Comparison of propofol versus propofol/fentanyl anesthesia for upper gastrointestinal endoscopy

Background: The rapid onset and short duration of propofol makes it an ideal anesthetic during esophagogastroduodenoscopy (EGD). Fentanyl is frequently used in combination with propofol during EGD to provide an analgesic component. The synergy that results from combining the two drugs may be beneficial but may also increase the potential for apnea, hypotension, nausea, and prolonged recovery. This pilot study was designed to test the hypothesis that propofol/fentanyl anesthesia provides better conditions than propofol alone during EGD and to compare the incidence of side effects between the two techniques. Methodology: This was an IRB approved, double blinded, prospective, placebo controlled study. One hundred consented patients undergoing EGD were randomly assigned into two Groups. Patients in the first (propofol/fentanyl) Group received fentanyl 1 mu g/kg followed by propofol 0.75 mg/kg bolus, while patients in the second (propofol) Group received propofol 1.5 mg/kg bolus. Patients in the Group that received fentanyl received half the initial induction dose of propofol in order to minimize the potential for apnea and hypoventilation due to the synergy between the two drugs. In both Groups, additional 20 mg propofol boluses were given at 1min intervals until adequate depth of anesthesia was reached. Propofol infusion was then started and adjusted to maintain adequate depth of anesthesia during the procedure. The primary end point was the quality of anesthesia as rated by the blinded endoscopist. The secondary end points were the incidence of hypotension, hypoxia, nausea, vomiting, and delayed recovery. Data from the two Groups were compared by the Wilcoxon rank test for the primary endpoint, by t-test for continuous measures, and by chi square for proportions including hypoxia and hypotension. Results: The endoscopists' evaluation scores were statistically significantly higher in the propofol/fentanyl Group. Fentanyl had a statistically significant sparing effect on propofol induction dose. No statistically significant difference between the two Groups was found in the other study parameters. Conclusion: The combination of propofol and fentanyl provides better quality of anesthesia than propofol alone during EGD with no apparent additional side effects.