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Recovery times and adverse events between propofol and midazolam during colonoscopy Switzer, Jennifer Margaret


Sedation and analgesia are integral to successful colonoscopy completion and controversy surrounds the optimal pharmacokinetic agent that will target and maintain a moderate sedation level, offer operational efficiency with reduced recovery time, and minimize risk for cardiopulmonary complications. Current practice is imprecise; manual administration of procedural sedation using a combination of benzodiazepine and opioids puts patients at risk for descending into deeper levels of sedation, which can lead to risk for cardiorespiratory depression, and an increase in recovery times for up to two hours. Studies have reported that propofol, a sedative agent with a short half life, can result in a shorter recovery, however there is limited research that has used consistent measurement to evaluate the procedural sedation recovery process or the influence of predictors such as age, sex, medication history, medical history, procedure time and body mass index (BMI), on recovery time and cardiopulmonary risk. Therefore, a non-experimental descriptive retrospective study was undertaken with two groups of 100 subjects who had either midazolam administered manually or propofol administered using the Sedasys® System for colonoscopy to explore the differences in procedure length and recovery time between these groups. Participants in the propofol group were somewhat younger and healthier than those in the midazolam group; average age 50.1 years versus 58.9 years, took fewer cardiac medications, had a lower BMI, and a lower incidence of cardiac or respiratory disease. Multiple regression analyses were conducted to assess the contribution of independent clinical predictors (age, sex, BMI, medical history and medication history) for duration of recovery from procedural sedation and analgesia and the incidence of sedation-related ii adverse events. Propofol provided the largest contribution to the variance in recovery time after controlling for other significant predictors (R-squared = 0.22). Based on the MOAA/S score, participants who received propofol were discharged home sooner than those who received midazolam. There were no adverse events in either group. The results of this study suggest that propofol for procedural sedation during colonoscopy may improve efficiencies and throughput in the endoscopy suite and may provide a safe means that can assist in meeting the rising demand for colonoscopy.

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