Abstract
Purpose
Cystoscopy, as with other endoscopic procedures, is a fearful and painful for the majority of patients. To this reduce fear, pain and discomfort, the routine administration of sedative drugs, such as midazolam and propofol, is widely accepted for a gastrointestinal endoscopy. There have also been some studies on midazolam anesthesia during cystoscopy. However, the effects and safety of propofol anesthesia during cystoscopy have not been established. Therefore, the effects and safety of propofol anesthesia during cystoscopy were investigated in this study.
Materials and Methods
200 male patients were divided into 2 groups: Group A consisted of 80 patients sedated using 1mg/kg propofol IV, and group B consisted of 120 patients who received normal saline IV instead of propofol. All patients received 90mg diclofenac IM for pain control. There were no significant differences in the ages and weights between the two groups. The vital signs and oxygen saturation were monitored before, during and after the cystoscopy. The degree of pain and satisfaction of the patients and urologist were measured.
Results
The pain scales were significantly reduced in group A compared to group B. Group A patients and the operator were also significantly more satisfied than those in group B. Although the blood pressure, pulse rate or respiratory rate changed during the cystoscopy, they were not clinically significant and there was no need for additional treatment. 12 patients in group A showed temporary hypoxia; however, they were treated with oxygen administration and recovered within several minutes.
References
1. Lee SH, Song YS, Park YH. Utility and safety of midazolam anesthesia during cystoscopy. Korean J Urol. 2002. 43:308–312.
2. Jeong HJ, Chung WS, Yoon HN. The efficacy and safety of midazolam induced sedative cystoscopy. Korean J Urol. 2004. 45:557–562.
3. Chokhavatia S, Nguyen L, Willians R, Kao J, Heavner JE. Sedation and analgesia for gastrointestinal endoscopy. Am J Gastroenterol. 1993. 88:393–396.
4. Forrest P, Galletly DC. Comparison of propofol and antagonised midazolam anesthesia for day case surgery. Anaesth Intensive Care. 1987. 15:394–401.
5. Janet MV, Paul FW. Ronald DM, editor. Outpatient anesthesia. Anesthesia. 2000. 5th ed. Philadelphia: Churchill Livingstone;2233.
6. Ballentine CH. Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Basic instrumentation and cystoscopy. Campbell's urology. 2002. 8th ed. Philadelphia: Saunders;111–121.
7. Patterson KW, Casey PB, Murray JP, O'Boyle CA, Cunningham AJ. Propofol sedation for outpatient upper gastrointestinal endoscopy: issues and guidelines. Gastrointest Endosc. 1989. 35:262–266.
8. Park CH, Kim HB, Song PO, Lee SH, Shin MK, Kim IK. Adequate dose requirements of propofol by injection during anesthesia induction. Korean J Anesthesiol. 1997. 32:226–230.
9. Beller JP, Pottecher T, Lugnier A, Mangin P, Otteni JC. Prolonged sedation with propofol in ICU patient: recovery and blood concentration changes during periodic interruptions in infusion. Br J Anaesth. 1988. 61:583–588.
10. Sterib A, Freys G, Beller JP, Curzola U, Otteni JC. Propofol in elderly high risk patients. A comparison of haemodynamic effects with thiopentone during induction of anaesthesia. Anaesthesia. 1988. 43:Suppl. 111–114.
11. Cummings GC, Dixon J, Kay NH, Windsor JP, Major E, Morgan M, et al. Dose requirements of ICI 35868 (propofol, 'Diprivan') in a new formulation for induction of anaesthesia. Anaesthesia. 1984. 39:1168–1171.
12. Bell GD. Premedication, preparation, and surveillance. Endoscopy. 2000. 32:92–100.
13. Carrasco G, Cabre L, Sobrepere G, Costa J, Molina R, Cruspinera A, et al. Synergistic sedation with propofol and midazolam for intensive care patients after coronary artery bypass grafting. Crit Care Med. 1998. 26:844–851.
14. Reimann FM, Samson U, Derad I, Fuchs M, Schiefer B, Stange EF. Synergistic sedation with low-dose midazolm and propofol for colonoscopies. Endoscopy. 2000. 32:239–244.
15. Bhardwaj G, Conlon S, Bowles J, Baralt J. Use of midazolam and propofol during colonoscopy: 7 years of experience. Am J Gastroenterol. 2002. 97:495–497.
16. Hamsen JJ, Ulmer BJ, Rex DK. Technical performance of colonoscopy in patients sedated with nurse-administered propofol. Am J Gastroenterol. 2004. 99:52–56.
17. Rex DK, Overley C, Kinser K, Coates M, Lee A, Goodwine BW, et al. Safety of propofol administered by registered nurse with gastroenterologist supervision in 2000 endoscopic cases. Am J Gastroenterol. 2002. 97:1159–1163.
18. Oh IH, Han SY, Moon SH, Lee JH, Choi DH, Roh MH, et al. Study on the degree of oxygen saturation during upper gastrointestinal endoscopy using propofol/fentanyl with oxygenation. Korean J Gastrointest Endosc. 2001. 22:399–405.
19. Oei-Lim VL, Kalkman CJ, Bartelsman JF, Res JC, van Wezel HB. Cardiovascular responses, arterial oxygen saturation and plasma catecholamine concentration during upper gastrointestinal endoscopy using conscious sedation with midazolam of propofol. Eur J Anaesthesiol. 1998. 15:535–543.
20. Patterson KW, Casey PB, Murray JP, O'Boyle CA, Cunningham AJ. Propofol sedation for outpatient upper gastrointestinal endoscopy: comparison with midazolam. Br J Anaesth. 1991. 67:108–111.