A Riphaus1, T Gstettenbauer, M B Frenz, T Wehrmann. 1. Department of Internal Medicine I (Gastroenterology and Interventional Endoscopy), Siloah Hospital, Hanover, Germany.
Abstract
BACKGROUND AND STUDY AIMS: Propofol sedation is increasingly being used for endoscopy in the outpatient setting. In view of the agent's short period of action, current recommendations that patients should avoid driving or using public transport unescorted for 24 h may be too strict. Psychomotor recovery and driving skills before and after sedation were therefore assessed. PATIENTS AND METHODS: A total of 100 patients undergoing routine upper or lower gastrointestinal endoscopy were randomly sedated either with propofol alone or with midazolam plus pethidine. The recovery time and quality of recovery were assessed. Psychomotor recovery was evaluated using the number connection test (NCT) and a driving simulator test 1 h before and 2 h after the endoscopic procedure. RESULTS: Ninety-six patients completed the 2-hour post-sedation procedure. Vital signs were recorded, and no clinically relevant complications occurred. The mean recovery time and quality of recovery were significantly better after propofol sedation (14 +/- 9 min vs. 25 +/- 8 min and 8.7 +/- 1.3 vs. 6.3 +/- 1.1 points) ( P < 0.01). Psychomotor and driving skills after propofol sedation were similar to the baseline results, while in the midazolam/pethidine group, patients showed significantly more lane deviations (1.1 +/- 0.9 vs. 1.6 +/- 0.9), time over the speed limit (0.3 +/- 0.83 vs. 0.6 +/- 0.88), missed stoplights more often (0.05 +/- 0.31 vs. 0.11 +/- 0.35), and had slower reaction times for unexpected events (1.11 +/- 0.46 s vs. 1.39 +/- 0.44 s) ( P < 0.01). The time needed to complete the NCT after sedation did not differ between the two groups (32.1 +/- 12.0 s vs. 33.4 +/- 12.6 s for propofol; 31.5 +/- 11.2 s vs. 34.6 +/- 12.8 s for midazolam/pethidine). CONCLUSIONS: Current recommendations that patients should refrain from driving and unescorted use of public transport for 24 h after sedation may need to be reconsidered in patients who receive propofol sedation.
RCT Entities:
BACKGROUND AND STUDY AIMS: Propofol sedation is increasingly being used for endoscopy in the outpatient setting. In view of the agent's short period of action, current recommendations that patients should avoid driving or using public transport unescorted for 24 h may be too strict. Psychomotor recovery and driving skills before and after sedation were therefore assessed. PATIENTS AND METHODS: A total of 100 patients undergoing routine upper or lower gastrointestinal endoscopy were randomly sedated either with propofol alone or with midazolam plus pethidine. The recovery time and quality of recovery were assessed. Psychomotor recovery was evaluated using the number connection test (NCT) and a driving simulator test 1 h before and 2 h after the endoscopic procedure. RESULTS: Ninety-six patients completed the 2-hour post-sedation procedure. Vital signs were recorded, and no clinically relevant complications occurred. The mean recovery time and quality of recovery were significantly better after propofol sedation (14 +/- 9 min vs. 25 +/- 8 min and 8.7 +/- 1.3 vs. 6.3 +/- 1.1 points) ( P < 0.01). Psychomotor and driving skills after propofol sedation were similar to the baseline results, while in the midazolam/pethidine group, patients showed significantly more lane deviations (1.1 +/- 0.9 vs. 1.6 +/- 0.9), time over the speed limit (0.3 +/- 0.83 vs. 0.6 +/- 0.88), missed stoplights more often (0.05 +/- 0.31 vs. 0.11 +/- 0.35), and had slower reaction times for unexpected events (1.11 +/- 0.46 s vs. 1.39 +/- 0.44 s) ( P < 0.01). The time needed to complete the NCT after sedation did not differ between the two groups (32.1 +/- 12.0 s vs. 33.4 +/- 12.6 s for propofol; 31.5 +/- 11.2 s vs. 34.6 +/- 12.8 s for midazolam/pethidine). CONCLUSIONS: Current recommendations that patients should refrain from driving and unescorted use of public transport for 24 h after sedation may need to be reconsidered in patients who receive propofol sedation.