Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Conscious Sedation During Gastrointestinal Endoscopy: Midazolam vs Propofol

의식하 진정 내시경검사: Midazolam vs Propofol

  • Koo, Ja-Seol (Department of Internal Medicine, Korea University College of Medicine) ;
  • Choi, Jai-Hyun (Department of Internal Medicine, Korea University College of Medicine)
  • 구자설 (고려대학교 의과대학 내과학교실) ;
  • 최재현 (고려대학교 의과대학 내과학교실)
  • Published : 2011.02.27
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Abstract

Endoscopy is increasingly performed with the patient under conscious sedation in many countries. The majority of patients can be adequately and safely sedated during routine upper endoscopy and colonoscopy with a combination of a benzodiazepine and opioid. Midazolam is a water-soluble benzodiazepine that is characterized by a rapid onset of action and a shorter duration compared with that of the other drugs of the same class. The major side effect of midazolam is respiratory depression, which can be reversed by flumazenil, a benzodiazepine- specific antagonist. Propofol is a lipid-soluble agent that has the advantages of a more rapid onset of action and a shorter recovery time compared to that of midazolam. However, it should be used with caution since it can lead to hypotension and respiratory depression. Propofol can be safely and effectively administered by nonanesthesiology physicians and nurses provided that they have received adequate training. Two models have been proposed for the administration of propofol by endoscopists: nurse-administered propofol sedation (NAPS) and combination propofol (propofol plus other agents) sedation. In order to modify the pharmacological disadvantages of propofol, fospropofol sodium, a water-soluble prodrug of propofol, has recently been developed. In addition, new delivery systems have been devised: patient-controlled sedation and computer-assisted personalized sedation, in which the computer continuously monitors the patient's condition and adjusts the dose of propofol accordingly. Endoscopists must have a thorough understanding of the medications used for endoscopic sedation and they must acquire the skills necessary for the treatment of cardiopulmonary complications. Therefore, it is necessary to develop a practice guideline pertaining to endoscopic sedation and also training programs for physicians and nurses in Korea.

내시경검사에 진정제를 사용하는 의식하 진정 내시경검사는 점차 증가하고 있으며 벤조다이아제핀과 아편유사제가 흔히 사용되었다. Midazolam은 다른 벤조다이아제핀계 약물보다 효과가 빠르게 나타나고 지속시간이 짧은 장점이 있으나 부작용으로 호흡억제가 발생할 수 있다. 그러나, 벤조다이아제핀 길항제인 flumazenil을 사용하여 midazolam의 호흡억제 효과를 감소시킬 수 있다. Midazolam과 아편유사제의 병합은 효과적이며 안전한 진정방법으로 일반적인 상부위장관 내시경과 대장내시 경 검사에 적합하다. Propofol은 지용성으로 midazolam보다 진정 유도와 회복이 빠른 장점이 있으나 저혈압과 일시적 무호흡이 보고되어 주의가 필요하다. 내시경 의사의 감독 하에 적절하게 훈련받은 의료인에 의한 propofol 투여는 효과적이고 안전하며, propofol 투여 방법으로는 간호사가 환자를 감시하면서 propofol을 투약하는 nurse-administered propofol sedation (NAPS)과 propofol과 다른 약물을 병용하는 propofol 병합요법이 있다. 새로운 진정제로 propofol 전구 물질인 fospropofol이 개발되었으며 새로운 약물 투여 방법으로 propofol 주입을 환자 스스로 조절하는 patient-controlled sedation과 환자 상태에 따라 자동으로 약물을 조절하는 computer-assisted personalized sedation이 연구 중에 있다. 안전하고 효과적인 의식하 진정 내시경검사를 위하여 내시경 의사는 사용 약물에 대한 충분한 지식을 갖춰야 하고 발생할 수 있는 부작용에 대처할 수 있어야 한다. 이를 위해 국내 실정에 적합한 내시경검사 지침과 의사 및 간호사를 위한 교육 훈련 프로그램이 개발되어야 할 것이다.

Keywords

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