Combination of propofol and nasal sufentanil or intravenous midazolam for colonoscopy: a comparative study

Introduction
The aim of the study was to compare and evaluate the side effects (SEs) and sedation characteristics of synergistic sedation with doses of 0.25 μg kg-1 or 0.5 μg kg-1 intranasal (IN) sufentanil, and intravenous (IV) midazolam during propofol-based sedation in patients undergoing colonoscopy.

Material and methods
This was a prospective, randomized, double-blind study. The patients were randomly allocated into one of 3 groups: group I (n = 33) – sufentanil IN 0.5 μg kg–1; group II (n = 33) – sufentanil IN 0.25 μg kg-1; and group III (n = 33) – IN 0.9% NaCl (placebo) and IV 0.04 mg kg-1 midazolam. After 15 minutes, all patients received 0.5 mg kg-1 propofol intravenously. Cardiorespiratory side effects and sedation characteristics were compared.

Results
The propofol consumption in group III was significantly higher than in group I and II (P < 0.001). Spontaneous eye opening time was significantly longer in group III than in group I and II ( < 0.001). The patients in group III had significantly longer recovery times than patients in group I and II (P < 0.0001). Hypotension and bradycardia were not encountered during the study. The incidence of hypoxaemia was significantly greater in group III compared to other groups (P < 0.001). Pain control and endoscopist satisfaction was significantly better for group I and II than for group III (P < 0.001).

Conclusions
Synergistic sedation can be achieved safely and effectively by the combination of propofol and IN sufentanil or IV midazolam for colonoscopy. However, IN sufentanil can be considered as a reasonable alternative to IV midazolam due to less respiratory depression, and better pain control and endoscopist satisfaction.