Propofol versus Midazolam for Sedation during Percutaneous Transluminal Angioplasty

doi:10.1016/S1051-0443(96)70827-8

Journal of Vascular and Interventional Radiology

Volume 7, Issue 5, September 1996, Pages 673-680

https://doi.org/10.1016/S1051-0443(96)70827-8 Get rights and content

Purpose

To prospectively and randomly compare use of propofol versus midazolam for sedation during percutaneous transluminal angioplasty (PTA).

Materials and Methods

Forty patients (27 men, 13 women; mean age 64.4 years ± 12.2) who underwent PTA of the arteries below the diaphragm were prospectively randomized for sedation with propofol or midazolam. Both drugs were administered after an initial bolus injection by means of continuous infusion to achieve conscious sedation at levels II-III according to the Ramsay classification. Patients and interventionalists were blinded to the applied sedative. Both groups were similar with regard to American Society of Anesthesiology status, heart rate, blood pressure, arterial oxygen pressure (pO₂), arterial carbon dioxide pressure (pCO₂), arterial oxygen saturation (SpO₂), and visual analogue scores for general condition, anxiety, and pain. During PTA, heart rate, blood pressure, and pulse oximetry (tpO₂) were monitored continually. Every 30 minutes, an arterial blood gas analysis was performed. Visual analogue scores were obtained before, during, and after intervention.

Results

Decreases in SpO₂, pO₂, and tpO₂ were significantly greater after sedation with midazolam (P < .05; t test). The increase in pCO₂ was significantly greater after midazolam (P < .05; t test). No significant difference between the drugs was found with regard to any of the other parameters. Both drugs resulted in sufficient sedation and anxiolysis (P < .01 for both drugs for visual analogue score for anxiety before and during PTA; matched pairs test). Satisfaction of the interventionalist was significantly greater for propofol (P < .05; t test).

Conclusion

Propofol causes less respiratory depression than midazolam for equivalent sedation and anxiolysis in patients undergoing PTA.

References (26)

M.G. Pratila et al.
Propofol versus midazolam for monitored sedation: a comparison of intraoperative and recovery parameters
J Clin Anesth
(1993)
M.R. Polster et al.
Comparison of the sedative and amnestic effects of midazolam and propofol
Br J Anaest
(1993)
A.R. Manara et al.
Sedation during spinal anaesthesia: a case for the routine administration of oxygen
Br J Anaesth
(1989)
K.W. Patterson et al.
Propofol sedation for upper gastrointestinal endoscopy: comparison with midazolam
Br J Anaesth
(1991)
S.M. Geddes et al.
Skin conductance responses in patients sedated with midazolam or propofol
Br J Anaesth
(1994)
E. Jessop et al.
Comparison of infusions of propofol and methohexitone to provide light general anaesthesia during surgery with regional blockade
Br J Anaesth
(1985)
V.G. Mc Dermott et al.
Sedation and patient monitoring in vascular and interventional radiology
Br J Radiol
(1993)
K.H. Wittenberg et al.
Patterns of intravenous anesthesia for interventional radiology procedures: national survey of physician preferences and practices (abstr)
JVIR
(1996)
S. Pohlmann et al.
Propofol-Narkose für die Endoskopie-gefährlicher als Midazolam?
Bildgebung/Imaging
(1993)
J.G. Reves et al.
Midazolam: pharmacology and uses
Anesthesiology
(1985)

P.S. Sebel et al.

Propofol: a new intravenous anesthetic

Anesthesiology

(1989)

A. Dubois et al.

Use of propofol for sedation during gastrointestinal endoscopies

Anaesthesia

(1988)

E.L. Bloomfield et al.

Intravenous sedation for MR imaging of the brain and spine in children: pentobarbital versus propofol

Radiology

(1993)

Cited by (22)

Outpatient percutaneous image-guided microwave ablation with monitored anesthesia care: An exploratory study
2023, Clinical Imaging
To evaluate the feasibility, safety, and periprocedural perception of pain for a combination approach of moderate and deep sedation for image-guided percutaneous microwave ablation of both primary and secondary malignant lesions.
This was a retrospective study of 33 image-guided percutaneous microwave ablation procedures performed on 33 patients in an outpatient-based interventional radiology center. We used a combination of midazolam, fentanyl, propofol, and/or ketamine to achieve mild to moderate sedation for the procedure, and also to achieve deeper sedation as needed for the ablation portion.
Technical success was achieved in all image-guided percutaneous microwave ablation procedures. Mean procedural time was 49.4 min. There were no major complications. Intraprocedural pain was absent in all patients. All 33 patients were deemed fit for discharge within 30 min following the procedure.
The combination approach of moderate and deep sedation for anesthesia during image-guided percutaneous microwave ablation is an advantageous option. This approach has a strong safety profile, good technical success, short procedure times, low levels of intraprocedural and post-procedural pain, and short recovery from anesthesia.
Sedation with Propofol During Catheter-Directed Thrombolysis for Acute Submassive Pulmonary Embolism Is Associated with Increased Mortality
2019, Journal of Vascular and Interventional Radiology
Citation Excerpt :
Fentanyl causes mild, if any, significant cardiovascular effects at typical clinical doses (23); however, these effects can be augmented when used in combination with propofol or benzodiazepines (9). Extensive research has directly compared sedation with propofol with other sedatives such as midazolam and/or fentanyl; however, none of the studies specifically targeted patients with pulmonary emboli (13–17,24–28). Several randomized controlled trials found moderate sedation with propofol favorable to benzodiazepines secondary to faster recovery times (13,24–26).
To evaluate if sedation with propofol during catheter-directed thrombolysis (CDT) in patients with acute submassive pulmonary embolism (PE) affects survival.
This single-institution, retrospective study identified 136 patients from 2011–2017 who underwent CDT for acute submassive PE. Patients were grouped based on procedural sedation—propofol versus fentanyl and/or midazolam. Groups were compared for differences in baseline characteristics. Primary endpoint was in-hospital mortality. Logistic regression analysis was performed to evaluate for independent variables predictive of mortality. Propensity-matched analysis was also performed.
Propofol was given to 18% (n = 25) of patients, and fentanyl and/or midazolam was given to 82% (n = 111) of patients. Mortality was 28% (n = 7) in the propofol group versus 3% (n = 3) in the fentanyl/midazolam group (P = .0003). Patients receiving propofol had 10.4 times the risk of cardiopulmonary arrest or dying during hospitalization compared with patients receiving fentanyl and/or midazolam (95% confidence interval, 2.9–37.3, P = .0003). The number needed to harm was 4 (95% confidence interval, 2.8–6.8). Logistic regression model analysis including Pulmonary Embolism Severity Index score, right-to-left ventricle diameter ratio and age was not predictive of mortality (P = .19). Adding type of sedation made the model predictive of mortality (P < .001). Propensity-matched analysis controlling for baseline differences in age, adjunctive maneuvers, American Society of Anesthesiologists class, and intubation before the procedure revealed that statistical significance between groups remained (P = .01).
Sedation with propofol during CDT for acute submassive PE is associated with increased mortality and should be used with caution.
Pain and anxiety: Two problems, two solutions
2005, Journal of Vascular and Interventional Radiology
Propofol for deep procedural sedation in the ED
2005, American Journal of Emergency Medicine
We sought to evaluate the use of propofol (2,6-diisopropylphenol) for ED procedural sedation, particularly when administered in a routine fashion for a variety of indications.
This was a prospective observational study conducted in an urban teaching ED. Propofol was administered by handheld syringe and combined with fentanyl. Measurements included propofol and fentanyl dose, serial vital signs, pulse oximetry, adverse events, and patient and physician satisfaction.
One hundred thirty-six subjects (18 to 69 years) were enrolled. Procedures included 82 (60.3%) abscess incision and drainages and 47 (34.6%) orthopedic reductions. Adverse events occurred in 14 cases (10.3%; 95% confidence interval 5.2% to 15.4%), including hypotension in 5, hypoxemia in 7, and apnea in 5. One patient required intubation. Both patient and physician satisfaction were excellent.
ED procedural sedation with propofol was effective and well accepted by patients and physicians. However, it produced a significant incidence of hypotension, hypoxemia, and apnea.
Sedation and analgesia in the interventional radiology department
2003, Journal of Vascular and Interventional Radiology
Administration of sedation and analgesia in the interventional radiology suite is often necessary during painful diagnostic and therapeutic procedures. Although sedative and analgesic agents are generally safe, catastrophic complications related to their use can occur, often as a result of incorrect drug administration or inadequate patient monitoring. The incidence of adverse outcomes related to provision of sedation and analgesia can be reduced with improved understanding of the pharmacology of these medications, by providing adequate monitoring to sedated patients, by recognizing patients who are at increased risk of experiencing an adverse drug reaction, and by early and appropriate management of complications.
Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage
2003, Clinical Radiology
AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03–0.08 mg) and 4.28 mg (2–7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1–7 points, mean 2.9) correlated well with those given by the patients (1–6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121–127.

View all citing articles on Scopus

^☆: From the Department of Diagnostic Radiology, University Hospital, Philipps University, Baldingerstrasse, 35033 Marburg, Germany. From the 1996 SCVIR annual meeting.

View full text

Vascular InterventionPropofol versus Midazolam for Sedation during Percutaneous Transluminal Angioplasty☆

Purpose

Materials and Methods

Results

Conclusion

J Clin Anesth

Br J Anaest

Br J Anaesth

Br J Anaesth

Br J Anaesth

Br J Anaesth

Sedation and patient monitoring in vascular and interventional radiology

Br J Radiol

Patterns of intravenous anesthesia for interventional radiology procedures: national survey of physician preferences and practices (abstr)

JVIR

Propofol-Narkose für die Endoskopie-gefährlicher als Midazolam?

Bildgebung/Imaging

Midazolam: pharmacology and uses

Anesthesiology

Propofol: a new intravenous anesthetic

Anesthesiology

Use of propofol for sedation during gastrointestinal endoscopies

Anaesthesia

Intravenous sedation for MR imaging of the brain and spine in children: pentobarbital versus propofol

Radiology

Vascular Intervention
Propofol versus Midazolam for Sedation during Percutaneous Transluminal Angioplasty☆