Asian Research Thesis Index

Abstract

Background: A wide variety of sedation techniques are employed to facilitate various invasive diagnostic and therapeutic procedures. Increasingly, propofol is emerging as the preferred sedative agent. Traditionally, it has been administered as intermittent boluses to achieve deep sedation to facilitate gastrointestinal endoscopy. Propofol target controlled infusion can be employed to provide suitably conducive conditions for this purpose. Objective: The primary objective sought to compare the proportion of hypoxia between the study group receiving intermittent boluses of propofol at 0.25mg/kg as needed, and the other receiving target-controlled infusion of propofol at 2.5mcg/ml during upper gastrointestinal endoscopy. The secondary objectives were to compare the occurrence of hypotension, bradycardia, and the time to wake up between the two groups. Primary outcome measure: Decrease in oxygen saturation below 90 percent (SpO2 <90%) Secondary outcome measures: Decrease in systolic blood pressure of more than 20% from baseline; decrease in heart rate to less than 50 beats per minute. Study design: prospective, single centre, randomized controlled trial Study setting: The Aga Khan University Hospital, Nairobi. Sample size: One hundred and seventy-six participants were enrolled; 88 belonging to the intermittent bolus arm and 88, to the target-controlled infusion arm. Study population: Included all ASA I and II patients between the ages of 18 and 65 years scheduled to undergo upper gastrointestinal endoscopy (oesophagogastroduodenoscopy) under sedation. Sedation procedure: One hundred and seventy-six participants were allocated randomly into one of two groups corresponding to the mode of propofol used for sedation (a) Premedication with midazolam 0.05mg/kg added to an initial bolus of propofol 1mg/kg, followed by repeat boluses of 0.25mg/kg as needed (B, n = 88) and (b) Premedication with midazolam 0.05mg/kg added to an initial target effect-site concentration of 4mcg/ml, followed by maintenance target effect-site concentration of 2.5mcg/ml, titrated upward or downward by 0.5mcg/ml from baseline infusion rate as needed (T, n = 88). Oxygenation and haemodynamic parameters were evaluated by determining oxygen saturation, blood pressure and heart rate immediately before administering the sedative and at 2.50, 5.00, 7.50 and 10.00 minutes. Standard care was, in addition to the above, provided. Data collection: A data collection tool was used to record data (refer to appendix V). Patients’ baseline vital signs, including blood pressure, heart rate and oxygen saturation were entered. Any occurrence of oxygen desaturation below 90% in both study groups was also recorded. The sedation starting time, stopping time, waking up time and overall duration of time

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