Impact of opioid addition on procedural conditions during colonoscopy: a randomized trial comparing propofol-based sedation protocols.

Background: Propofol is the most effective sedative for colonoscopy; however, opioids do have several adverse effects that need to be discussed. The objective of this study was to compare the ease of colonoscopy during propofol-based sedation with and without fentanyl, while closely monitoring ventilatory data and the safety of the procedure.

Methods: This prospective single-center trial randomized 50 patients who underwent minor colonoscopies. The propofol group received sedation exclusively via propofol, whereas the propofol+fentanyl group was premedicated with 1 µg/kg fentanyl. Patients were monitored using a bioimpedance ventilatory monitor, and both the patients and endoscopists were questioned regarding their level of satisfaction.

Results: The endoscopists reported a higher level of ease with the colonoscopy procedure (mean on a 5-point scale, 1.2 vs. 1.72; p=0.028) and the overall patient satisfaction score was higher (1.15 vs. 1.28, p=0.026) in the propofol+fentanyl group. No significant differences were observed in the ventilatory parameters between the groups. No major adverse events were reported in any of the groups.

Conclusions: The inclusion of fentanyl leads to enhanced levels of satisfaction for both the endoscopist and the patient, without any impact on ventilation and safety. The use of bioimpedance monitoring of ventilation during colonoscopy is a suitable approach that may enhance the safety of procedural sedation.