• Alessandro Repici, Nico Pagano, Cesare Hassan, Alessandra Carlino, Giacomo Rando, Giuseppe Strangio, Fabio Romeo, Angelo Zullo, Elisa Ferrara, Eva Vitetta, Daniel de Paula Pessoa Ferreira, Silvio Danese, Massimo Arosio, and Alberto Malesci.
• Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Via Manzoni 56 20089 Rozzano, Milan, Italy. alessandro.repici@humanitas.it
• World J. Gastroenterol. 2011 Sep 7; 17 (33): 3818-23.

AimTo assess the efficacy and safety of a balanced approach using midazolam in combination with propofol, administered by non-anesthesiologists, in a large series of diagnostic colonoscopies.MethodsConsecutive patients undergoing diagnostic colonoscopy were sedated with a single dose of midazolam (0.05 mg/kg) and low-dose propofol (starter bolus of 0.5 mg/kg and repeated boluses of 10 to 20 mg). Induction time and deepest level of sedation, adverse and serious adverse events, as well as recovery times, were prospectively assessed. Cecal intubation and adenoma detection rates were also collected.ResultsOverall, 1593 eligible patients were included. The median dose of propofol administered was 70 mg (range: 40-120 mg), and the median dose of midazolam was 2.3 mg (range: 2-4 mg). Median induction time of sedation was 3 min (range: 1-4 min), and median recovery time was 23 min (range: 10-40 min). A moderate level of sedation was achieved in 1561 (98%) patients, whilst a deep sedation occurred in 32 (2%) cases. Transient oxygen desaturation requiring further oxygen supplementation occurred in 8 (0.46%; 95% CI: 0.2%-0.8%) patients. No serious adverse event was observed. Cecal intubation and adenoma detection rates were 93.5% and 23.4% (27.8% for male and 18.5% for female, subjects), respectively.ConclusionA balanced sedation protocol provided a minimalization of the dose of propofol needed to target a moderate sedation for colonoscopy, resulting in a high safety profile for non-anesthesiologist propofol sedation.

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