Daniel S. Zhang, MD, Roman Stana, MD, Bincy Abraham, MD, FACG
Houston Methodist Hospital, Houston, TX
Introduction: Patients with inflammatory bowel disease (IBD) frequently undergo endoscopic procedures for diagnosis and management of disease activity. We have shown in a prior study that our IBD patient population have higher sedation requirements, which is consistent with other studies (1-3). However, there is limited data on induction dosing requirements comparing the IBD patient population to the non-IBD population. Here we conducted a retrospective study comparing the induction propofol dose and sedation time required for IBD patients compared to non IBD patients.
Methods: Patients 18 years or older undergoing elective outpatient endoscopy with an American Society of Anesthesiologists (ASA) score of 2 or less using total intravenous anesthesia (TIVA) from one designated anesthesiologist was included in the study. Adverse events were recorded. Age, body mass index (BMI), relevant comorbidities, medications, and endoscopic disease activity scores were recorded.. The primary outcome was induction dose, which was defined as the amount of propofol per kilogram required to adequately and safely anesthetize a patient for the procedure as determined by the anesthesiologist. The secondary endpoint was the time to sedation. We used one anesthesiologist to reduce any variations in delivering anesthesia. The sample size needed for the primary outcome with 80% power and an alpha 0.05 was 88 total patients based on a mean difference of 0.5mg/kg propofol induction dose.
Results: A total of 152 patients undergoing elective outpatient endoscopies met inclusion criteria, with 108 patients in the IBD arm and 44 patients in the non-IBD arm. Baseline characteristics were similar except for lower BMI 25.7 in the IBD group vs 29.1 kg/m2 in non-IBD group (Table 1). Baseline characteristics of the IBD group are shown in Table 2. Propofol induction dose was greater in the IBD group 3.42 ± 0.39 mg/kg compared to the non-IBD group 1.79 ± 0.17 seconds (p < 0.05) (Table 3). Sedation time was lower in the IBD group 38.9 ± 2.1 seconds when compared to the non-IBD group 88.5 ± 8.8 seconds (p < 0.05). No adverse events were reported in either group.
Discussion: Induction propofol dosage was significantly greater and sedation times were significantly faster in the IBD group compared to the non IBD group. Further studies are needed to understand the mechanism of propofol in contributing to anesthesia in the setting of inflammatory diseases compared to the general population.
Citation: Daniel S. Zhang, MD, Roman Stana, MD, Bincy Abraham, MD, FACG. P0482 - FASTER SEDATION TIMES FOR INFLAMMATORY BOWEL DISEASE (IBD) PATIENTS UNDERGOING ELECTIVE ENDOSCOPIC PROCEDURES CAN BE SAFELY ACHIEVED WITH A HIGHER PROPOFOL INDUCTION DOSAGE COMPARED TO NON-IBD PATIENTS. Program No. P0482. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.