Background and study aims: 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.
Patients and methods: 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.
Results: 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).
Conclusions: 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.