Establishing a Protocol for Propofol Patient Controlled Sedation for Colonoscopy
Adam B. Brown, D.O., George G. Neuman, M.D., David B. Berman, M.D., Donald M. Mathews, M.D.
Department of Anesthesiology, Saint Vincents Hospital Manhattan, New York, New York

Introduction: Patient controlled sedation (PCS) is an attractive technique when “conscious sedation” is needed for lowstimulation procedures. The goal of our study was to develop a system in which patients could safely self-administer propofol during colonoscopy using a commercially available PCA pump with a high degree of satisfaction.
Methods: The study was done in two phases. Patient criteria and data recording were similar in both phases. All patients were (ASA I-III), scheduled for elective, outpatient colonoscopy and had standard pre-anesthetic interviews. In phase one of the study we observed multiple anesthesia providers as they sedated 31 patients for colonoscopy using propofol alone. Through our observations of drug dosing, timing, and patient response, a PCS dose of 25 mg was chosen. In phase two, 11 patients in the PCS group had the Curlin 4000 Plus PCA pump (Curlin Medical, LLC 15751 Graham St. Huntington Beach, CA 92649) connected directly to their IV. The pump was programmed to deliver propofol 25 mg with a lockout of one minute. Patients were given the handset for the PCA pump. They were initially coached to self-administer propofol until their level of consciousness assessed
using Observers Assessment of Sedation Score was 3 (responded to name called loudly and repeatedly) prior to insertion of the colonoscope. Patients were reminded of their ability to make themselves sleepier during the procedure. Our data collection consisted of drug dose, procedure time, PCS attempts, PCS doses, respiratory complications, hemodynamic alterations, and need for provider intervention. All patients were questioned after the procedure about recall and recall of pain. Patients were also asked to give an anesthetic satisfaction score, scale (0-10). Groups were compared with unpaired t-testing, z test for proportions or Mann-Whitney Rank Sum test as appropriate. A p value <0.05 was considered significant.
Results: The total dose of propofol was the same for both groups (table). There were no respiratory events or hemodynamic perturbations encountered in the PCS group. Compared with the observation group, patients in the PCS group demonstrated a tendency towards recall, a difference which did not reach significance. Satisfaction scores for both groups are demonstrated in the graphs and were not significantly different.

Conclusion: This study was designed to determine whether patients, through a patient-controlled system, could replicate the comfortable level of sedation with propofol achieved by the observed anesthesia providers. Preliminary data collected in Phase two suggests that the use of PCS results in similar propofol dosing with fewer respiratory and hemodynamic events. Although the PCS group was more likely to have recall, the overall satisfaction was comparable. The dosing protocol established appears to limit the potential for adverse events. However the discrepancy between PCS attempts to deliveries may indicate a need for a shorter lockout period. This preliminary data suggests that further investigation is warranted.

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