Compare Propofol to Fentanyl and Midazolam for Colonoscopy

Background The use of colonoscopy has become an important diagnostic and therapeutic tool in the evaluation of multiple medical conditions of the gastrointestinal tract. Despite its widespread use, there continues to be debate concerning the best pharmacologic approach to patient satisfaction and discomfort of the procedure and to minimize side effects.

Aim Two standard pharmacologic (Propofol or Fentanyl and low-dose Midazolam) approaches for colonoscopy will be evaluated systematically to determine if these two approaches are equivalent in terms of patient rating of satisfaction and patient discomfort to the procedure and side effects

Study Design This is a prospective randomized study of 262 participants undergoing outpatient colonoscopy at an independent academic medical center. The primary outcome of this study is participant's satisfaction, and the secondary outcome is discomfort of the patient as perceived by the physician performing the procedure.

Other Variables of Interest.

• Duration of procedure as defined by time the patient arrives in the room to the time the patient is appropriate for discharge.
• Difficulty of procedure rated by the physician on a scale of 0-10
• Colonoscopy completion rates (intubation of cecum).
• Complications including oxygen desaturation or hypotension.
• Cost of the two medication regiments

Inclusion criteria

• Age > 18
• Elective outpatient colonoscopy
• American Society of Anesthesiology Class (ASA) < IV

Exclusion criteria

• Age < 18
• Inpatient status
• Emergency procedure
• History of colonic or rectal resection
• History of hypersensitivity to Propofol (or soy or egg products),Fentanyl or Midazolam
• ASA of IV
• Neurological deficit
• Acute gastrointestinal bleeding
• On anticoagulation agents
• Noncompliance with bowel regiment
• Pregnant women
• Prisoners