Intravenous sedation with propofol during endoscopic sphincter of Oddi manometry

Endoscopic manometry of the sphincter Oddi (SO) is a sophisticated method w hich requires a cooperative patient. Therefore, during endoscopic manometry sufficient i. v. sedation is crucial, and additionally must no affect SO-m otility. In a pilot trial SO-motility was determined in ten patients with suspected SO-dysfunction (SOD) under initial sedation with 4,8 +/- 1 mg midazolam (ba seline), and 3 min after an i. v. bolus of 50 mg of propofol. In addition, endoscopic manometry was performed in 57 consecutive patients with suspecte d SOD from 10/94-9/95 under sedation with midazolam (6,2 +/- 1.6 mg); and f rom 10/95-9/96 with propofol (268 +/- 111 mg). Sedation was always performe d by an independent physician according to a standardized protocol. Neither the SO-baseline pressure nor the parameters of phasic SO-motility w ere significantly altered by propofol (including two patients with proven S OD). Propofol causes a more rapid onset of sedation, and the time interval to oh tain successful biliary cannulation was shorter than under midazolam (p < 0,05). Successful manometric recordings could be obtained in 82% of th e patients under midazolam but in 96% of the patients under propofol-sedati on (p < 0,05); respectively. The patient cooperation was significantly better rated (by the endoscopist) in the propofol group than in the midazolam group (p < 0,01). The blood pr essure and the heart rate were not significantly affected in both groups, h owever, propofol caused a significant decrease of the oxygen saturation (p < 0,05). Accordingly, an apnea episode had to be mastered by mask ventilati on via ambu ba in one patient under propofol-sedation (uneventful recovery) . In the midazolam group flumazenil-adminstration was necessary in four pat ients. The post-procedure recovery was faster after propofol - than after m idazolam-sedation (p < 0,05). In conclusion, propofol is suitable for i. v. sedation during endoscopic manometry of the spincter of Oddi.