Propofol-based deep sedation for colonoscopy: does sufentanil, alfentanil or ketamine help? A propensity score weighted retrospective study.

Abstract

Introduction: Gastrointestinal endoscopy is a frequent procedure for diagnosing and following up on various digestive disorders. It is often conducted under propofol sedation. The aim of this work is, first, to determine whether the addition of sufentanil, alfentanil, or ketamine to propofol has a propofol-sparing effect and, secondarily, how these drugs affect the patients' hemodynamic parameters and oxygenation as well as the duration of the procedure.

Methods: Data from patients who underwent colonoscopy were extracted from the anesthesia records database and divided into four groups. Patients received either propofol or a combination of propofol and sufentanil, alfentanil, or ketamine. After inverse propensity weighting, we determined the average treatment effects for each group for the primary and secondary endpoints.

Results: Sufentanil was associated with a less than 10% decrease in propofol consumption. Alfentanil and ketamine showed no propofol-sparing effect. Sufentanil was associated with 2 min shorter procedures. Alfentanil was associated with more patients presenting hypoxemia and had no propofol-sparing effect.

Conclusion: Should a balanced sedation technique be chosen, sufentanil appears to be the adjuvant of choice, given its propofol-sparing effect and the absence of induced hypoxemia. A further prospective study is necessary to explain the lack of propofol-sparing effect of ketamine and alfentanil and confirm and explain the negative impact of alfentanil on patients' oxygenation.