endosc 2024;57(6):814-820. Published online July 24, 2024; DOI: https://doi.org/10.5946/ce.2024.019

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: This study aimed to evaluate the safety and efficacy of continuous propofol infusion for anesthesia during endoscopic ultrasonography (EUS).
Methods
A total of 427 consecutive patients who underwent EUS between May 2018 and February 2019 were enrolled in this study. The patients were divided into two propofol infusion groups: continuous (n=207) and intermittent (n=220). The following parameters were compared: (1) propofol dose, (2) respiratory and circulatory depression, (3) body movement requiring discontinuation of the examination, (4) awakening score, and (5) patient satisfaction.
Results
The median total maintenance dose of propofol was significantly higher in the continuous group than in the intermittent group (160.0 mg vs. 130.0 mg, respectively); however, the reduction in SpO2 was significantly lower in the continuous group (2.9% vs. 13.2%). Body movements occurred less frequently in the continuous group than in the intermittent group (40.1% vs. 49.5%, respectively). The rate of complete awakening was significantly higher in the continuous group than in the intermittent group. Finally, there was a significant difference in the percentage of patients who answered “absolutely yes” when asked about receiving EUS again: 52.7% in the continuous group vs. 34.3% in the intermittent group.
Conclusions
Continuous infusion resulted in stable sedation and reduced propofol-associated risks.

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Bispectral index-guided propofol sedation during endoscopic ultrasonography: Ayana Okamoto, Ken Kamata, Takeshi Miyata, Tomoe Yoshikawa, Rei Ishikawa, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Yasutaka Chiba, Toshiharu Sakurai, Naoshi Nishida, Masayuki Kitano, Masatoshi Kudo; Clin Endosc 2022;55(4):558-563. Published online July 12, 2022; DOI: https://doi.org/10.5946/ce.2022.001

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Background
/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS).
Methods
This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room.
Results
The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001).
Conclusions
During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.

Citations

Citations to this article as recorded by

Propofol‐alone sedative efficacy in observational biliopancreatic endoscopic ultrasound
Hisaki Kato, Yuki Kawasaki, Kazuya Sumi, Yuki Shibata, Norihiro Nomura, Jun Ushio, Junichi Eguchi, Takayoshi Ito, Haruhiro Inoue
DEN Open.2025;[Epub] CrossRef
General anesthesia and/or deep hypnotic state in propofol-based conscious sedation for endoscopy
Halim Bou Daher, Ali El Mokahal, Mohamad Ali Ibrahim, Rana Yamout, Nour Hochaimi, Chakib Ayoub, Yasser H. Shaib, Ala I. Sharara
iGIE.2024; 3(2): 286. CrossRef
EEG bispectral index sensor guidance improves accuracy and safety of procedural sedation
A. Oh, N. Karim, A. Pitt, S. Hodgetts, D.W. Edwards, D. Mullan, H-U. Laasch
Clinical Radiology.2024; 79(12): e1490. CrossRef
Comparison of bispectral index-guided endoscopic ultrasonography with continuous vs. intermittent infusion of propofol: a retrospective study in Japan
Ayana Okamoto, Ken Kamata, Tomohiro Yamazaki, Shunsuke Omoto, Kosuke Minaga, Mamoru Takenaka, Masatoshi Kudo
Clinical Endoscopy.2024; 57(6): 814. CrossRef
Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy
Sonja Skiljic, Dino Budrovac, Ana Cicvaric, Nenad Neskovic, Slavica Kvolik
Life.2023; 13(2): 473. CrossRef
Clinical and economic value of bispectral index monitoring for adequate endoscopic sedation
Se Woo Park
Clinical Endoscopy.2022; 55(4): 518. CrossRef
Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report
Jaesang Lee, Hosik Moon, Sungjin Hong, Jinyoung Chon, Hyejin Kwon, Hunwoo Park, Jiyung Lee
Medicina.2022; 59(1): 65. CrossRef

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Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam: Ji Hyung Nam, Dong Kee Jang, Jun Kyu Lee, Hyoun Woo Kang, Byung-Wook Kim, Byung Ik Jang, the Committees of Quality Management and Conscious Sedation of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2022;55(2):234-239. Published online October 12, 2021; DOI: https://doi.org/10.5946/ce.2021.126

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Background
/Aims: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions.
Methods
This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction.
Results
A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups.
Conclusions
Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.

Citations

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Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea
Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee
Clinical Endoscopy.2024; 57(4): 476. CrossRef
The effective dose of butorphanol tartrate in patients of different ages undergoing painless gastroscopy
Yaorui Sun, Shujiao Liu, Wenli Si, Quanyi Zhang, Fei Yu, Ming Su, Chao Sun
Journal of International Medical Research.2024;[Epub] CrossRef
Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal endoscopy: a cohort study
Yuan-rui Zhao, Ke-sheng Huang, Guo Hou, Lan Yao, Li-ping Lu, Song Xu, Ying-tao Lian, Zhun Yao, Zhui Yu
World Journal of Emergency Medicine.2023; 14(1): 31. CrossRef
Effective dose of propofol combined with a low-dose esketamine for gastroscopy in elderly patients: A dose finding study using dixon’s up-and-down method
Yuling Zheng, Yafei Xu, Bixin Huang, Ying Mai, Yiwen Zhang, Zhongqi Zhang
Frontiers in Pharmacology.2022;[Epub] CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef

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Safety and Recipient Satisfaction of Propofol Sedation in Outpatient Endoscopy: A 24-Hour Prospective Investigation Using a Questionnaire Survey: Yoshihide Kanno, Tetsuya Ohira, Yoshihiro Harada, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Yoshiki Koike, Taku Yamagata, Toshitaka Sakai, Kaori Masu, Keisuke Yonamine, Kazuaki Miyamoto, Megumi Tanaka, Tomohiro Shimada, Fumisato Kozakai, Kazuki Endo, Haruka Okano, Daichi Komabayashi, Takeshi Shimizu, Shohei Suzuki, Kei Ito; Clin Endosc 2021;54(3):340-347. Published online December 11, 2020; DOI: https://doi.org/10.5946/ce.2020.138

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Background
/Aims: The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepine drugs in outpatient endoscopy.
Methods
In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a nextday questionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24 hours, and examinee satisfaction were evaluated.
Results
Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performed between November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopic ultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. The mean propofol dose was 69.6±24.4 mg (range, 20–200 mg). Diazepam, midazolam, and/or pentazocine in combination with propofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia, in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of the patients desired propofol sedation in future examinations.
Conclusions
Propofol sedation was found to be safe—without severe adverse events or accidents—for outpatient endoscopy on the basis of the patients’ next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painless endoscopic screening.

Citations

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Comparison of sedation with pentazocine or pethidine hydrochloride for endoscopic ultrasonography in outpatients: A single‐center retrospective study
Makiko Urabe, Kenji Ikezawa, Yusuke Seiki, Ko Watsuji, Yasuharu Kawamoto, Takeru Hirao, Yugo Kai, Ryoji Takada, Takuo Yamai, Kaori Mukai, Tasuku Nakabori, Hiroyuki Uehara, Kazuyoshi Ohkawa
DEN Open.2025;[Epub] CrossRef
Remimazolam and Its Place in the Current Landscape of Procedural Sedation and General Anesthesia
Matthew Brohan, Janette Brohan, Basavana Goudra
Journal of Clinical Medicine.2024; 13(15): 4362. CrossRef
How to implement adverse events as a quality indicator in gastrointestinal endoscopy
Tom G. Moreels
Digestive Endoscopy.2024; 36(1): 89. CrossRef
Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam
Ji Hyung Nam, Dong Kee Jang, Jun Kyu Lee, Hyoun Woo Kang, Byung-Wook Kim, Byung Ik Jang
Clinical Endoscopy.2022; 55(2): 234. CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef

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Efficacy and Safety of Etomidate in Comparison with Propofol or Midazolam as Sedative for Upper Gastrointestinal Endoscopy: Jae Hyun Kim, Sanghwan Byun, Youn Jung Choi, Hye Jung Kwon, Kyoungwon Jung, Sung Eun Kim, Moo In Park, Won Moon, Seun Ja Park; Clin Endosc 2020;53(5):555-561. Published online March 31, 2020; DOI: https://doi.org/10.5946/ce.2019.210

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Background
/Aims: In this study, we compared the efficacy and safety of etomidate with those of propofol or midazolam for the maintenance of sedation during endoscopy.
Methods
The study enrolled patients who underwent sedative endoscopy in our hospital and divided them into three groups. Patients in each group were administered midazolam as induction therapy and were subsequently administered either midazolam (M + M group), propofol (M + P group), or etomidate (M + E group) as maintenance medication. The primary outcome was overall cardiovascular and respiratory adverse events.
Results
In total, 105 patients who underwent sedative endoscopic examination were enrolled. The outcomes related to the procedure and sedation were not significantly different among the groups. Overall cardiovascular and respiratory adverse events were observed in 9 patients (25.7%) in the M + M group, 8 patients (23.5%) in the M + P group, and 10 patients (27.8%) in the M + E group. The logistic regression analysis revealed that etomidate use was not an independent risk factor for overall cardiovascular and respiratory adverse events.
Conclusions
The outcomes following the use of etomidate for maintenance after induction with midazolam for sedation in upper gastrointestinal endoscopy were not inferior to those following midazolam or propofol use from the perspectives of safety and efficacy.

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Comparison of ciprofol–alfentanil and propofol–alfentanil sedation during bidirectional endoscopy: A prospective, double-blind, randomised, controlled trial
Jiqiang Zhang, Ruijuan Liu, Ruirui Bi, Xia Li, Mengjun Xu, Lijuan Li, Yuxi su, Wenjun Yan
Digestive and Liver Disease.2024; 56(4): 663. CrossRef
Effects of Earmuffs and Eye Masks on Propofol Sedation during Spinal Anesthesia for Orthopedic Surgery: A Randomized Controlled Trial
Jin-Woo Park, Sung Il Bae, Jungyul Ryu, Seung Hyun Chung, Sang-Hwan Do
Journal of Clinical Medicine.2023; 12(3): 899. CrossRef
Effect of intravenous anesthesia by etomidate in combination with propofol on gastrointestinal endoscopy
Bo CHEN, Ke ZHANG, Mingshuai YU
Minerva Surgery.2023;[Epub] CrossRef
New sedatives and analgesic drugs for gastrointestinal endoscopic procedures
Jae Min Lee, Yehyun Park, Jin Myung Park, Hong Jun Park, Jun Yong Bae, Seung Young Seo, Jee Hyun Lee, Hyung Ku Chon, Jun-Won Chung, Hyun Ho Choi, Jun Kyu Lee, Byung-Wook Kim
Clinical Endoscopy.2022; 55(5): 581. CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef
Comparative Safety Profiles of Sedatives Commonly Used in Clinical Practice: A 10-Year Nationwide Pharmacovigilance Study in Korea
Yeo-Jin Choi, Seung-Won Yang, Won-Gun Kwack, Jun-Kyu Lee, Tae-Hee Lee, Jae-Yong Jang, Eun-Kyoung Chung
Pharmaceuticals.2021; 14(8): 783. CrossRef
Physical and Chemical Compatibility of Etomidate and Propofol Injectable Emulsions
Chunling Wang, Shengnan Wang, Cuishuan Wu, Li Lei, Dong-Xin Wang, Qiang Zhang
Pharmacology.2021; 106(11-12): 644. CrossRef

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Association between Type of Sedation and the Adverse Events Associated with Gastrointestinal Endoscopy: An Analysis of 5 Years’ Data from a Tertiary Center in the USA: Basavana Goudra, Ahmad Nuzat, Preet Mohinder Singh, Anuradha Borle, Augustus Carlin, Gowri Gouda; Clin Endosc 2017;50(2):161-169. Published online April 29, 2016; DOI: https://doi.org/10.5946/ce.2016.019

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Background
/Aims: The landscape of sedation for gastrointestinal (GI) endoscopic procedures and the nature of the procedures themselves have changed over the last decade. In this study, an attempt is made to analyze the frequency and etiology of all major adverse events associated with GI endoscopy.
Methods
All adverse events extracted from the electronic database and local registry were analyzed. Although the data analysis was retrospective, the adverse events themselves were documented prospectively. These events were evaluated after subdivision into propofol-based anesthesia and intravenous conscious sedation groups.
Results
Cardiorespiratory events, including cardiac arrest, were the most common adverse events during esophagogastroduodenoscopy, while bleeding was more frequent in patients undergoing colonoscopy. Pancreatitis was the most frequent adverse event in patients undergoing endoscopic retrograde cholangiopancreatography. The frequencies of most adverse events were significantly higher in patients anesthetized with propofol. Automatic regression modeling showed that the type of sedation, the American Society of Anesthesiologists physical status classification, and the procedure type were some of the predictors of immediate life-threatening complications.
Conclusions
Clearly, our regression modeling suggests a strong association between the type of sedation as well as various patient factors and the frequency of adverse events. The possible reasons for our results are the changing demographics, the worsening comorbidities of the patient population, and the increasing technical complexity of these procedures. Although extensive use of propofol has increased patient satisfaction and procedure acceptability, its use is also associated with more frequent adverse events.

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Focused Review Series: Endoscopic Sedation Revisited: Principles and Practice

Endoscopist-Directed Propofol: Pros and Cons: Eun Hye Kim, Sang Kil Lee; Clin Endosc 2014;47(2):129-134. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.129

Abstract PDF PubReader ePub

Concerns about the safety of endoscopist-directed propofol (EDP) have been voiced that propofol should be given only by healthcare professionals trained in the administration of general anesthesia. Here we discuss the safety and drawbacks of EDP for routine endoscopic procedures. Currently, both diagnostic and therapeutic endoscopy are well tolerated and accepted by both patients and endoscopists due to the application of sedation in most clinics worldwide. Accordingly, propofol use is increasing in many countries. It is crucial for endoscopists to be very familiar with the use of propofol or a combination of drugs. However, the controversy regarding the administration of sedation by an endoscopist or an anesthesiologist continues. Until now, there have been no randomized control trials comparing sedation induced by propofol administered by an endoscopist or by an anesthesiologist. It might be difficult to perform this kind of study. For the convenience and safety of sedative endoscopy, it would be important that EDP be generally applied to endoscopic procedures, and for more safety, an anesthesiologist may automatically take care of particular patients at high risk of suffering from propofol side effects.

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Original Articles

Comparison between Midazolam Used Alone and in Combination with Propofol for Sedation during Endoscopic Retrograde Cholangiopancreatography: Yu Seok Kim, Myung-Hwan Kim, Seung Uk Jeong, Byung Uk Lee, Sang Soo Lee, Do Hyun Park, Dong-Wan Seo, Sung Koo Lee; Clin Endosc 2014;47(1):94-100. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.94

Abstract PDF PubReader ePub

Background/Aims

Endoscopic retrograde cholangiopancreatography (ERCP) is an uncomfortable procedure that requires adequate sedation for its successful conduction. We investigated the efficacy and safety of the combined use of intravenous midazolam and propofol for sedation during ERCP.

Methods

A retrospective review of patient records from a single tertiary care hospital was performed. Ninety-four patients undergoing ERCP received one of the two medication regimens, which was administered by a nurse under the supervision of a gastroenterologist. Patients in the midazolam (M) group (n=44) received only intravenous midazolam, which was titrated to achieve deep sedation. Patients in the midazolam pulse propofol (MP) group (n=50) initially received an intravenous combination of midazolam and propofol, and then propofol was titrated to achieve deep sedation.

Results

The time to the initial sedation was shorter in the MP group than in the M group (1.13 minutes vs. 1.84 minutes, respectively; p<0.001). The recovery time was faster in the MP group than in the M group (p=0.031). There were no significant differences between the two groups with respect to frequency of adverse events, pain experienced by the patient, patient discomfort, degree of amnesia, and gag reflex. Patient cooperation, rated by the endoscopist as excellent, was greater in the MP group than in the M group (p=0.046).

Conclusions

The combined use of intravenous midazolam and propofol for sedation during ERCP is more effective than midazolam alone. There is no difference in the safety of the procedure.

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Propofol versus Midazolam for Sedation during Esophagogastroduodenoscopy in Children: Ji Eun Oh, Hae Jeong Lee, Young Hwan Lee; Clin Endosc 2013;46(4):368-372. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.368

Abstract PDF PubReader ePub

Background/Aims

To evaluate the efficacy and safety of propofol and midazolam for sedation during esophagogastroduodenoscopy (EGD) in children.

Methods

We retrospectively reviewed the hospital records of 62 children who underwent ambulatory diagnostic EGD during 1-year period. Data were collected from 34 consecutive patients receiving propofol alone. Twenty-eight consecutive patients who received sedation with midazolam served as a comparison group. Outcome variables were length of procedure, time to recovery and need for additional supportive measures.

Results

There were no statistically significant differences between the two groups in age, weight, sex, and the length of endoscopic procedure. The recovery time from sedation was markedly shorter in propofol group (30±16.41 minutes) compared with midazolam group (58.89±17.32 minutes; p<0.0001). During and after the procedure the mean heart rate was increased in midazolam group (133.04±19.92 and 97.82±16.7) compared with propofol group (110.26±20.14 and 83.26±12.33; p<0.0001). There was no localized pain during sedative administration in midazolam group, though six patients had localized pain during administration of propofol (p<0.028). There was no serious major complication associated with any of the 62 procedures.

Conclusions

Intravenous administered propofol provides faster recovery time and similarly safe sedation compared with midazolam in pediatric patients undergoing upper gastrointestinal endoscopy.

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Procedural Sedation for Pediatric Upper Gastrointestinal Endoscopy in Korea
Yoo Min Lee, Ben Kang, Yu Bin Kim, Hyun Jin Kim, Kyung Jae Lee, Yoon Lee, So Yoon Choi, Eun Hye Lee, Dae Yong Yi, Hyo-Jeong Jang, You Jin Choi, Suk Jin Hong, Ju Young Kim, Yunkoo Kang, Soon Chul Kim
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Eun Hye Kim, Sang Kil Lee
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Ahmet Sebe, Hayri Levent Yilmaz, Zikret Koseoglu, Mehmet Oguzhan Ay, Muge Gulen
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Comparison of Midazolam Alone versus Midazolam Plus Propofol during Endoscopic Submucosal Dissection: Young Shim Cho, Euikeun Seo, Jung-Ho Han, Soon Man Yoon, Hee Bok Chae, Seon Mee Park, Sei Jin Youn; Clin Endosc 2011;44(1):22-26. Published online September 30, 2011; DOI: https://doi.org/10.5946/ce.2011.44.1.22; Retraction in: Clin Endosc 2012;45(1):108

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Conscious Sedation During Gastrointestinal Endoscopy: Midazolam vs Propofol: Ja Seol Koo, M.D. and Jai Hyun Choi, M.D.; Korean J Gastrointest Endosc 2011;42(2):67-73. Published online February 28, 2011

Abstract PDF: Endoscopy is increasingly performed with the patient under conscious sedation in many countries. The majority of patients can be adequately and safely sedated during routine upper endoscopy and colonoscopy with a combination of a benzodiazepine and opioid. Midazolam is a water-soluble benzodiazepine that is characterized by a rapid onset of action and a shorter duration compared with that of the other drugs of the same class. The major side effect of midazolam is respiratory depression, which can be reversed by flumazenil, a benzodiazepine-specific antagonist. Propofol is a lipid-soluble agent that has the advantages of a more rapid onset of action and a shorter recovery time compared to that of midazolam. However, it should be used with caution since it can lead to hypotension and respiratory depression. Propofol can be safely and effectively administered by nonanesthesiology physicians and nurses provided that they have received adequate training. Two models have been proposed for the administration of propofol by endoscopists: nurse-administered propofol sedation (NAPS) and combination propofol (propofol plus other agents) sedation. In order to modify the pharmacological disadvantages of propofol, fospropofol sodium, a water-soluble prodrug of propofol, has recently been developed. In addition, new delivery systems have been devised: patient-controlled sedation and computer-assisted personalized sedation, in which the computer continuously monitors the patient's condition and adjusts the dose of propofol accordingly. Endoscopists must have a thorough understanding of the medications used for endoscopic sedation and they must acquire the skills necessary for the treatment of cardiopulmonary complications. Therefore, it is necessary to develop a practice guideline pertaining to endoscopic sedation and also training programs for physicians and nurses in Korea. (Korean J Gastrointest Endosc 2011;42:67-73)

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The Adequate Induction Dose of Propofol for Conscious Sedation During Esophagogastroduodenoscopy in Persons 60 Years or Older: Hyeung Cheol Moon, M.D., Gun Young Hong, M.D., Du Jin Kim, M.D., Sang Chul Choi, M.D., Sang Wook Park, M.D. and Yeun Keun Lim, M.D.; Korean J Gastrointest Endosc 2010;41(3):134-139. Published online September 30, 2010

Abstract PDF

Background/Aims: Propofol is an effective sedative drug in endoscopic procedures, but it has potentially serious adverse effects, so close monitoring of the vital signs should be performed during endoscopy. This study was undertaken to determine the adequate induction dose of propofol for safe and effective sedation during esophagogastrodudenoscopy (EGD) in persons 60 years or older.

Methods: Three hundred patients who visited our hospital for EGD were randomly assigned to three groups (A,B and C). An initial induction dose of 0.5 mg/kg, 0.75 mg/kg and 1.0 mg/kg of propofol was allocated to groups A, B and C, respectively.

Results: The 0.5 mg/kg, 0.75 mg/kg and, 1 mg/kg dose of propofol were all safe as an initial dose of propofol for achieving sedation during EGD in persons 60 years or older. There was no difference in the total amount of propofol among the three groups. Group C had a significantly shorter induction time and a lower dose was required for an additional injection of propofol without increasing adverse events, as compared to the two other groups.

Conclusions: We suggest that 1 mg/kg of propofol is an effective induction dose for sedation during EGD in persons 60 years or older. (Korean J Gastrointest Endosc 2010;40:134-139)

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The Adequate Dose of Propofol for Inducing Sedation during Performance of Upper Gastrointestinal Endoscopy in Koreans: Gun Young Hong, M.D., Kang Seok Seo, M.D., Sang Wook Park, M.D., Hyeung Cheol Moon, M.D., Sang Chul Choi, M.D. and Yeun Keun Lim, M.D.; Korean J Gastrointest Endosc 2009;39(2):66-71. Published online August 30, 2009

Abstract PDF: Background
/Aims: Propofol sedation is increasingly being used when performing upper gastrointestinal endoscopy because of its rapid onset and good recovery profile. For achieving safe sedation during endoscopy, close monitoring of the vital signs is necessary because of the sedation's potentially serious adverse effects. There are only a few studies on the induction of sedation with using propofol for endoscopy in Korea. The present study was undertaken to evaluate the adequate initial injected dose of propofol for achieving safe and effective sedation when performing upper gastrointestinal endoscopy in Koreans.
Methods
From March 2008 to July 2008, 150 subjects who visited Kwangju Christian Hospital were randomized into 3 groups. An initial bolus dose of 0.5 mg/kg, 1.0 mg/kg and 1.5 mg/kg of propofol was allocated to groups A, B and C, respectively. The effectiveness and safety profiles of each injected dose of propofol were prospectively assessed by measuring various parameters of the vital signs and the adverse events.
Results
Group C had a significantly shorter induction time and the patients in group C did not require additional injections of propofol without increasing adverse events, as compared to that of the other 2 groups.
Conclusions
1.5 mg/kg of propofol was found to be more appropriate than 0.5 mg/kg or 1.0 mg/kg of propofol as the initial injected dose for induction of sedation during performance of upper gastrointestinal endoscopy in Koreans. (Korean J Gastrointest Endosc 2009;39:66-71)

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Conscious Sedation with Midazolam Combined with Propofol for Colonoscopy: Ja Seol Koo, M.D., Jai Hyun Choi, M.D., Sung Woo Jung, M.D., Woo Sik Han, M.D., Jong Sup Lee, M.D., Hyung Joon Yim, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Hong Sik Lee, M.D., Sang Woo Lee, M.D., Chang Duck Kim, M.D. and Ho Sang Ryu, M.D.; Korean J Gastrointest Endosc 2007;34(6):298-303. Published online June 30, 2007

Abstract PDF: Background/Aims: There is increasing interest in the use of propofol as a sedative agent for colonoscopy. We evaluated the safety and efficacy of the synergistic sedation with midazolam combined with low-dose propofol versus that of midazolam alone. Methods: A total of 56 patients from among those who underwent total colonoscopy between August 2004 and October 2004 were randomly assigned to one of three medication treatment groups. Group A (n=18) received low-dose midazolam (0.03 mg/kg IV) plus propofol, group B (n=19) received high-dose midazolam (0.07 mg/kg IV) plus propofol, and group C (n=19) received high-dose midazolam alone. The patients' vital signs were monitored throughout the course of the study. The recovery time and quality as well as the patients' comfort level were also assessed. Results: There were no significant differences in baseline characteristics among the treatment groups. There were also no differences in the duration and insertion time of the colonoscopy among the three groups. The patients' comfort level and cardiorespiratory parameters during colonoscopy were similar among the three groups. The sedation efficacy and recovery times were also similar among the three groups. Conclusions: Midazolam combined with low-dose propofol as a sedative for colonoscopy exhibits similar effects on safety, patient' comfort level and recovery time to those of midazolam alone.

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Patient-Controlled Sedation versus Nurse-Administered Sedation with Propofol during Colonoscopy: Jee Hyun Oh, M.D., Hoon Cho, M.D., Yeung Muk Kim, M.D., Mu Yeul Lee, M.D., Guang Soon An, M.D., Hyun Jeung Kim, M.D., Hyun Gwang Jung, M.D., Kang Min Kim, M.D. and Joon Sang Lee, M.D.; Korean J Gastrointest Endosc 2005;31(1):32-38. Published online July 30, 2005

Abstract PDF: Background
/Aims: Patient-controlled sedation (PCS) allows the patients to titrate the dosages of sedative drug according to their needs. The objective of this study was to compare the safety and the efficacy of nurse-administered propofol sedation (NAPS) with those of PCS. Methods: Eighty one patients were randomly assigned to two groups. All patients received meperidine 25 mg and propofol 40 mg as an initial dose for sedation. Patients in PCS group were subsequently infused with propofol 15 mg over 80 seconds through infusion pump whenever they required. Patients in NAPS group were injected with 10∼20 mg propofol by nurse with supervision by endoscopist. The dosage of propofol, cardiopulmonary parameters, procedure time, sedation score, pain score, the patients' and endoscopists' satisfaction scores were assessed. Results: With regard to blood pressure, pulse rate and oxygen saturation, serious complications were not observed. Especially, there was no significant difference of mean total dose between two groups (NAPS group and PCS group received 76.7⁑24.7 mg and 82.5⁑26.6 mg respectively). Pain score was higher in woman than in man (p=0.03). Conclusions: 1.2∼1.5 mg/kg of propofol with small dose of opioid during colonoscopy was effective and safe. NAPS was more practical and useful method of sedation than PCS during colonoscopy. (Korean J Gastrointest Endosc 2005;31:32⁣38)

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Propofol을 사용한 상부 위장관 내시경시 의식 진정을 위한 적정 용량에 관한 연구: Korean J Gastrointest Endosc 2003;27(5):395-395. Published online November 20, 2003

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Propofol 과 Fentanyl 로 상부 위장관 내시경시 산소 공급에 따른 산소 포화도에 관한 연구 ( Study on the Degree of Oxygen Saturation during Upper Gastrointestinal Endoscopy Using Propofol / Fentanyl With Oxygenation ): Korean J Gastrointest Endosc 2001;22(6):399-405. Published online November 30, 2000

Abstract PDF: Background
/Aims: Propofol is usually used for anesthesia in the case of day surgery. We studied the effects of propofol plus fentanyl for sedation and the effect of oxygenation during gastroscopy, Methods: 154 patients who asked conscious sedation during gastroscopy were randomly divided into three groups. The first group (PF-0 group, 50 patients) and the second group (PF group, 48 patients) were received an initial bolus dose of propofol (40 mg) plus fentanyl (50 ㎍) intravenously, followed by additional doses of propofol at one minute interval until conscious sedation. PF-0 group was received preoxygenation (3 L/min) via nasal canula, and PF group was not, The third group (56 patients) received an initial bolus dose of midazolam (3 mg) intravenously, followed by additional doses of midazolam at two minutes interval (M group). Results: In PF-0 group, time to achieve sedation, regain orientation, and recover walking ability were 118.0±85.2 sec, 67.5±91.2 sec and 11.1±5.3 min. Gag reflex during the procedure was absent or nearly absent in 96% of patients. Despite the changes of blood pressure and heart rate compared to the values taken prior to the procedures were observed, all values were not clinically significant, In PF-0 group, transient oxygen desaturation (SaO2<90%) was observed in four (8.0%) patients. Conclusions: Propofol plus fentanyl with oxygenation seems to be more acceptable and suitable method for sedation during outpatient gastroscopic examination. (Korean J Gastrointest Endosc 2001;22:399-405)

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상부 위장관 내시경 검사 시 전처치로서의 Propofol의 효과 ( Propofol as Premedication for Upper Gastrointestinal Endoscopy ): Korean J Gastrointest Endosc 2000;20(3):165-170. Published online November 30, 1999

Abstract PDF: Background
/Aims: Benzodiazepine is generally used when sedation is required for endoscopy, while propofol, a phenol-derived intravenous anesthetic agent, appears to have a more suitable phamacokinetic profile. The aim of this study was to evaluate the effectiveness and safety of propofol as premedication for upper gastrointestinal endoscopy. Methods: Between July 1998 and October 1998, 44 male patients and 70 female patients were involved in this study. The relative ease of upper gastrointestinal endoscopy, patient's tolerance, and amnestic effects on 64 patients with propofol was compared with 50 patients with non-sedation. Pulse rate and arterial oxygen saturation was monitored. The endoscopist and patients replied to a questionnaire. Results: Patients receiving propofol tolerated endoscopy much more than patients with non-sedation (p＜0.01). The change in pulse rate was less variable but arterial oxygen saturation showed a statistically significant decrease in patients receiving propofol (p＜0.01). Propofol induced complete amnesia in 93.7% of the patients and partial anesthesia in 4.7%. Most of the patients receiving propofol accepted the same sedative methods in their next endoscopy (p＜0.01). Conclusions: Propofol is highly effective, with a short recovery time and satisfaction of the patients, but careful monitoring is recommended because of its untoward effect of hypoxia. It is recommended that propofol be used as a premedication especially in patients who are apprehensive about a repeated endoscopy.

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상부 위장관 내시경의 전처치로서 Propofol의 효과 ( The Effect of Propofol for Sedation during Upper Gastrointestinal Endoscopy ): Korean J Gastrointest Endosc 1999;19(5):716-720. Published online November 30, 1998

Abstract PDF: Background
/Aims: This research was conducted in order to study the clinical usefulness and stability of the propofol used for sedation during upper gastrointestinal endoscopy. Methods: The objective of this research was to study one hundred patients, who were chosen based upon their preference to be examined through diagnostic upper gastrointestinal endoscopy accompanied with propofol from July 1998 to August 1998, and who showed normality in the pulmonary function test and ECG. The elements observed were hemodynamic variations, injection dosage, injection time, recovery time and side effects. Results: All patatints had no recollection of the procedure during gastrointestinal endoscopy. It was found that the older the patients were, the less amount of propofol sleep was indued. Systolic blood pressure, diastolic blood pressure and the mean arterial blood pressure were lowered noticeably after sleep, compared with those before the injection of propofol, while the heart rate hardly changed. Conclusions: Profopol is believed to be a useful sedative for upper gastrointestinal endoscopy. As blood pressre can be lowered however, a cautious attitude should be considered when injecting propofol in the elderly or in patients who have cardiovascular disease. (Korean J Gastrointest Endosc 19: 716∼720, 1999)

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Propofol 지속정주를 이용한 상부소화관 내시경 ( Gastrointestinal Endoscopy under Sedation with a Continuous Infusion of Propofol ): Korean J Gastrointest Endosc 1999;19(5):706-715. Published online November 30, 1998

Abstract PDF: Background
/Aims: Propofol is a short-acting intravenous sedative-hypnotic agent that can be used as a hypnotics for upper gastrointestinal endoscopy. A study was conducted to evaluate the effectiveness and safety of propofol as a hypnotic agent for upper gastrointestinal endoscopy. Methods: From June to October 1998, twenty eight patients undergoing upper gastrointestinal endoscopy were to receive propofol. Vital signs and peripheral oxygen saturation (SpO2) were monitored by pulse oximetry during continuous infusion of propofol. Propofol (1% solution) was initially infused by 26.7 mg/kg/hr until loss of eyelash reflex and then titrated to 6∼10 mg/kg/hr according to the patient's response and vital sign. Propofol infusion was discontinued while the endoscopic fiber was removed. Recovery time was defined from discontinuation of infusion to positive Romberg test. Evaluation was made from the endoscopists' assessment, patients' satisfaction, patients' recall of the procedure, and consciousness of the patients. Results: It was discovered that systolic, diastolic pressure and heart rate were significantly decreased, compared to control group. But clinically significant changes were not found. Apnea did not exist. And the respiration rate was significantly increased during propofol infusion. Peripheral oxygen saturation (SpO2) was transiently decreased during endoscopy. 14 patients (50%) complained of transient dizziness. Pain and redness over the infusion site was not found. The mean total dose of propofol was 133.6 mg. The mean infusion time of propofol was 6.2 minutes. Mean response and recovery time was 3.7 2.1, 20.9 5.4 minutes. Endoscopists' assessment and patients' comfort for endoscopy were satisfactory. When we asked 28 patients about willingness to undergo the same procedure in the future, 27 patients (96.4%) agreed. Degree of amnesia after examination revealed total amnesia in 27 patients (96.4%), partial amnesia in 1 patients (3.6%), and recall was not. Conclusions: Propofol has beneficial effects as hypnotic for upper gastrointestinal endoscopy without significant alteration in cardiopulmonary parameters. Patients' and endoscopists' assessment is good. This suggest that propofol may be used more frequently as a kind of premedication, especially in the cases of repeated endoscopy. (Korean J Gastrointest Endosc 19: 706∼715, 1999)

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