Skip to main content
SpringerLink
Log in

A comparative study on the efficacy and safety of propofol combined with different doses of alfentanil in gastroscopy: a randomized controlled trial

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

Propofol can be used alone or in combination with opioids during gastroscopy. This study aimed to assess the efficacy and safety of intravenous propofol and different doses of alfentanil in patients undergoing gastroscopy.

Methods

A total of 300 patients undergoing sedative gastroscopy were randomly divided into four groups, and 0.9% saline (group A), 2 μg/kg alfentanil (group B), 3 μg/kg alfentanil (group C) or 4 μg/kg alfentanil (group D) were injected intravenously 1 min before the intravenous injection of 1.5 mg/kg propofol. If body movement and coughing occurred during the procedure, 0.5 mg/kg propofol would be administered intravenously. The primary outcome (awakening time) and secondary outcomes were recorded and analyzed, including hemodynamic changes, the incidences of body movement, coughing, hypoxemia, hypotension, hypertension, bradycardia, tachycardia, nausea and vomiting, drowsiness and dizziness.

Results

Patients in group C (7.0 [5.0 to 8.0] min) and group D (6.0 [5.0 to 7.0] min) woke up significantly earlier than those in group A (8.0 [6.0 to 10.0] min) (P < 0.001). Patients in group A experienced more body movement (P = 0.001) and coughing (P < 0.001) than the other groups. With the increasing dose of alfentanil, the morbidity of hypotension and bradycardia increased significantly (P = 0.001), while the incidence of dizziness decreased significantly (P = 0.037). The incidences of hypoxemia, tachycardia, drowsiness, nausea and vomiting were similar among the four groups (P > 0.05).

Conclusions

Intravenous 1.5 mg/kg propofol combined with 3 μg/kg alfentanil is more suitable for patients undergoing gastroscopy, and the dose of alfentanil can be reduced according to the patient’s actual physical condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data set used and/or analysed during the current study available from the corresponding author on reasonable request.

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  PubMed  Google Scholar 

  2. Leung WK, Wu MS, Kakugawa Y, Kim JJ, Yeoh KG, Goh KL, Wu KC, Wu DC, Sollano J, Kachintorn U, Gotoda T, Lin JT, You WC, Ng EK, Sung JJ. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol. 2008;9:279–87.

    Article  PubMed  Google Scholar 

  3. Teh JL, Shabbir A, Yuen S, So JB. Recent advances in diagnostic upper endoscopy. World J Gastroenterol. 2020;26:433–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Abraham NS, Fallone CA, Mayrand S, Huang J, Wieczorek P, Barkun AN. Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a Canadian randomized controlled cost-outcome study. Am J Gastroenterol. 2004;99:1692–9.

    Article  PubMed  Google Scholar 

  5. Men F, Wei L, Liu B, Wu F, Liu J, Guo N, Niu Q. Comparison of the safety of the application of painless gastroscopy and ordinary gastroscopy in chronic hypertension patients combined with early gastric cancer. Oncol Lett. 2018;15:3558–61.

    PubMed  PubMed Central  Google Scholar 

  6. Zhou S, Zhu Z, Dai W, Qi S, Tian W, Zhang Y, Zhang X, Huang L, Tian J, Yu W, Su D. National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals. Br J Anaesth. 2021;127:56–64.

    Article  CAS  PubMed  Google Scholar 

  7. Tagaito Y, Isono S, Nishino T. Upper airway reflexes during a combination of propofol and fentanyl anesthesia. Anesthesiology. 1998;88:1459–66.

    Article  CAS  PubMed  Google Scholar 

  8. Cao S, Li Y, Wang L, Cui J, Jia N, Li R, Zhao C, Wang C, Wu Y, Wen A. Synergistic analgesic effect of propofol-alfentanil combination through detecting the inhibition of cAMP signal pathway. J Pharm Pharmacol. 2016;68:1170–6.

    Article  CAS  PubMed  Google Scholar 

  9. Scott HB, Choi SW, Wong GT, Irwin MG. The effect of remifentanil on propofol requirements to achieve loss of response to command vs. loss of response to pain. Anaesthesia. 2017;72:479–87.

    Article  CAS  PubMed  Google Scholar 

  10. Zhao YJ, Liu S, Mao QX, Ge HJ, Wang Y, Huang BQ, Wang WC, Xie JR. Efficacy and safety of remifentanil and sulfentanyl in painless gastroscopic examination: a prospective study. Surg Laparosc Endosc Percutan Tech. 2015;25:e57-60.

    Article  PubMed  Google Scholar 

  11. Scholz J, Steinfath M, Schulz M. Clinical pharmacokinetics of alfentanil, fentanyl and sufentanil. An update. Clin Pharmacokinet. 1996;31:275–92.

    Article  CAS  PubMed  Google Scholar 

  12. Roozekrans M, van der Schrier R, Aarts L, Sarton E, van Velzen M, Niesters M, Dahan A, Olofsen E. Benefit versus severe side effects of opioid analgesia: novel utility functions of probability of analgesia and respiratory depression. Anesthesiology. 2018;128:932–42.

    Article  CAS  PubMed  Google Scholar 

  13. Kılıc E, Demiriz B, Isıkay N, Yıldırım AE, Can S, Basmacı C. Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients. Saudi Med J. 2016;37:1191–5.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Doğanay G, Ekmekçi P, Kazbek BK, Yılmaz H, Erkan G, Tüzüner F. Effects of alfentanil or fentanyl added to propofol for sedation in colonoscopy on cognitive functions: Randomized controlled trial. Turk J Gastroenterol. 2017;28:453–9.

    Article  PubMed  Google Scholar 

  15. Hsieh C-H, Lin T-Y, Wang T-Y, Kuo C-H, Lin S-M, Kuo H-P, Lo Y-L. The safety and efficacy of alfentanil-based induction in bronchoscopy sedation: a randomized, double-blind, controlled trial. Medicine (Baltimore). 2016;95:e5101.

    Article  CAS  PubMed  Google Scholar 

  16. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, Schwam EM, Siegel JL. Validity and reliability of the observer’s assessment of alertness/sedation scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990;10:244–51.

    CAS  PubMed  Google Scholar 

  17. Kim TK, Niklewski PJ, Martin JF, Obara S, Egan TD. Enhancing a sedation score to include truly noxious stimulation: the Extended Observer’s Assessment of Alertness and Sedation (EOAA/S). Br J Anaesth. 2015;115:569–77.

    Article  CAS  PubMed  Google Scholar 

  18. Mason KP, Green SM, Piacevoli Q, International Sedation Task Force. Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: a consensus document from the World SIVA International Sedation Task Force. Br J Anaesth. 2012;108:13–20.

    Article  CAS  PubMed  Google Scholar 

  19. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7:89–91.

    Article  CAS  PubMed  Google Scholar 

  20. Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127:1246–58.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yip GM, Chen ZW, Edge CJ, Smith EH, Dickinson R, Hohenester E, Townsend RR, Fuchs K, Sieghart W, Evers AS, Franks NP. A propofol binding site on mammalian GABAA receptors identified by photolabeling. Nat Chem Biol. 2013;9:715–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Li Q, Zhou Q, Xiao W, Zhou H. Determination of the appropriate propofol infusion rate for outpatient upper gastrointestinal endoscopy-a randomized prospective study. BMC Gastroenterol. 2016;16:49.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Joo J, Yu S, Koh HJ. Delayed adverse events after procedural sedation in pediatric patients with hematologic malignancies. Medicina (Kaunas). 2022;58:1208.

    Article  PubMed  Google Scholar 

  24. Sieg A, bng-Study-Group, Beck S, Scholl SG, Heil FJ, Gotthardt DN, Stremmel W, Rex DK, Friedrich K. Safety analysis of endoscopist-directed propofol sedation: a prospective, national multicenter study of 24 441 patients in German outpatient practices. J Gastroenterol Hepatol. 2014;29:517–23.

    Article  CAS  PubMed  Google Scholar 

  25. Lysakowski C, Dumont L, Pellegrini M, Clergue F, Tassonyi E. Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaesthesia. Br J Anaesth. 2001;86:523–7.

    Article  CAS  PubMed  Google Scholar 

  26. Gemma M, Pennoni F, Tritto R, Agostoni M. Risk of adverse events in gastrointestinal endoscopy: zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event. PLoS ONE. 2021;16:e0253515.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Leslie K, Allen ML, Hessian EC, Peyton PJ, Kasza J, Courtney A, Dhar PA, Briedis J, Lee S, Beeton AR, Sayakkarage D, Palanivel S, Taylor JK, Haughton AJ, O’Kane CX. Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study. Br J Anaesth. 2017;118:90–9.

    Article  CAS  PubMed  Google Scholar 

  28. Ebert TJ. Sympathetic and hemodynamic effects of moderate and deep sedation with propofol in humans. Anesthesiology. 2005;103:20–4.

    Article  CAS  PubMed  Google Scholar 

  29. Sneyd JR, Absalom AR, Barends CRM, Jones JB. Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis. Br J Anaesth. 2022;128:610–22.

    Article  CAS  PubMed  Google Scholar 

  30. Vuyk J, Engbers FH, Burm AG, Vletter AA, Griever GE, Olofsen E, Bovill JG. Pharmacodynamic interaction between propofol and alfentanil when given for induction of anesthesia. Anesthesiology. 1996;84:288–99.

    Article  CAS  PubMed  Google Scholar 

  31. Mertens MJ, Olofsen E, Burm AG, Bovill JG, Vuyk J. Mixed-effects modeling of the influence of alfentanil on propofol pharmacokinetics. Anesthesiology. 2004;100:795–805.

    Article  CAS  PubMed  Google Scholar 

  32. Miner JR, Driver BE, Moore JC, Faegerstrom E, Klein L, Prekker M, Cole JB. Randomized clinical trial of propofol versus alfentanil for moderate procedural sedation in the emergency department. Am J Emerg Med. 2017;35:1451–6.

    Article  PubMed  Google Scholar 

  33. Nilsson A, Nilsson L, Ustaal E, Sjöberg F. Alfentanil and patient-controlled propofol sedation—facilitate gynaecological outpatient surgery with increased risk of respiratory events. Acta Anaesthesiol Scand. 2012;56:1123–9.

    Article  CAS  PubMed  Google Scholar 

  34. Yoon HI, Kim JH, Lee JH, Park S, Lee CT, Hwang JY, Nahm SF, Han S. Comparison of propofol and the combination of propofol and alfentanil during bronchoscopy: a randomized study. Acta Anaesthesiol Scand. 2011;55:104–9.

    Article  CAS  PubMed  Google Scholar 

  35. Kim H, Hyun JN, Lee KJ, Kim HS, Park HJ. Oxygenation before endoscopic sedation reduces the hypoxic event during endoscopy in elderly patients: a randomized controlled trial. J Clin Med. 2020;9:3282.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Jang SY, Park HG, Jung MK, Cho CM, Park SY, Jeon SW, Tak WY, Kweon YO, Kim SK, Jeon YH. Bispectral index monitoring as an adjunct to nurse-administered combined sedation during endoscopic retrograde cholangiopancreatography. World J Gastroenterol. 2012;18:6284–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Lin YJ, Wang YC, Huang HH, Huang CH, Liao MX, Lin PL. Target-controlled propofol infusion with or without bispectral index monitoring of sedation during advanced gastrointestinal endoscopy. J Gastroenterol Hepatol. 2020;35:1189–95.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

This work was funded by Liaoning Natural Science Foundation of China [2020-MS-053] and Clinical and Basic Research Programs of Medical Science Development Fund [S088].

Author information

Authors and Affiliations

  1. Department of Anesthesiology, People’s Hospital of China Medical University (People’s Hospital of Liaoning Province), NO. 33 Wenyi Road, Shenhe District, Shenyang, 110016, Liaoning, China

    Ling-Ling Wang, Chang-Ming Wang, Yi-Wen Zhang & Jing Zhang

  2. Department of Anesthesiology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China

    Zhan-Ying Guan

  3. Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110001, Liaoning, China

    Ping Zhao

Authors
  1. Ling-Ling Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhan-Ying Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chang-Ming Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yi-Wen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ping Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Chang-Ming Wang or Ping Zhao.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 92 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, LL., Guan, ZY., Wang, CM. et al. A comparative study on the efficacy and safety of propofol combined with different doses of alfentanil in gastroscopy: a randomized controlled trial. J Anesth 37, 201–209 (2023). https://doi.org/10.1007/s00540-022-03145-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-022-03145-5

Keywords

Search

Navigation