Sedation with Midazolam, Fentanyl and Propofol in Gastrointestinal Endoscopy Procedures: A Systematic Review

Introduction: Gastrointestinal endoscopy plays an important role in gastroenterology. Sedation in this type of examination reduces the risks of physical damage to the patient, increases patient comfort and collaboration, and also provides the endoscopist with better conditions for the procedure. The most commonly used sedatives, i.e., midazolam and fentanyl, can result in inadequate sedation or slow recovery when used alone, while propofol is a swift fast-acting sedative.

Objectives: To compare, through a systematic review, the use of sedation with midazolam, propofol and fentanyl in adult patients who underwent gastrointestinal endoscopy, according to safety; recovery time of cognitive functions and motor coordination; discomfort during and after the procedure; and patient satisfaction.

Methods: Studies originally published in English using the descriptors "midazolam", "propofol", "fentanyl" and "gastrointestinal endoscopy" were analyzed, considering the use of these medications and their combinations, delimiting the filters for adult humans, and published articles over the past ten years.

Results: 103 studies were found with 11 items in a different Medline search base. According to the inclusion and exclusion criteria, five articles were selected providing sufficient data for the purpose of this research.

Conclusion: Sedation with propofol is associated with improved cognition to the detriment of midazolam and fentanyl alone. Deep sedation was the most comfortable for patients. The target controlled infusion with propofol combined with midazolam/fentanyl produced sedation with fewer hypotension episodes, and shorter recovery and discharge times. Concomitant administration of midazolam, fentanyl and propofol does not cause desaturation and may lead to changes in blood pressure 1 minute after the start of the endoscopy.

Keywords: endoscopy, fentanyl, gastrointestinal tract, midazolam, propofol, sedation.