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Endoscopy 2005; 37(12): 1205-1210
DOI: 10.1055/s-2005-870217
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Combining Physostigmine with Meperidine for Sedation and Analgesia During Colonoscopy

I.  Z.  Yardeni1 , E.  Melzer2 , V.  Smolyarenko1 , A.  Zeidel1 , A.  Chervinsky2 , Y.  Binder2 , B.  Beilin1
  • 1Department of Anesthesiology, Rabin Medical Center, Campus Golda-Hasharon, Petah Tikva, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  • 2Department of Gastroenterology, Rabin Medical Center, Campus Golda-Hasharon, Petah Tikva, Israel
Further Information

Publication History

Submitted 24 February 2005

Accepted after revision 15 April 2005

Publication Date:
05 December 2005 (online)

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Abstract

Background and Study Aim: Opiate or benzodiazepine drugs are often used during colonoscopy, but they are associated with respiratory depression and prolonged recovery. Physostigmine, a tertiary anticholinesterase agent, is known to enhance analgesia and to reverse the central nervous system depressant effects of these drugs. This study compared the effect of giving meperidine alone with the effect of giving meperidine in combination with physostigmine in patients who were undergoing complete colonoscopy.
Patients and Methods: A total of 44 outpatients undergoing elective colonoscopy were randomly assigned to receive analgesia with either meperidine 0.5 mg/kg intravenously (group 1, n = 24) or physostigmine 10 micrograms/kg intravenously, followed 5 minutes later by meperidine 0.5 mg/kg intravenously (group 2; n = 20). The patients were assessed with regard to oxygen saturation, hemodynamic changes, pain perception and sedation scores, readiness to go home, and adverse effects.
Results: The group 1 patients’ oxygen saturations consistently fell, both during the procedure and in the recovery period; in group 2, oxygen saturations remained stable throughout the procedure and recovery period (95.88 % ± 0.99 vs. 98.15 ± 0.99, P < 0.001). Patients in group 2 reported lower pain perception scores during the procedure (measured using a visual analog scale) than patients in group 1 (1.46 ± 0.31 vs. 1.75 ± 0.41; F 1,42 = 6.484, P < 0.015) and were less sedated during recovery (F 1,41 = 6.56, P < 0.015). No significant differences were found between the two groups with regard to heart rate or arterial blood pressure. All patients in group 2 were ready to go home after 25 minutes in the recovery area; three patients in group 1 were not ready to leave at 25 minutes and left the facility after 60 minutes. Four patients suffered from minor side effects of physostigmine (sweating and nausea).
Conclusions: Combining physostigmine with meperidine as preparatory treatment for patients undergoing colonoscopy prevents respiratory depression, improves analgesia, and shortens recovery time, with only mild side effects.

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B. Beilin, M. D.

Anesthesiology Department, Rabin Medical Center, Campus Golda-Hasharon ·

7 Keren Kayemet Le-Israel St · Petah Tikva 49372 · Israel

Fax: +972-3-937470

Email: beilinb@clalit.org.il