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Patient Satisfaction With Propofol for Outpatient Colonoscopy: A Prospective, Randomized, Double-Blind Study

Padmanabhan, Anantha M.D.1; Frangopoulos, Christoforos M.D.2; Shaffer, Lynn E.T. Ph.D.3

doi: 10.1097/DCR.0000000000000909
Original Contributions: Endoscopy
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BACKGROUND: Previous literature has shown that propofol has ideal anesthetic properties for patients undergoing colonoscopy, a common procedure at outpatient surgery centers. However, there is a paucity of information regarding patient satisfaction with propofol.

OBJECTIVE: The aim of this study was to evaluate patient satisfaction with propofol compared with nonpropofol (fentanyl/midazolam) anesthesia for outpatient colonoscopies. Safety and complications were secondary end points.

DESIGN: This study was a double-blind, randomized, parallel-group controlled clinical trial (NCT 02937506).

SETTING: This study was conducted at a single ambulatory surgery center at an urban teaching community health system.

PATIENTS: Patients were scheduled for outpatient colonoscopy. Those with high-risk cardiac or pulmonary disease were excluded.

INTERVENTIONS: Anesthesia personnel administered either fentanyl/midazolam (n = 300) or propofol (n = 300) for sedation during outpatient colonoscopy. A single, highly experienced endoscopist performed all colonoscopies.

MAIN OUTCOME MEASURES: The primary outcomes measured were patient satisfaction (5-point Likert scale) and procedure complications. Data were collected on the day of endoscopy by the nursing staff of the postanesthesia care unit. A subinvestigator blinded to the randomization called patients 24 to 72 hours after discharge to obtain data on postprocedure problems and status of resumption of normal activities. Analysis was intention-to-treat.

RESULTS: Fewer patients who received propofol remembered being awake during the procedure (2% vs 17% for fentanyl, p < 0.0001) and were more likely to rate the amount of anesthesia received as being “just right” (98.7% vs 91.3% for fentanyl, p = 0.0002) and state that they were “very satisfied” with their anesthesia (86.3% vs 74% for fentanyl, p = 0.0005). Twenty-six percent of fentanyl procedures were rated “difficult” compared with 4.3% for propofol (p < 0.0001), and complications were fewer in the propofol group (2.7% vs 11.7%, p < 0.0001).

LIMITATIONS: The endoscopist could not be completely blinded to the anesthetic administered.

CONCLUSIONS: Patients prefer propofol over a combination of fentanyl/midazolam as their anesthetic for outpatient colonoscopies. From a patient and provider perspective, propofol appears to be superior to fentanyl/midazolam for outpatient colonoscopy. See Video Abstract at http://links.lww.com/DCR/A445.

1 Graduate Medical Education, Transitional Year Residency Program, Mount Carmel Health System, Columbus, Ohio

2 Graduate Medical Education, University of North Carolina, Chapel Hill, North Carolina

3 Office of Research Affairs, Mount Carmel Health System, Columbus, Ohio

Funding/Support: None reported.

Financial Disclosures: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons Seattle, WA, June 10 to 14, 2017.

Correspondence: Anantha Padmanabhan, M.D., Graduate Medical Education, Mount Carmel Health System, 793 West State St, Columbus, OH 43222. E-mail: apaddy84@gmail.com

© 2017 The American Society of Colon and Rectal Surgeons