Propofol alone versus midazolam plus propofol for sedation in outpatient endoscopic procedures: A randomized controlled trial

Abstract

Background: Propofol and midazolam are the most commonly used sedatives in endoscopic procedures. The purpose of this study was to compare these two sedation regimens prescribed during outpatient endoscopy and colonoscopy procedures.

Materials and Methods: In this randomized clinical trial, 242 low?risk anesthesia patients (American society of anesthesilogist [ASA] I–II) referred to the endoscopy and
colonoscopy ward of Al?Zahra Hospital, Isfahan, from January to June 2025, were studied. Patients were divided into two groups: sedation with propofol (P) and midazolam +  propofol (M + P). After the collection of data, they were analyzed through SPSS version 18 software.

Results: In the procedures, the P group had lower systolic blood pressure (BP) readings (P = 0.003) and a lower respiratory rate (RR) (P < 0.001) compared to the control group. Heart rates were not different. Pain visual analogue scale scores were lower in the P group (P = 0.012), but endoscopist satisfaction scores and patient satisfaction scores were not different between groups. Recovery was lowered in the P group (P < 0.001). Even though the requirement for the booster dose was more variable – occurring more often in the P group with endoscopy (P = 0.040) and in the M + P group with colonoscopy (P < 0.001) – the average booster dose was equal (P = 0.126). A correlati on was found between body mass index and the booster dose of propofol in the P group.

Conclusion: Propofol supplementation with midazolam enhanced some of the hysiological
parameters, like RR and systolic BP stability. However, it was at the expense of prolonged recovery and increased pain experience. Propofol alone ensured quicker recovery and greater analgesia but needed increased monitoring as a result of larger physiological excursions.