Carlsson U, Grattidge P
Department of Surgery, General Hospital, Oskarshamn, Sweden.
Endoscopy. 1995 Mar;27(3):240-3. doi: 10.1055/s-2007-1005678.
A benzodiazepine is generally used when sedation is required for endoscopy, whilst the newer agent propofol appears to have a more suitable pharmacokinetic profile. The aim of this study was to compare the quality of sedation provided by midazolam and propofol under controlled conditions.
Ninety healthy outpatients requesting sedation at diagnostic gastroscopy were prospectively randomized to receive a bolus dose of either midazolam 0.06 mg/kg or propofol 0.6 mg/kg, followed by repeat doses of 50% of the initial dose as required. No topical anesthesia was used. The endoscopist and the patient replied to a questionnaire.
Patients receiving propofol tolerated endoscopy better (p = 0.01); reached a deeper maximum level of sedation (p = 0.001); and recovered more rapidly (p = 0.001). There was a similar frequency of amnesia for the procedure (propofol 67% vs. midazolam 65%); of oxygen desaturation (four patients in each group, < 85%); and of perceived patient comfort (p = 0.5).
Compared to midazolam, propofol facilitated gastroscopy to a greater extent. However, due to its narrower therapeutic range, propofol is the more demanding agent to administer, thus making it less universally applicable than midazolam.
在内镜检查需要镇静时，通常使用苯二氮䓬类药物，而新型药物丙泊酚似乎具有更合适的药代动力学特征。本研究的目的是在可控条件下比较咪达唑仑和丙泊酚所提供镇静的质量。
90名因诊断性胃镜检查需要镇静的健康门诊患者被前瞻性随机分组接受单次剂量的咪达唑仑0.06mg/kg或丙泊酚0.6mg/kg，随后根据需要给予初始剂量50%的重复剂量。未使用局部麻醉。内镜医师和患者回答一份问卷。
接受丙泊酚的患者对内镜检查的耐受性更好（p = 0.01）；达到更深的最大镇静水平（p = 0.001）；且恢复更快（p = 0.001）。对检查过程的遗忘发生率相似（丙泊酚67%对咪达唑仑65%）；氧饱和度降低的发生率相似（每组4例患者，< 85%）；以及患者自我感觉舒适度相似（p = 0.5）。
与咪达唑仑相比，丙泊酚在更大程度上促进了胃镜检查。然而，由于其治疗窗较窄，丙泊酚是更难以给药的药物，因此使其不如咪达唑仑普遍适用。
