Efficacy of Propofol With Midazolam and Meperidine Versus Midazolam and Meperidine for ERCP by Endoscopists with Variable Experience

Abstract

AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly done with intravenous benzodiazepine and meperidine sedation. Propofol alone or in combination is more effective than conventional sedation. There were limited studies comparing the efficacy of propofol with midazolam and meperidine (PMM) to midazolam and meperidine (MM) in ERCP. This study aim to compare the efficacy and safety of PMM to MM in ERCP by endoscopists with variable experience. METHODS: A prospective randomized controlled study in 140 patients scheduled for ERCP at a tertiary center was done. Patients were randomized to either PMM (group A, n=70,) or MM (group B, n=70). The induction time, procedure time, recovery time, pain and satisfaction scores, co-operation and complications were recorded. ERCPs were performed by trainees or staffs. RESULTS: The mean induction time and mean recovery time in group A were shorter than that of group B. (p=0.00, p=0.000) The mean oxygen saturation reduction and the oxygen desaturation to < 90 % in group A were less than in group B. (p=0.014, p=0.0000). The mean systolic blood pressure reduction was higher in group A than in Group B. (p=0.000). The patient-co-operation was 74.28% in group A and 41.42% in group B. (p=0.000). The overall outcomes for trainees and staffs for each group were similar. The adverse events in elderly were not different from those of younger patients in both groups. CONCLUSION: PMM was better than MM regarding patient-co-operation, rapid induction and recovery time and less episode of oxygen saturation.