Comparison of propofol versus propofol/fentanyl anesthesia

Abstract

Background: The rapid onset and short duration of propofol makes it an ideal
anesthetic during esophagogastroduodenoscopy (EGD). Fentanyl is frequently used in
combination with propofol during EGD to provide an analgesic component. The synergy
that results from combining the two drugs may be beneficial but may also increase
the potential for apnea, hypotension, nausea, and prolonged recovery. This pilot study
was designed to test the hypothesis that propofol/fentanyl anesthesia provides better
conditions than propofol alone during EGD and to compare the incidence of side
effects between the two techniques.
Methodology: This was an IRB approved, double blinded, prospective, placebo
controlled study. One hundred consented patients undergoing EGD were randomly
assigned into two Groups. Patients in the first (propofol/fentanyl) Group received
fentanyl 1 μg/kg followed by propofol 0.75 mg/kg bolus, while patients in the second
(propofol) Group received propofol 1.5 mg/kg bolus. Patients in the Group that received
fentanyl received half the initial induction dose of propofol in order to minimize the
potential for apnea and hypoventilation due to the synergy between the two drugs.
In both Groups, additional 20 mg propofol boluses were given at 1min intervals until
adequate depth of anesthesia was reached. Propofol infusion was then started and
adjusted to maintain adequate depth of anesthesia during the procedure. The primary
end point was the quality of anesthesia as rated by the blinded endoscopist. The
secondary end points were the incidence of hypotension, hypoxia, nausea, vomiting,
and delayed recovery. Data from the two Groups were compared by the Wilcoxon rank
test for the primary endpoint, by t-test for continuous measures, and by chi square for
proportions including hypoxia and hypotension