• C Roseveare, C Seavell, P Patel, J Criswell, J Kimble, C Jones, and H Shepherd.
• Dept. of Medicine, Royal Hampshire County Hospital, Winchester, United Kingdom. CRoseveare@compuserve.com
• Endoscopy. 1998 Nov 1;30(9):768-73.

Background And Study AimsPatient-controlled sedation (PCS) enables titration of dosage to an individual's requirements and is potentially useful in colonoscopy. The aim was to compare the value of patient-controlled sedation, using propofol and alfentanil, with that of intravenous diazemuls and pethidine during colonoscopy.Patients And MethodsFollowing randomization, 66 patients undergoing colonoscopy received either an intravenous bolus of pethidine (50 mg) and diazemuls (10-20 mg) prior to colonoscopy or were connected to an infusion pump containing propofol (10 mg/ml) and alfentanil (25 microg/ml). Patients self-administered 0.5 ml boluses as often as they required. Pain and sedation score were recorded by a nurse specialist and on a patient questionnaire. An anaesthetist was present throughout the procedure.ResultsPCS provided lighter sedation (median sedation score, 3 versus 4; P=0.0001), less analgesia (median pain score, 1 versus 0; P=0.004), a smaller maximum fall in systolic blood pressure (23 mmHg versus 33 mmHg; P=0.02) and a faster recovery time (median 10 min versus 40 min; P=0.0001), irrespective of the dose administered, compared with a diazemuls-pethidine combination. The duration of the procedure was unaffected. All patients were satisfied with their level of sedation.ConclusionsPatient-controlled sedation is an effective alternative to premedication with narcotic/benzodiazepine combinations during colonoscopy.

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