Premedication Of Butorphanol Benefits Gastrointestinal Endoscopy Screening Under Sedation: A Randomized, Controlled, Double-Blinded Clinical Trial

Background: Propofol is often used as a sedative agent in gastrointestinal endoscopy screening, but it has adverse effects like hypotension, bradycardia, and respiratory depression. This study aims to evaluate if premedication with butorphanol could decrease the total consumption of propofol to stable hemodynamics in patients and compare the benefits between premedication with butorphanol and sufentanil on patients undergoing gastrointestinal endoscopy screening under sedation with propofol. Methods: A total of 200 patients undergoing elective gastrointestinal endoscopy screening (esophagogastroduodenoscopy followed by colonoscopy) with American Society of Anesthesiologists physical status I and II were randomly grouped into group 1 (the placebo group), group 2 (5 mu g/kg butorphanol group), group 3 (10 mu g/kg butorphanol group), and group 4 (0.05 mu g/kg sufentanil group). A similar total volume of medication was administrated to all patients respectively, and then they were all subsequently administrated propofol through target-controlled infusion (TCI) with an effect-site concentration of 3.5 mu g/ml, before and during the procedure. We compared the total consumption of propofol, the cardiovascular parameters, duration of endoscopy procedure, satisfaction scores of the endoscopist and patients, adverse reactions in patients, RASS scores, injection pain scores, and recovery time among the four groups. Results: Patients in the four groups had similarly stable hemodynamics. The consumption of propofol was higher in the placebo group than in group 3 (236.2 +/- 40.9 mg vs 213.6 +/- 41.6 mg, P = 0.007). In addition, the recovery time of group 2 was shorter than those in the other groups (8.3 +/- 3.0 vs 11.26 +/- 3.3, 10.5 +/- 2.3, 11.5 +/- 3.0, P = 0.000), the injection pain score of placebo group was higher than the other groups (P = 0.000) and the scores in group 2, group 3 were lower than group 4 (0.2 +/- 0.4 vs 0.45 +/- 0.73, 0.16 +/- 0.42 vs 0.45 +/- 0.73, P < 0.05). The incidence of bucking/hiccupping was lowest in group 3 (6% vs 28%, 18%, 16%, P = 0.000). The incidence of body movement was also lowest in group 3 (8% vs 50%, 28%, 30%, P = 0.000), compared with the other three groups. The satisfaction scores by endoscopists were higher in group 3 than in the other three groups (P < 0.01), and the satisfaction scores by patients were higher in the experimental groups than in the placebo group (P < 0.001), and it was higher in group 3 than in group 4 (4.9 +/- 0.3 vs 4.7 +/- 0.5, P < 0.05). Conclusions: Premedication with butorphanol has many benefits, especially premedication with 10 mu g/kg butorphanol. It can decrease the total consumption of propofol, relieve the propofol injection pain, increase patient and endoscopist satisfaction, and it has less effect on respiration compared with 0.05 mu g/kg sufentanil. Thus, we recommended premedication of 10 mu g/kg butorphanol for patients undergoing gastrointestinal endoscopy screening under sedation with propofol.