Quality of psychomotor recovery after propofol sedation for routine endoscopy: a randomized and controlled study

 

 Buy Article Permissions and Reprints

Background and study aims: Propofol sedation is increasingly being used for endoscopy in the outpatient setting. In view of the agent’s short period of action, current recommendations that patients should avoid driving or using public transport unescorted for 24 h may be too strict. Psychomotor recovery and driving skills before and after sedation were therefore assessed.
Patients and methods: A total of 100 patients undergoing routine upper or lower gastrointestinal endoscopy were randomly sedated either with propofol alone or with midazolam plus pethidine. The recovery time and quality of recovery were assessed. Psychomotor recovery was evaluated using the number connection test (NCT) and a driving simulator test 1 h before and 2 h after the endoscopic procedure.
Results: Ninety-six patients completed the 2-hour post-sedation procedure. Vital signs were recorded, and no clinically relevant complications occurred. The mean recovery time and quality of recovery were significantly better after propofol sedation (14 ± 9 min vs. 25 ± 8 min and 8.7 ± 1.3 vs. 6.3 ± 1.1 points) (P < 0.01). Psychomotor and driving skills after propofol sedation were similar to the baseline results, while in the midazolam/pethidine group, patients showed significantly more lane deviations (1.1 ± 0.9 vs. 1.6 ± 0.9), time over the speed limit (0.3 ± 0.83 vs. 0.6 ± 0.88), missed stoplights more often (0.05 ± 0.31 vs. 0.11 ± 0.35), and had slower reaction times for unexpected events (1.11 ± 0.46 s vs. 1.39 ± 0.44 s) (P < 0.01). The time needed to complete the NCT after sedation did not differ between the two groups (32.1 ± 12.0 s vs. 33.4 ± 12.6 s for propofol; 31.5 ± 11.2 s vs. 34.6 ± 12.8 s for midazolam/pethidine).
Conclusions: Current recommendations that patients should refrain from driving and unescorted use of public transport for 24 h after sedation may need to be reconsidered in patients who receive propofol sedation.

References

• 1 Korttila K. Recovery from outpatient anaesthesia: factors affecting outcome.  Anaesthesia. 1995;  50 (Suppl) 22-28
  PubMedGoogle Scholar
• 2 Korttila K. Recovery period and discharge. In: White PF (ed) Outpatient anesthesia. New York; Churchill Livingstone 1990: 369-371
  Google Scholar
• 3 Sinclair D R, Chung F, Smiley A. General anesthesia does not impair simulator driving skills in volunteers in the immediate recovery period: a pilot study.  Can J Anaesth. 2003;  50 238-245
  PubMedGoogle Scholar
• 4 Willey J, Vargo J J, Connor J T. et al . Quantitative assessment of psychomotor recovery after sedation and analgesia for outpatient EGD.  Gastrointest Endosc. 2002;  56 810-816
  CrossrefPubMedGoogle Scholar
• 5 Assy N, Rosser B G, Grahame G R. et al . Risk of sedation for upper GI endoscopy exacerbating subclinical hepatic encephalopathy in patients with cirrhosis.  Gastrointest Endosc. 1999;  49 690-694
  PubMedGoogle Scholar
• 6 Vasudevan A E, Goh K L, Bulgiba A M. Impairment of psychomotor responses after conscious sedation in cirrhotic patients undergoing therapeutic upper GI endoscopy.  Am J Gastroenterol. 2002;  97 1717-1721
  CrossrefPubMedGoogle Scholar
• 7 Schwender D, Muller A, Madler M. et al . Recovery of psychomotor and cognitive functions following anesthesia: propofol/alfentanil and thiopental/isoflurane/ alfentanil.  Anaesthesist. 1993;  42 583-591
  PubMedGoogle Scholar
• 8 Oswald W D, Roth E. Der Zahlenverbindungs-Test (ZVT). Handanweisung. Göttingen; Hogrefe 1978
  Google Scholar
• 9 Reitan R M. Validity of the trail making test as an indication of organic brain damage.  Percept Mot Skills. 1958;  8 271-276
  CrossrefPubMedGoogle Scholar
• 10 Kankaria A, Lewis J H, Ginsberg G. et al . Flumazenil reversal of psychomotor impairment due to midazolam or diazepam for conscious sedation for upper endoscopy.  Gastrointest Endosc. 1996;  44 416-421
  CrossrefPubMedGoogle Scholar
• 11 British Society of Gastroenterology .Clinical practice guidelines: safety and sedation during endoscopic procedures. London; British Society of Gastroenterology 2003 http://http://www.bsg.org.uk/clinical_prac/guidelines/sedation.htm
  Google Scholar
• 12 Hofmann C, Jung M. Empfehlungen der DGVS für die Durchführung endoskopischer Untersuchungen. Stuttgart; Sauerbruch und Scheuerlen 2002
  Google Scholar
• 13 Chung F. Recovery pattern and home-readiness after ambulatory surgery.  Anesth Analg. 1995;  80 896-902
  CrossrefPubMedGoogle Scholar
• 14 Aldrete J A. Modifications to the postanesthesia score for use in ambulatory surgery.  J Perianesth Nurs. 1998;  13 148-155
  CrossrefPubMedGoogle Scholar
• 15 Korttila K. Recovery after intravenous sedation: a comparison of clinical and paper and pencil tests used in assessing late effects of diazepam.  Anaesthesia. 1976;  31 724-731
  CrossrefPubMedGoogle Scholar
• 16 Nuotto E J, Korttila K T, Lichtor J L. et al . Sedation and recovery of psychomotor function after intravenous administration of various doses of midazolam and diazepam.  Anesth Analg. 1992;  74 265-271
  CrossrefPubMedGoogle Scholar
• 17 Thapar P, Zacny J P, Choi M. et al . Objective and subjective impairment from often-used sedative/analgesic combinations in ambulatory surgery, using alcohol as a benchmark.  Anesth Analg. 1995;  80 1092-1098
  PubMedGoogle Scholar
• 18 Sobel K G, McCart G M. Drug use and accidental falls in an intermediate care facility.  Drug Intell Clin Pharm. 1983;  17 539-542
  PubMedGoogle Scholar
• 19 Neutel C I. Risk of traffic accident injury after a prescription for a benzodiazepine.  Ann Epidemiol. 1995;  5 239-244
  CrossrefPubMedGoogle Scholar
• 20 Johansson K, Bryding G, Dahl M L. et al . Traffic dangerous drugs are often found in fatally injured older male drivers.  J Am Geriatr Soc. 1997;  45 1029-1031
  PubMedGoogle Scholar
• 21 Bastos M L, Galante L. Toxicological findings in victims of traumatic deaths.  J Forensic Sci. 1976;  21 176-186
  PubMedGoogle Scholar
• 22 Vermeeren A. Residual effects of hypnotics: epidemiology and clinical implications.  CNS Drugs. 2004;  18 297-328
  CrossrefPubMedGoogle Scholar
• 23 Ogg T W. An assessment of postoperative outpatient cases.  Br Med J. 1972;  4 573-576
  PubMedGoogle Scholar
• 24 Patterson K W, Casey P B, Murray J P. et al . Propofol sedation for outpatient upper gastrointestinal endoscopy: comparison with midazolam.  Br J Anaesth. 1991;  67 108-111
  CrossrefPubMedGoogle Scholar
• 25 Carlsson U, Grattidge P. Sedation for upper gastrointestinal endoscopy: a comparative study of propofol and midazolam.  Endoscopy. 1995;  27 240-243
  PubMedGoogle Scholar
• 26 Sipe B W, Rex D K, Latinovich D. et al . Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists.  Gastrointest Endosc. 2002;  55 815-825
  CrossrefPubMedGoogle Scholar
• 27 Wehrmann T, Kokabpick S, Lembcke B. et al . Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study.  Gastrointest Endosc. 1999;  49 677-683
  PubMedGoogle Scholar
• 28 Seifert H, Schmitt T H, Gultekin T. et al . Sedation with propofol plus midazolam versus propofol alone for interventional endoscopic procedures: a prospective, randomized study.  Aliment Pharmacol Ther. 2000;  14 1207-1214
  CrossrefPubMedGoogle Scholar
• 29 Riphaus A, Stergiou N, Wehrmann T. Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study.  Am J Gastroenterol. 2005;  100 1957-1963
  CrossrefPubMedGoogle Scholar
• 30 Grant S A, Murdoch J, Millar K. Blood propofol concentration and psychomotor effects on driving skills.  Br J Anaesth. 2000;  85 396-400
  PubMedGoogle Scholar
• 31 Martin J P, Sexton B F, Saunders B P. et al . Inhaled patient-administered nitrous oxide/oxygen mixture does not impair driving ability when used as analgesia during screening flexible sigmoidoscopy.  Gastrointest Endosc. 2000;  51 701-703
  CrossrefPubMedGoogle Scholar
• 32 Norton A C, Dundas C R. Induction agents for day-case anaesthesia: a double-blind comparison of propofol and midazolam antagonised by flumazenil.  Anaesthesia. 1990;  45 198-203
  CrossrefPubMedGoogle Scholar

T. Wehrmann, M. D., Ph. D.

Dept. of Internal Medicine I · Klinikum Hannover-Siloah

Roesebeckstraße 15 · 30449 Hannover · Germany

Fax: +49-511-9272669

Email: twehrmann@hotmail.com