A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

Megan Lise Allen, Kate Leslie, Geoffrey S Hebbard, Ian Trevor Jones, Tejinder Mettho, Paul Thomas Maruff

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24 Citations (Scopus)

Abstract

Purpose: This study aimed to determine if the incidence of recall was equivalent between light and deep sedation for colonoscopy. Secondary analysis included complications, patient clinical recovery, and post-procedure cognitive impairment. Methods: Two hundred patients undergoing elective outpatient colonoscopy were randomized to light (bispectral index [BIS] 70-80) or deep (BIS <60) sedation with propofol and fentanyl. Recall was assessed by the modified Brice questionnaire, and cognition at baseline and discharge was assessed using a Cogstate test battery. Results: The median (interquartile range [IQR]) BIS values were different in the two groups (69 [65-74] light sedation vs 53 [46-59] deep sedation; P <0.0001). The incidence of recall was 12 in the light sedation group and 1 in the deep sedation group. The risk difference for recall was 0.11 (90 confidence interval, 0.05 to 0.17) in the intention-to-treat analysis, thus refuting equivalence in recall between light and deep sedation (0.05 significance level; 10 equivalence margin). Overall sedation-related complications were more frequent with deep sedation than with light sedation (66 vs 47 , respectively; P = 0.008). Recovery was more rapid with light sedation than with deep sedation as determined by the mean (SD) time to reach a score of 5 on the Modified Observer?s Assessment of Alertness/Sedation Scale [3 (4) min vs 7 (4) min, respectively; P <0.001] and by the median [IQR] time to readiness for hospital discharge (65 [57-80] min vs 74 [63-86] min, respectively; P = 0.001). The incidence of post-procedural cognitive impairment was similar in those randomized to light (19 ) vs deep (16 ) sedation (P = 0.554). Conclusion: Light sedation was not equivalent to deep sedation for procedural recall, the spectrum of complications, or recovery times. This study provides evidence to inform discussions with patients about sedation for colonoscopy. This trial was registered at the Australian and New Zealand Clinical Trials Registry, number 12611000320954.
Original languageEnglish
Pages (from-to)1169 - 1178
Number of pages10
JournalCanadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Volume62
Issue number11
DOIs
Publication statusPublished - 2015

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