Tiefe Sedierung bei gastroenterologisch-endoskopischen Eingriffen: Sicherheit und Nutzen einer Kombination aus Midazolam und Propofol

BACKGROUND AND OBJECTIVE: Midazolam (M) is well known and established in endoscopic procedures for so-called conscious sedation. Propofol (P) is given during endoscopy for deep sedation. The combination of both (M/P) in endoscopic procedures is new. In this prospective study the safety of the combination was tested, in a second prospective study the combination M/P with Propofol alone was compared. PATIENTS AND METHODS: In the first study 143 patients undergoing 150 endoscopic procedures (expected > 30 min) were included. Deep sedation was induced by an i.v. bolus of 2.5 mg midazolam, followed by small doses of propofol. The sedation was performed by a second physician experienced in intensive care. In the second prospective study 64 patients undergoing two necessary endoscopic procedures were included: one deep sedation with propofol alone, the second one with combination of midazolam bolus followed by propofol. RESULTS: It was demonstrated that induction of deep sedation by an i.v. bolus of 2.5 mg midazolam, followed by small doses of propofol is safe, without undesirable side effects, e.g. respiratory or circulation depression. Recovery time increased (4 to 8 minutes) with the combination M/P, costs decreased by saving 59% propofol per minute. This may be important for longer endoscopic procedures. CONCLUSION: The combination of M/P for deep sedation during endoscopy may be useful when long procedures are expected or patients are at risk with propofol alone.