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Open Access Research article

Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Wai-Meng Ho123, Chia-Ming Yen2, Chin-Hung Lan4, Chung-Yi Lin5, Su-Boon Yong6, Kai-Lin Hwang7 and Ming-Chih Chou18*

Author Affiliations

1 Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., Taichung, 402, Taiwan

2 Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Taichung Branch, No.66, Sec. 1, Fongsing Rd., Tanzih, Taichung, 427, Taiwan

3 Department of Anesthesiology, School of Medicine, Tzu Chi University, No.701, Chung Yang Rd., Sec .3, Hualien, 970, Taiwan

4 Department of Anesthesiology, Buddhist Tzu Chi General Hospital, No. 707, Sec. 3, Chung Yang Rd., Hualien, 970, Taiwan

5 Division of Gastroenterology and hepatology, Buddhist Tzu Chi General Hospital, Taichung Branch, No.66, Sec. 1, Fongsing Rd., Tanzih, Taichung, 427, Taiwan

6 Department of Pediatrics, Show Chwan Memorial Hospital, No.500, Sec 1, Chung Shan Rd., Changhua, 500, Taiwan

7 Department of Public Health, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., Taichung, 402, Taiwan

8 Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., Taichung, 402, Taiwan

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BMC Gastroenterology 2012, 12:164  doi:10.1186/1471-230X-12-164

Published: 21 November 2012

Abstract

Background

There is increasing interest in balanced propofol sedation (BPS) titrated to moderate sedation (conscious sedation) for endoscopic procedures. However, few controlled studies on BPS targeted to deep sedation for diagnostic endoscopy were found. Alfentanil, a rapid and short-acting synthetic analog of fentanyl, appears to offer clinically significant advantages over fentanyl during outpatient anesthesia.

It is reasonable to hypothesize that low dose of alfentanil used in BPS might also result in more rapid recovery as compared with fentanyl.

Methods

A prospective, randomized and double-blinded clinical trial of alfentanil, midazolam and propofol versus fentanyl, midazolam and propofol in 272 outpatients undergoing diagnostic esophagogastroduodenal endoscopy (EGD) and colonoscopy for health examination were enrolled. Randomization was achieved by using the computer-generated random sequence. Each combination regimen was titrated to deep sedation. The recovery time, patient satisfaction, safety and the efficacy and cost benefit between groups were compared.

Results

260 participants were analyzed, 129 in alfentanil group and 131 in fentanyl group. There is no significant difference in sex, age, body weight, BMI and ASA distribution between two groups. Also, there is no significant difference in recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between two groups. Though deep sedation was targeted, all cardiopulmonary complications were minor and transient (10.8%, 28/260). No serious adverse events including the use of flumazenil, assisted ventilation, permanent injury or death, and temporary or permanent interruption of procedure were found in both groups. However, fentanyl is New Taiwan Dollar (NT$) 103 (approximate US$ 4) cheaper than alfentanil, leading to a significant difference in total cost between two groups.

Conclusions

This randomized, double-blinded clinical trial showed that there is no significant difference in the recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between the two most common sedation regimens for EGD and colonoscopy in our hospital. However, fentanyl is NT$103 (US$ 4) cheaper than alfentanil in each case.

Trial registration

Institutional Review Board of Buddhist Tzu Chi General Hospital (IRB097-18) and Chinese Clinical Trial Registry (ChiCTR-TRC-12002575)

Keywords:
Balanced propofol sedation; Alfentanil; Fentanyl; Deep sedation; Diagnostic endoscopy; Cost benefit