Efficiency and patient experience with propofol vs conventional sedation: A prospective study

Area of Science:

• Gastroenterology
• Anesthesiology
• Clinical Medicine

Background:

• Sedation methods impact colonoscopy efficiency and patient experience.
• Anaesthesiologist-administered sedation (AAP) with propofol and endoscopist-administered conscious sedation (EAC) with fentanyl/midazolam are common practices.

Purpose of the Study:

• To compare the duration of colonoscopy and total room time between AAP and EAC.
• To evaluate patient satisfaction and adverse events associated with each sedation method.

Main Methods:

• Prospective, non-randomized comparative study in a Canadian academic endoscopy unit.
• Enrolled 230 adult patients undergoing colonoscopy with either AAP or EAC.
• Assessed patient demographics, procedure data, difficulty, endoscopist level, and patient satisfaction via survey.

Main Results:

• EAC (14.7 min) was associated with shorter mean procedure time than AAP (18.3 min) (P = 0.002).
• Mean total room time was significantly shorter with EAC (30.1 min) compared to AAP (36.8 min) (P < 0.001).
• Resident participation doubled procedure time; AAP was linked to increased total room time, lower pain, and a trend towards higher satisfaction, but had more adverse events.

Conclusions:

• Endoscopist-administered conscious sedation (EAC) is more time-efficient for colonoscopy than anaesthesiologist-administered sedation (AAP).
• Resident involvement significantly increases colonoscopy duration irrespective of sedation type.
• While AAP may reduce pain and improve satisfaction, EAC offers greater efficiency with fewer reported adverse events in this study.