Routine Propofol Sedation Increases Risk During Colonoscopy

Summary and Comment |
March 28, 2013

Routine Propofol Sedation Increases Risk During Colonoscopy

  1. Chris E. Forsmark, MD

In a large database study, anesthesia assistance was associated with an elevated risk for perforation, splenic injury, or aspiration pneumonia.

  1. Chris E. Forsmark, MD

The use of anesthesiologist-administered propofol sedation for colonoscopy is increasing in the U.S. (JW Gastroenterol April 13 2012 and JW Gastroenterol Feb 17 2012). Propofol use during colonoscopy is associated with shorter recovery time and higher patient satisfaction but also an estimated 20% increase in health care costs. Whereas most studies on the use of propofol sedation during colonoscopy have focused on its economic cost, researchers now explore another possible disadvantage — increased risk for complications.

Using a database of linked U.S. Medicare and cancer registry data, investigators identified patients without cancer who underwent diagnostic colonoscopy between 2000 and 2009, assessed whether they received anesthesiology services, and determined whether they were hospitalized during the 30 days following colonoscopy for perforation, splenic injury, or aspiration pneumonia. Data on the type of anesthetic agent used were unavailable, but investigators assumed that anesthesiologist-administered propofol was used most often.

Of 165,527 colonoscopy examinations in 100,359 patients, 35,128 procedures (21.2%) were performed with anesthesia assistance. Complications of aspiration, perforation, or splenic injury occurred more frequently in patients who received anesthesia assistance than in those who did not (0.22% vs. 0.16%, P<0.001; odds ratio, 1.46; 95% confidence interval, 1.09–1.94). This difference was mostly attributable to the difference in risk for aspiration (0.14% vs. 0.10%; P=0.02). The risks for perforation and splenic injury were similar between groups. Other independent risk factors for these complications were older age, male sex, increased comorbidity, and undergoing the procedure in a hospital.


Although the overall rate of complications was very low, the use of anesthesia services for diagnostic colonoscopy resulted in a higher risk for complications. These findings might result in part from confounding if patients who received anesthesia assistance were sicker or more prone to complications and were chosen to receive anesthesia for those reasons. Also, the data were from a period when propofol was sometimes administered by trained nurses rather than anesthesiologists, and the relative safety of this approach compared to anesthesia-administered services cannot be determined. Finally, these findings might be more pronounced in the types of patients included in this trial (≥65 years old), and whether the observed increased risk is present in younger or more healthy patients remains to be determined.


Reader Comments (13)

Andy Hayes Software

Conventional narcotics do not diminish the serious pain of a conventional colonoscopy for me, so have used Propofol for the last two in a hospital setting. It makes for a nice, no-pain nap and I'm sold on it. Next one is tomorrow, but I got this whole message out during prep. ;)

Roberts, C

Sedation-free colonoscopies? Maybe not. I had my first (and last) colonscopy in 1991. I was apparently Versed and Valium-resistant and felt incomprehensible agonizing pain during the procedure. However, I was unable to communicate as I was "paralyzed" to move or speak. Somehow, I have to get over my fear to have another procedure. I don't know how I am going to do that even though it is so many years later. I can feel it like it was yesterday. General anesthesia for me....or no procedure. Everyone is an individual and you cannot have blanket protocols for all.


Had colonoscopy 2 days ago with propofol and vomited during procedure. Luckily, no aspiration. during previous 3 colonoscopies, sedated with Versed and was pleased with that and will choose that next time. I vomited first half of MoviPrep and could not finish second half that morning due to nausea. Told anaesthesiologist that, and wondering why he chose propofol since increased risk I would vomit.

john bowser Retired

I had a colonoscopy in June, 2015 where propofol was used. I had no complications or problems afterward.

In September, I went through a sleep study and was diagnosed with severe sleep apnea. I was obviously suffering from sleep apnea when the colonoscopy was performed because the conditions that led to the sleep study were present long before the colonoscopy was performed. Neither the doctor nor the anesthesiologist knew I had sleep apnea and no special precautions were taken. However, the next time I have a colonoscopy, I will let my doctor know that I suffer from sleep apnea and will take my CPAP with me if so instructed..

Lisa Roush Resident

I was sedated with 200 mg of propofol, about 20 minutes later, I was nausea, vomited and coughed. An anesthesiologist put suctioned into my mouth and throat. I coughed. My oxgyen slowly declined. The anesthesiologist replaced an endotracheal tube and I was bagged about 10 breathes. My oxygen went back to normal. I continued to cough. When procedure was done. I woke up, coughed with blood sputum and was confused. I breathed irregular and wore oxygen mask. An ambulance came and took me to the emergency room. I was nausea, vomited up and my fever quickly up 38.5 c, I was febrile and jittery. My blood pressure was low. My white cell count went up. My kidney function was weak. My doctor said I had a massive bacteria infection in over my body and I had aspiration pneumonia. I had sepsis. I admitted to the hospital for receive IV fluid and antibiotics every four hours for three days. I had fever ups and downs. I wore nasal oxygen cannula for two days. I was improved and discharged from the hospital. I am sepsis survivor. I had no problems with two previous colonoscopy procedures. I still believe I have side effects with propofol.

Kathy Prince Other Healthcare Professional, Unspecified

I recently aspirated during my propofol-sedated colonoscopy and it was frightening.
The Cooper study was a very large study that demonstrated that while the overall risk of aspiration is small, propofol increases the risk to an individual patient by 50%. Additionally, anesthesia services are adding 1.1 billion anually to the costs of colonoscopies. It is time to re-think this and consider the European model of gentle, careful sedation-free colonoscopies in which people are educated about their expectations.

Shanni Fox Other
Competing Interests: I am a patient with a vested interest in avoiding the addictive drugs used in conscious sedation

What about in the case of a recovering addict / alcoholic who does not want to have BDZs or Narcotics. Would Propofol be a reasonable choice then?
(I have had 2 upper endoscopy proceedures without sedation and they went just fine, but I think a colonoscopy without sedation would be more difficult and risky... I was going to ask for propofol until I read your post. Now I am trying to weigh the dangers of propofol use vs the detox, cravings, and threat to my sobriety I will have if I get Benzos +narcotics . . . )

Shawn Prinos Other Healthcare Professional, Unspecified

Just spent 6 days in the hospital after aspirating during my routine colonoscopy. Diprivan was used, and I woke suddenly with chest pain, then vomitting. Awful experience, and I've had many previous colonoscopies in the past with no problems. Could be the diprovan.

Barbara Resident, Other

I am concerned about the use of propofol being used during my upcoming colonoscopy. I take Oxycotin and Percocet daily. Will these drugs affect my level of sedation?

Bart Hansen

Wikipedia says it is indeed an amnestic. I just had a colonoscopy with propofol and I did recover more quickly. My GI doc justified the increased cost of having an anesthesiologist present by his not having to monitor my vitals during the procedure.

H.A, MD Physician, Anesthesiology, New York

Propofol was designed as an induction agent for general anesthesia, not intended as the sole sedation element. It is neither analgesic nor amnestic and requires very deep and therefore potentially dangerous sedation levels to be effective. Using it as the sole agent leads to increased frequency of respiratory and cardiovascular compromise especially in the elderly and obese population alleviated only by the clock. It's use is cavalier and thoughtless, used only in a useless attempt to appear quicker in the eyes of the unknowledgable endoscopist, which it might be only for an anesthesiologist unable to use a balanced technique properly. Complications can always be blamed on any technique but is less likely using drugs specifically designed for specific tasks, i.e. narcotic + benzodiaz + hypnotic.

Cheryl Kee n/a

I recently had a EGD & Colonoscopy done at the same time. I can more then assure you my Doctor is a VERY knowledgable endoscopist and has been doing it for more then 30+ Years. They had to use Propofol with me, Because of a medication I take the normal Versed combo would not have worked with me. So Please don't assume all Doctors are unknowledgable !

John D Woody

Too many assumptions. No real facts! More opinion, than evidence based medicine. Too many unknowns about the numbers. Was Propofol used as the sole agent or other agents included?

Competing interests: None declared

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