Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists

Clin Gastroenterol Hepatol. 2003 Nov;1(6):425-32. doi: 10.1016/s1542-3565(03)00226-x.


Background & aims: Propofol is under evaluation as a sedative for endoscopic procedures. We compared nurse-administered propofol to midazolam plus fentanyl for outpatient colonoscopy.

Methods: One hundred outpatients undergoing colonoscopy were randomized to receive propofol or midazolam plus fentanyl, administered by a registered nurse and supervised only by an endoscopist. Endpoints were patient satisfaction, procedure and recovery times, neuropsychologic function, and complications.

Results: The mean dose of propofol administered was 277 mg; mean doses of midazolam and fentanyl were 7.2 mg and 117 microg, respectively. Mean time to sedation was faster with propofol (2.1 vs. 6.1 min; P<0.0001), and depth of sedation was greater (P<0.0001). Patients receiving propofol reached full recovery sooner (16.5 vs. 27.5 min; P=0.0001) and were discharged sooner (36.5 vs. 46.1 min; P=0.01). After recovery, the propofol group scored better on tests reflective of learning, memory, working memory span, and mental speed. Six minor complications occurred in the propofol group: 4 episodes of hypotension, 1 episode of bradycardia, and 1 rash. Five complications occurred with the use of midazolam and fentanyl: one episode of oxygen desaturation requiring mask ventilation and 4 episodes of hypotension. Patients in the propofol vs. midazolam and fentanyl groups reported similar degrees of overall satisfaction using a 10-cm visual analog scale (9.3 vs. 9.4, P>0.5).

Conclusions: Nurse-administered propofol resulted in several advantages for outpatient colonoscopy compared with midazolam plus fentanyl, but did not improve patient satisfaction.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adjuvants, Anesthesia / administration & dosage*
  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care*
  • Anesthesia Recovery Period
  • Attention / drug effects
  • Auditory Threshold / drug effects
  • Blood Pressure / drug effects
  • Cognition / drug effects
  • Colonoscopy*
  • Conscious Sedation / nursing
  • Diastole / drug effects
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Female
  • Fentanyl / administration & dosage*
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Hypotension / chemically induced
  • Male
  • Midazolam / administration & dosage*
  • Middle Aged
  • Nursing, Supervisory
  • Oxygen / blood
  • Pain / etiology
  • Patient Satisfaction
  • Propofol / administration & dosage*
  • Prospective Studies
  • Psychomotor Performance / drug effects
  • Quality of Health Care
  • Severity of Illness Index
  • Systole / drug effects
  • Time Factors


  • Adjuvants, Anesthesia
  • Hypnotics and Sedatives
  • Midazolam
  • Oxygen
  • Fentanyl
  • Propofol