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Computer-Assisted Propofol Sedation Reduces Recovery Time, Authors Find

Study compares propofol with midazolam/fentanyl combo

The use of computer-assisted propofol sedation for routine upper endoscopy and colonoscopy reduced recovery-room time by almost 20%, according to new study data released May 19 at Digestive Disease Week 2015. The study, conducted by researchers at the Virginia Mason Medical Center (VMMC) in Seattle, Washington, showed that the process yielded a better recovery experience compared with the commonly used combination of midazolam and fentanyl.

“Some patients do not respond well to sedation with midazolam and fentanyl, and others find that these two medications cause them to be in a ‘fog’ immediately after they wake up,” said lead investigator Andrew Ross, MD. “Results from our study demonstrate that clinicians can use computer-assisted propofol sedation (CAPS) for these patients and shorten their recovery time.”

Seeing the need for an alternative to midazolam and fentanyl sedation, gastroenterologists and anesthesiologists at VMMC tested the CAPS system to see whether it could be a safe and effective sedation system for their routine upper endoscopy and colonoscopy patients.

In their study, the researchers used the CAPS system in 1,466 patients who were  considered to be normal and healthy (class 1) or to have mild systemic diseases (class 2), as defined by the American Society of Anesthesiologists (ASA). After undergoing their endoscopic procedures, the CAPS patients had an average recovery time of 27 minutes, which was 6 minutes (approximately 20%) faster than that of similar patients who underwent sedation with midazolam and fentanyl.

Normally, sedation using propofol requires the presence of an anesthesiologist during each endoscopic procedure. However, with computer-assisted sedation, anesthesiologists do not have to be directly involved in a procedure, but must be available when needed, giving hospitals and health systems the ability to more efficiently staff the procedures, the authors said.

“Early results from patient and clinician experience surveys suggest that satisfaction scores with computer-assisted propofol sedation are higher for both patients and clinicians compared with standard procedures,” Ross remarked. “Clinicians provided a much higher satisfaction score because they believed CAPS provided a better level of sedation than other methods, while patients reported a slightly higher satisfaction score focusing on their recovery.”

Ross added that, while the data demonstrate that CAPS worked well, the method can be used only for class 1 and class 2 patients.

The researchers suggest that additional studies should be conducted to see whether there may be other benefits to CAPS beyond reducing the recovery time, such as how it might change the workflow in a hospital’s endoscopic unit. They also believe that further patient analysis should be conducted to determine what factors define an “ideal” CAPS patient.

Source: Medical Xpress; May 19, 2015.

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