Result of study on propofol use and paradoxical reactions in gastrointestinal endoscopy sedation

Abstract

Background: Sedation relieves patient anxiety, discomfort, and pain. Additionally, it allows the procedure to proceed smoothly. Propofol (2,6 diisopropylphenol -10 mg/ml) for sedation is a short-acting sedative, amnestic, and hypnotic induction agent. The determination of dosage and the intervals for drug administration in the context of endoscopic procedures is contingent upon the individual response of each patient, leading to considerable variability in the overall consumption of propofol. In some cases, sedative agents could cause paradoxical reactions. Paradoxical reactions not only degrade the performance of the procedure, but may also cause physical harm to the patient. This not only degrades the endoscopic process and performance, but the patient may cause physical injury to himself. The factors related to paradoxical excitement during propofol-induced sedation remain unclear. Aim: This study aims to evaluate use, mean dose of propofol (10 mg/ml) and paradoxical reaction during propofol induced sedated endoscopy performed by non-anesthesiologists Materials and Methods: We retrospectively reviewed 6393 sedative endoscopies among of total 6393 patients at the Intermed Hospital, Gastroenterology and Endoscopy center, from 2018 to 2022. Data’s were presented as mean± standard deviation. Statistical analysis was carried out using Pearson correlation test. Results: Among 3693 participants, aged between 16 and 69 years (mean age - 42.78±12.76 years), n=2118 individuals (57.351%) underwent upper gastrointestinal endoscopy, with a mean age of 45.06±12.97 years. Additionally, n=251 individuals (6.797%) within the age range of 17-70 years (mean age - 46.72±11.60 years) underwent colonoscopy, while 1324 participants (35.852%) underwent panendoscopy. The mean dose of propofol administered for sedation was 101.92±47.31 mg for upper gastrointestinal endoscopy, 151.51±61.5 mg for colonoscopy, and 188.55±60.17 mg for panendoscopy. The incidence of paradoxical reaction was 24.24% (n=895). Correlation analyses indicated a weak negative correlation between age and the occurrence of paradoxical reactions. Conversely, body weight, gender, and the administered propofol dose demonstrated weak positive correlations with the incidence of paradoxical reactions. Conclusion: The average dose of propofol used varied and was statistically different depending on the type and duration of endoscopy. Paradoxical reactions to propofol sedation are related to a young age, being overweight, and the dosage of propofol.