Safety and Efficacy of Fentanyl Versus Pethidine During Propofol-based Sedated Colonoscopy: Prospective Randomized Study

Summary

During sedative colonoscopy, use of propofol have been increased world wide. The onset time of propofol is shorter than midazolam. However the most popular additive pain killer, pethidine show different pharmacodynamic feature. The pethidine has longer onset time than propofol (nearly 30 minutes) and require more time to recovery. For this reason, the use of fentanyl has been increased world widely. However, exact comparison of pethidine and fentanyl was not studied. Therefore, we designed this study to compare both drug to check satisfaction of this drug.

Timeline

Start

2013-09

Primary completion

2015-08

Completion

2015-08

Publications

• Background Agostoni M, Fanti L, Arcidiacono PG, Gemma M, Strini G, Torri G, Testoni PA. Midazolam and pethidine versus propofol and fentanyl patient controlled sedation/analgesia for upper gastrointestinal tract ultrasound endoscopy: a prospective randomized controlled trial. Dig Liver Dis. 2007 Nov;39(11):1024-9. doi: 10.1016/j.dld.2007.08.004. Epub 2007 Oct 29.
• Background Barriga J, Sachdev MS, Royall L, Brown G, Tombazzi CR. Sedation for upper endoscopy: comparison of midazolam versus fentanyl plus midazolam. South Med J. 2008 Apr;101(4):362-6. doi: 10.1097/SMJ.0b013e318168521b.
• Background Beers R, Camporesi E. Remifentanil update: clinical science and utility. CNS Drugs. 2004;18(15):1085-104. doi: 10.2165/00023210-200418150-00004.
• Background Bilgin H, Basagan Mogol E, Bekar A, Iscimen R, Korfali G. A comparison of effects of alfentanil, fentanyl, and remifentanil on hemodynamic and respiratory parameters during stereotactic brain biopsy. J Neurosurg Anesthesiol. 2006 Jul;18(3):179-84. doi: 10.1097/01.ana.0000210998.10410.2e.
• Background Cinar K, Yakut M, Ozden A. Sedation with midazolam versus midazolam plus meperidine for routine colonoscopy: a prospective, randomized, controlled study. Turk J Gastroenterol. 2009 Dec;20(4):271-5. doi: 10.4318/tjg.2009.0025.
• Background Cohen LB, Hightower CD, Wood DA, Miller KM, Aisenberg J. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam. Gastrointest Endosc. 2004 Jun;59(7):795-803. doi: 10.1016/s0016-5107(04)00349-9.
• Background Cohen LB, Wecsler JS, Gaetano JN, Benson AA, Miller KM, Durkalski V, Aisenberg J. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. 2006 May;101(5):967-74. doi: 10.1111/j.1572-0241.2006.00500.x.
• Background Dere K, Sucullu I, Budak ET, Yeyen S, Filiz AI, Ozkan S, Dagli G. A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation. Eur J Anaesthesiol. 2010 Jul;27(7):648-52. doi: 10.1097/EJA.0b013e3283347bfe.
• Background Fakheri HT, Kiasari AZ, Taghvaii T, Hosseini V, Mohammadpour RA, Nasrollah A, Kabirzadeh A, Shahmohammadi S. Assessment the effect of midazolam sedation on hypoxia during upper gastrointestinal endoscopy. Pak J Biol Sci. 2010 Feb 15;13(4):152-7. doi: 10.3923/pjbs.2010.152.157.
• Background Hassan C, Benamouzig R, Spada C, Ponchon T, Zullo A, Saurin JC, Costamagna G. Cost effectiveness and projected national impact of colorectal cancer screening in France. Endoscopy. 2011 Sep;43(9):780-93. doi: 10.1055/s-0030-1256409. Epub 2011 May 27.
• Background Hayee B, Dunn J, Loganayagam A, Wong M, Saxena V, Rowbotham D, McNair A. Midazolam with meperidine or fentanyl for colonoscopy: results of a randomized trial. Gastrointest Endosc. 2009 Mar;69(3 Pt 2):681-7. doi: 10.1016/j.gie.2008.09.033.
• Background Heuss LT, Froehlich F, Beglinger C. Changing patterns of sedation and monitoring practice during endoscopy: results of a nationwide survey in Switzerland. Endoscopy. 2005 Feb;37(2):161-6. doi: 10.1055/s-2004-826143.
• Background Heuss LT, Sugandha SP, Beglinger C. Carbon dioxide accumulation during analgosedated colonoscopy: comparison of propofol and midazolam. World J Gastroenterol. 2012 Oct 14;18(38):5389-96. doi: 10.3748/wjg.v18.i38.5389.
• Background Hoj AT, Vilmann P. [Propofol for sedation during colonoscopy. A survey of a Cochrane review]. Ugeskr Laeger. 2010 May 17;172(20):1532-4. Danish.
• Background Hsieh YH, Chou AL, Lai YY, Chen BS, Sia SL, Chen IC, Chang YL, Lin HJ. Propofol alone versus propofol in combination with meperidine for sedation during colonoscopy. J Clin Gastroenterol. 2009 Sep;43(8):753-7. doi: 10.1097/MCG.0b013e3181862a8c.
• Background Komatsu R, Turan AM, Orhan-Sungur M, McGuire J, Radke OC, Apfel CC. Remifentanil for general anaesthesia: a systematic review. Anaesthesia. 2007 Dec;62(12):1266-80. doi: 10.1111/j.1365-2044.2007.05221.x.
• Background Latta KS, Ginsberg B, Barkin RL. Meperidine: a critical review. Am J Ther. 2002 Jan-Feb;9(1):53-68. doi: 10.1097/00045391-200201000-00010.
• Background Lewis JR, Cohen LB. Update on colonoscopy preparation, premedication and sedation. Expert Rev Gastroenterol Hepatol. 2013 Jan;7(1):77-87. doi: 10.1586/egh.12.68.
• Background Mandel JE, Lichtenstein GR, Metz DC, Ginsberg GG, Kochman ML. A prospective, randomized, comparative trial evaluating respiratory depression during patient-controlled versus anesthesiologist-administered propofol-remifentanil sedation for elective colonoscopy. Gastrointest Endosc. 2010 Jul;72(1):112-7. doi: 10.1016/j.gie.2010.01.031. Epub 2010 May 20.
• Background Mandel JE, Tanner JW, Lichtenstein GR, Metz DC, Katzka DA, Ginsberg GG, Kochman ML. A randomized, controlled, double-blind trial of patient-controlled sedation with propofol/remifentanil versus midazolam/fentanyl for colonoscopy. Anesth Analg. 2008 Feb;106(2):434-9, table of contents. doi: 10.1213/01.ane.0000297300.33441.32.
• Background McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. 2008 May;67(6):910-23. doi: 10.1016/j.gie.2007.12.046.
• Background Molina-Infante J, Duenas-Sadornil C, Mateos-Rodriguez JM, Perez-Gallardo B, Vinagre-Rodriguez G, Hernandez-Alonso M, Fernandez-Bermejo M, Gonzalez-Huix F. Nonanesthesiologist-administered propofol versus midazolam and propofol, titrated to moderate sedation, for colonoscopy: a randomized controlled trial. Dig Dis Sci. 2012 Sep;57(9):2385-93. doi: 10.1007/s10620-012-2222-4. Epub 2012 May 22.
• Background Mui LM, Teoh AY, Ng EK, Lee YT, Au Yeung AC, Chan YL, Lau JY, Chung SC. Premedication with orally administered midazolam in adults undergoing diagnostic upper endoscopy: a double-blind placebo-controlled randomized trial. Gastrointest Endosc. 2005 Feb;61(2):195-200. doi: 10.1016/s0016-5107(04)02590-8.
• Background Ozel AM, Oncu K, Yazgan Y, Gurbuz AK, Demirturk L. Comparison of the effects of intravenous midazolam alone and in combination with meperidine on hemodynamic and respiratory responses and on patient compliance during upper gastrointestinal endoscopy: a randomized, double-blind trial. Turk J Gastroenterol. 2008 Mar;19(1):8-13.
• Background Padmanabhan U, Leslie K, Eer AS, Maruff P, Silbert BS. Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol. Anesth Analg. 2009 Nov;109(5):1448-55. doi: 10.1213/ane.0b013e3181a6ad31. Epub 2009 Jul 17.
• Background Paspatis GA, Manolaraki M, Xirouchakis G, Papanikolaou N, Chlouverakis G, Gritzali A. Synergistic sedation with midazolam and propofol versus midazolam and pethidine in colonoscopies: a prospective, randomized study. Am J Gastroenterol. 2002 Aug;97(8):1963-7. doi: 10.1111/j.1572-0241.2002.05908.x.
• Background Qadeer MA, Vargo JJ, Khandwala F, Lopez R, Zuccaro G. Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis. Clin Gastroenterol Hepatol. 2005 Nov;3(11):1049-56. doi: 10.1016/s1542-3565(05)00742-1.
• Background Repici A, Pagano N, Hassan C, Carlino A, Rando G, Strangio G, Romeo F, Zullo A, Ferrara E, Vitetta E, Ferreira Dde P, Danese S, Arosio M, Malesci A. Balanced propofol sedation administered by nonanesthesiologists: The first Italian experience. World J Gastroenterol. 2011 Sep 7;17(33):3818-23. doi: 10.3748/wjg.v17.i33.3818.
• Background Riphaus A, Macias-Gomez C, Deviere J, Dumonceau JM. Propofol, the preferred sedation for screening colonoscopy, is underused. Results of an international survey. Dig Liver Dis. 2012 May;44(5):389-92. doi: 10.1016/j.dld.2011.10.019. Epub 2011 Nov 25.
• Background Riphaus A, Rabofski M, Wehrmann T. Endoscopic sedation and monitoring practice in Germany: results from the first nationwide survey. Z Gastroenterol. 2010 Mar;48(3):392-7. doi: 10.1055/s-0028-1109765. Epub 2010 Feb 5.
• Background Robertson DJ, Jacobs DP, Mackenzie TA, Oringer JA, Rothstein RI. Clinical trial: a randomized, study comparing meperidine (pethidine) and fentanyl in adult gastrointestinal endoscopy. Aliment Pharmacol Ther. 2009 Apr 15;29(8):817-23. doi: 10.1111/j.1365-2036.2009.03943.x. Epub 2009 Jan 20.
• Background Tox U, Schumacher B, Toermer T, Terheggen G, Mertens J, Holzapfel B, Lehmacher W, Goeser T, Neuhaus H. Propofol sedation for colonoscopy with a new ultrathin or a standard endoscope: a prospective randomized controlled study. Endoscopy. 2013 Jun;45(6):439-44. doi: 10.1055/s-0032-1326270. Epub 2013 Mar 6.
• Background Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013 Jan 28;19(4):463-81. doi: 10.3748/wjg.v19.i4.463.
• Background Ulmer BJ, Hansen JJ, Overley CA, Symms MR, Chadalawada V, Liangpunsakul S, Strahl E, Mendel AM, Rex DK. Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clin Gastroenterol Hepatol. 2003 Nov;1(6):425-32. doi: 10.1016/s1542-3565(03)00226-x.
• Background Usta B, Turkay C, Muslu B, Gozdemir M, Kasapoglu B, Sert H, Demircioglu RI, Karabayirli S. Patient-controlled analgesia and sedation with alfentanyl versus fentanyl for colonoscopy: a randomized double blind study. J Clin Gastroenterol. 2011 Aug;45(7):e72-5. doi: 10.1097/MCG.0b013e318201fbce.
• Background VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol. 2006 Oct;101(10):2209-17. doi: 10.1111/j.1572-0241.2006.00760.x.
• Background Wang D, Wang S, Chen J, Xu Y, Chen C, Long A, Zhu Z, Liu J, Deng D, Chen J, Tang D, Wang L. Propofol combined with traditional sedative agents versus propofol- alone sedation for gastrointestinal endoscopy: a meta-analysis. Scand J Gastroenterol. 2013 Jan;48(1):101-10. doi: 10.3109/00365521.2012.737360. Epub 2012 Oct 31.
• Background Wang F, Shen SR, Xiao DH, Xu CX, Tang WL. Sedation, analgesia, and cardiorespiratory function in colonoscopy using midazolam combined with fentanyl or propofol. Int J Colorectal Dis. 2011 Jun;26(6):703-8. doi: 10.1007/s00384-011-1162-3. Epub 2011 Mar 16.

Drugs

Indications

No indication recorded.