Sedation during upper GI endoscopy in cirrhotic outpatients: a randomized, controlled trial comparing propofol and fentanyl with midazolam and fentanyl

Sedation during upper GI endoscopy in cirrhotic outpatients: a randomized, controlled trial comparing propofol and fentanyl with midazolam and fentanyl

Author Correia, Lucianna Motta Autor UNIFESP Google Scholar
Bonilha, Danielle Queiroz Autor UNIFESP Google Scholar
Gomes, Gustavo Flores Autor UNIFESP Google Scholar
Brito, Juliana Ramos Autor UNIFESP Google Scholar
Nakao, Frank Shigueo Autor UNIFESP Google Scholar
Lenz, Luciano Autor UNIFESP Google Scholar
Silveira Rohr, Maria Rachel Autor UNIFESP Google Scholar
Ferrari, Angelo P. Autor UNIFESP Google Scholar
Della Libera, Ermelindo Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Background: Patients with liver cirrhosis frequently undergo diagnostic or therapeutic upper GI endoscopy (UGIE), and the liver disease might impair the metabolism of drugs usually administered for sedation.Objective and Setting: To compare sedation with a combination of propofol plus fentanyl and midazolam plus fentanyl in cirrhotic outpatients undergoing UGIE.Design: A prospective, randomized, controlled trial was conducted between February 2008 and February 2009.Main Outcomes Measurements: Efficacy (proportion of complete procedures using the initial proposed sedation scheme), safety (occurrence of sedation-related complications), and recovery time were measured.Results: Two hundred ten cirrhotic patients referred for UGIE were randomized to 2 groups: midazolam group (0.05 mg/kg plus fentanyl 50 mu g intravenously) or propofol group (0.25 mg/kg plus fentanyl 50 mu g intravenously). There were no differences between groups regarding age, sex, weight, etiology of cirrhosis, and Child-Pugh or American Society of Anesthesiologists classification. Sedation with propofol was more efficacious (100% vs 88.2%; P < .001) and had a shorter recovery time than sedation with midazolam (16.23 +/- 6.84 minutes and 27.40 +/- 17.19 minutes, respectively; P < .001). Complication rates were similar in both groups (14% vs 7.3%; P = .172).Limitations: Single-blind study; sample size.Conclusion: Both sedation schemes were safe in this setting. Sedation with propofol plus fentanyl was more efficacious with a shorter recovery time compared with midazolam plus fentanyl. Therefore, the former scheme is an alternative when sedating cirrhotic patients undergoing UGIE. (Gastrointest Enclose 2011;73:45-51.)
Language English
Date 2011-01-01
Published in Gastrointestinal Endoscopy. New York: Mosby-Elsevier, v. 73, n. 1, p. 45-51, 2011.
ISSN 0016-5107 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 45-51
Origin http://dx.doi.org/10.1016/j.gie.2010.09.025
Access rights Closed access
Type Article
Web of Science ID WOS:000285909400007
URI http://repositorio.unifesp.br/handle/11600/33278

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