Comparison of the Effects of Midazolam/Fentanyl, Midazolam/Propofol, and Midazolam/Fentanyl/Propofol on Cognitive Function After Gastrointestinal Endoscopy

摘要

Background: Drugs used for sedation/analgesia during gastrointestinal (GI) endoscopy, including midazolam, fentanyl, and propofol, result in short-term, reversible decline in cognitive function. This prospective cohort trial aimed to identify the sedative/analgesic regimen associated with the least impairment of cognition at the time of discharge. Methods: Patients undergoing elective GI endoscopy were included. Patients investigated at the Prince of Wales Hospital, Sydney, received midazolam/fentanyl (M/F), whereas patients investigated at the Prince of Wales Private Hospital, Sydney, received midazolam/fentanyl/propofol (M/F/P) or midazolam/propofol (M/P). Patients underwent a computerized neurocognitive test, the CogState Brief Battery, before sedation and at discharge. Results: Patients in the M/F group who received gastroscopy (n=22) were administered midazolam 3.36 mg (+/- 0.79 mg) and fentanyl 61.36 mu g (+/- 16.77 mu g), those who received colonoscopy (n=50) were administered midazolam 3.98 mg (+/- 1.06 mg) and fentanyl 74.50 mu g (+/- 24.48 mu g), and those who received gastroscopy/colonoscopy (n=28) were administered midazolam 4.82 mg (+/- 1.41 mg) and fentanyl 94.64 mu g (+/- 24.35 mu g). Patients in the M/F/P group who received colonoscopy (n=45) were administered midazolam 2.77 mg (+/- 0.55 mg), fentanyl 45.11 mu g (+/- 25.78 mu g), and propofol 148.64 mg (+/- 57.65 mg), and those who received gastroscopy/colonoscopy (n=36) were administered midazolam 2.64 mg (+/- 0.472 mg), fentanyl 35.28 mu g (+/- 19.16 mu g), and propofol 168.06 mg (+/- 60.75 mg). Nineteen patients in the M/P group who received gastroscopy (n=19) were administered midazolam 2.37 mg (+/- 0.04 mg) and propofol 13.68 mg (+/- 37.74 mg). Neurocognitive scores were significantly lower in the postprocedure test compared with baseline scores for detection, identification, and one card learning (P 3 mg (P 50 mu g (P<0.009). Conclusion: The use of propofol in GI endoscopy allows for less exposure to midazolam and fentanyl and is associated with improved cognition at the time of discharge.