Is Propofol Sedation with Midazolam Induction Safe During Endoscopic Procedures without Anesthesiologist?

Background/Aims: Sedation is important for the success and quality of endoscopy. We aimed to evaluate the safety of propofol during the endoscopy under supervision of a gastroenterologist without an anesthesiologist. Methodology: All propofol using endoscopic procedures between January 2004 and December 2008 were evaluated retrospectively. All patients received i.v. propofol plus midazolam during the procedures. Blood pressure, heart rate and pO(2) saturation were all recorded before and during the procedures. Results: Mean age of patients was 39.13 +/- 12.9 years (45% male). 50 endoscopic retrograde colangiography, 1430 colonoscopy, 2478 gastroscopy and 210 double balloon enteroscopy procedures were evaluated. First i.v. midazolam (mean 3 +/- 1.1mg) was used for sedation, then iv. propofol (mean dose 50 +/- 10mg) was titrated to achieve deep sedation. Before the procedures, mean pO(2), systolic blood pressure, and heart rate were 95 +/- 3%, 120 +/- 25mmHg, 87 +/- 20, respectively. Mean pO(2) decreased significantly during the procedures (from 95 +/- 3% to 83 +/- 5%) (p<0.005). Only one patient needed tracheal intubation. Arterial hypotension (<90 mmHg systolic pressure) was observed in 10% of patients (p>0.05). Two percent of patients had bradycardia (Heart rate <50 min). Conclusion: Using propofol after midazolam induction seems to be feasible only if the patients are carefully observed and their vital functions monitored during the procedures. Key words: endoscopy, propofol, sedation.