Propofol Alone Versus Propofol in Combination With Meperidine for Sedation During Colonoscopy Yu-Hsi Hsieh, MD,*w An-Liang Chou, MD,* Yu-Yung Lai, MD,z Bing-Shuo Chen, MD,z Swee-Leong Sia, MD,z I-Cheng Chen, MD,z Yin-Lung Chang, MD,z and Hwai-Jeng Lin, MDyJ Background: Despite the increasing popularity of propofol for sedation in colonoscopy, the optimal regimen is still controversial. Both propofol alone and propofol in combination with meperidine are frequently used during colonoscopy, but the impact of adding meperidine has not been evaluated. This study aimed to investigate if adding meperidine to propofol offers any advantage in terms of patient tolerance, recovery time, and postcolonoscopy discomforts. Method: Consecutive patients admitted to the physical checkup department of our hospital were randomized to receive either meperidine plus propofol (combination group, n = 100) or pro- pofol alone (propofol group, n = 100) for sedated colonoscopy. The patients’ tolerance and postcolonoscopy discomforts (pain, bloating, dizziness, and nausea/vomiting) were assessed with a 0-10 visual analog scale. The recovery times were assessed with 5-minute and 10-minute Aldrete scores. Results: The dose of propofol was less in the combination group than the propofol group (129.80 ± 37.93 mg vs. 147.90 ± 47.85, mean ± SD, P = 0.003). The endoscopists, anesthetists, and nurses all rated patients’ tolerance in favor of the combination group than the propofol group (mean ± SD, endoscopists, 9.17 ± 1.23 vs. 8.49 ± 1.60, P= 0.001; anesthetists, 9.21 ± 1.08 vs. 8.63 ± 1.37, P= 0.001; nurses, 9.18 ± 1.34 vs. 8.71 ± 1.47, P = 0.019, respectively). Patients in the combination group recovered earlier than the placebo group (5-min Aldrete scores: 9.48 ± 1.09 vs. 9.05 ± 1.32, mean ± SD, P= 0.013; short intervals to speak: 4.29 ± 4.05 min vs. 6.30 ± 5.22 min, P = 0.003; and departure: 18.62 ± 5.28 min vs. 20.28 ± 5.68 min, P = 0.034). There was also less abdominal bloating in the combination group after colonoscopy (1.23 ± 1.79 vs. 2.19 ± 2.12, mean ± SD, P = 0.004). Incidences of hypoxemia, hypotension, and overall satisfaction scores were comparable between the 2 groups. Conclusions: For sedated colonoscopy, propofol in combination with meperidine is better than propofol alone in improving patients’ tolerance and recovery. Key Words: propofol, meperidine, sedated colonoscopy (J Clin Gastroenterol 2009;43:753–757) M ost patients consider colonoscopy as an uncomfor- table examination. Sedation is frequently used to alleviate the discomfort and since the 1980s has been typically performed with a benzodiazepine, either alone or in combination with an opioid. 1 Propofol has been increasingly used in recent years. 2 It provides faster onset of sedation and rapid recovery of cognitive function. 3,4 Propofol can be given alone 3,5,6 or in combination with an opioid 7–11 or a benzodiazepine. 4,12,13 Compared with propofol alone, the combined regimens can reduce doses of propofol in most studies. 11–13 However, its effect on other aspects of anesthetic management, such as patient tolerance and recovery, remains unclear. Two studies compared propofol alone with propofol plus an opioid during sedated colonoscopy. Moerman et al 11 evaluated the effect of adding remifentanil to propofol and found that adding remifentanil resulted in a decrease of propofol dose but a slower recovery. Recently, VanNatta and Rex 14 compared propofol in combination with fentanyl and/or midazolam versus propofol alone and found that the propofol alone group had a longer recovery time. Patients receiving propofol alone felt more comfor- table during and after the procedure. Because the doses were different in both groups, the impact of benzodiazepines and/ or opioids was difficult to assess. Meperidine is the most frequently administered opioid in sedated endoscopy. 15 Its combination with propofol is also widely reported in the literature. 10,16,17 To our know- ledge, there has been no study comparing propofol alone with propofol combined with meperidine for sedated colonoscopy. The objective of this study was to investigate whether adding meperidine to propofol offers any advan- tage during sedated colonoscopy. MATERIALS AND METHODS This prospective study was conducted between July and December 2007 in Buddhist Dalin Tzu Chi General Hospital. Asymptomatic patients admitted to our physical checkup department were included. Patients with the following conditions were excluded: obstructive lesions of the colon, severe colitis, inadequate bowel preparation, contraindication to Buscopan (hyoscine N-butylbromide), allergy to propofol or meperidine, American Society of Anesthesiology (ASA) risk class 3 or higher, and age less than 18 years or refusal to provide written informed consent. The study was approved by the Institutional Review Board of the Buddhist Dalin Tzu Chi General Hospital. Patients enrolled in this study were randomly allocated into 2 groups using sealed envelopes containing propofol alone or meperidine plus propofol regimens. Blinding was Copyright r 2009 by Lippincott Williams & Wilkins Received for publication March 10, 2008; accepted July 8, 2008. From the *Division of Gastroenterology, Departments of Medicine; zAnesthesiology, Buddhist Dalin Tzu Chi General Hospital, Chia- Yi; wSchool of Medicine, Buddhist Tzu Chi University, Hwalien; yDivision of Gastroenterology, Department of Medicine, Lotung Poh-Ai Hospital, Yilan; and JSchool of Medicine, National Yang- Ming University, Taipei, Taiwan, ROC. The authors had no conflict of interest to disclose. Supported by research fund of Buddhist Dalin Tzu Chi General Hospital. Reprints: Hwai-Jeng Lin, MD, Division of Gastroenterology, Depart- ment of Medicine, Lotung Poh-Ai Hospital, 83 Nan Chang St, Lotung, Yilan 265, Taiwan (e-mail: hjlin@mail.pohai.org.tw). ORIGINAL ARTICLE J Clin Gastroenterol  Volume 43, Number 8, September 2009 www.jcge.com | 753