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Open Access Highly Accessed Research article

Cocktail sedation containing propofol versus conventional sedation for ERCP: a prospective, randomized controlled study

Phonthep Angsuwatcharakon1, Rungsun Rerknimitr1*, Wiriyaporn Ridtitid1, Pradermchai Kongkam1, Sahadol Poonyathawon2, Yuwadee Ponauthai1, Sakolkan Sumdin1 and Pinit Kullavanijaya1

Author Affiliations

1 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10310, Thailand

2 Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

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BMC Anesthesiology 2012, 12:20  doi:10.1186/1471-2253-12-20

Published: 9 August 2012

Abstract

Background

ERCP practically requires moderate to deep sedation controlled by a combination of benzodiazepine and opiod. Propofol as a sole agent may cause oversedation. A combination (cocktail) of infused propofol, meperidine, and midazolam can reduce the dosage of propofol and we hypothesized that it might decrease the risk of oversedation. We prospectively compare the efficacy, recovery time, patient satisfactory, and side effects between cocktail and conventional sedations in patients undergoing ERCP.

Methods

ERCP patients were randomized into 2 groups; the cocktail group (n = 103) and the controls (n = 102). For induction, a combination of 25 mg of meperidine and 2.5 mg of midazolam were administered in both groups. In the cocktail group, a bolus dose of propofol 1 mg/kg was administered and continuously infused. In the controls, 25 mg of meperidine or 2.5 mg/kg of midazolam were titrated to maintain the level of sedation.

Results

In the cocktail group, the average administration rate of propofol was 6.2 mg/kg/hr. In the control group; average weight base dosage of meperidine and midazolam were 1.03 mg/kg and 0.12 mg/kg, respectively. Recovery times and patients’ satisfaction scores in the cocktail and control groups were 9.67 minutes and 12.89 minutes (P = 0.045), 93.1and 87.6 (P <0.001), respectively. Desaturation rates in the cocktail and conventional groups were 58.3% and 31.4% (P <0.001), respectively. All desaturations were corrected with temporary oxygen supplementation without the need for scope removal.

Conclusions

Cocktail sedation containing propofol provides faster recovery time and better patients’ satisfaction for patients undergoing ERCP. However, mild degree of desaturation may still develop.

Trial registration

ClinicalTrials.gov, NCT01540084

Keywords:
Cocktail sedation containing propofol; Meperidine; Midazolam; ERCP