Document Detail


Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial.
MedLine Citation:
PMID:  12105827     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Propofol is increasingly used for gastrointestinal endoscopy because of its rapid recovery profile. There has been no prospective, randomized comparison of gastroenterologist-administered propofol to meperidine and midazolam for endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. Additionally, its cost-effectiveness has not been studied. METHODS: Seventy-five randomized patients received either gastroenterologist-administered propofol (n = 38) or meperidine/midazolam (n = 37) for endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. Monitoring with capnography allowed for rapid titration of propofol at the earliest signs of respiratory depression. Visual analogue scales measured tolerance and satisfaction. A cost-effectiveness analysis was performed by using return to baseline for both activity and food intake 24 hours after the procedure as the effectiveness measure. RESULTS: The groups had similar physiological outcomes and satisfaction. Patients receiving propofol had shorter recovery times (P < 0.001) and a higher recovery of both baseline activity level and dietary intake 24 hours after the procedure (P = 0.028). With incremental cost-effectiveness analysis, gastroenterologist-administered propofol cost an additional $403.00 per additional patient at 100% of baseline for both activity level and food intake when compared with standard sedation and analgesia. Sensitivity analysis indicated that the only model in which propofol administration would become the dominant strategy was with its administration by a registered nurse. CONCLUSIONS: Gastroenterologist-administered propofol using monitoring with capnography is similar to meperidine/midazolam for both physiological outcomes and patient/endoscopist satisfaction. Propofol leads to significantly improved recovery of baseline activity and food intake 24 hours after the procedure. Our model suggests that propofol would be more cost-effective than meperidine and midazolam for endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography if registered nurse administration were possible.
Authors:
John J Vargo; Gregory Zuccaro; John A Dumot; Kenneth M Shermock; J Brad Morrow; Darwin L Conwell; Patricia A Trolli; Walter G Maurer
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gastroenterology     Volume:  123     ISSN:  0016-5085     ISO Abbreviation:  Gastroenterology     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-09     Completed Date:  2002-08-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  8-16     Citation Subset:  AIM; IM    
Affiliation:
Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Analgesics, Opioid / administration & dosage*,  economics,  therapeutic use
Cholangiopancreatography, Endoscopic Retrograde*
Cost-Benefit Analysis
Endosonography*
Female
Gastroenterology / methods*
Health Care Costs
Heart / drug effects
Humans
Hypnotics and Sedatives / administration & dosage*,  economics,  therapeutic use
Male
Meperidine / administration & dosage*,  economics,  therapeutic use
Midazolam / administration & dosage*,  economics,  therapeutic use
Middle Aged
Patient Satisfaction
Propofol / administration & dosage*,  economics,  therapeutic use
Prospective Studies
Respiration / drug effects
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Hypnotics and Sedatives; 2078-54-8/Propofol; 57-42-1/Meperidine; 59467-70-8/Midazolam
Comments/Corrections
Comment In:
Gastroenterology. 2002 Jul;123(1):373-5   [PMID:  12105865 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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