Dose-sparing Balanced Propofol Sedation in Colonoscopy

This randomized controlled trial compared two balanced propofol analgosedation strategies in adults undergoing elective colonoscopy. Participants were randomized to either a standard-dose protocol using an initial propofol dose of 1.0 mg/kg or a structured dose-sparing protocol using an initial propofol dose of 0.5 mg/kg. Both protocols included midazolam and fentanyl. The standard-dose protocol was anesthesiologist-guided, whereas the dose-sparing protocol was administered by a gastroenterologist trained in advanced life support and airway management, with an anesthesia technician present and an anesthesiologist immediately available if required. The primary outcomes were patient satisfaction and clinically relevant respiratory adverse events, with apnea lasting more than 30 seconds as the principal respiratory safety endpoint. Secondary outcomes included propofol exposure, recovery, procedural performance, cardiovascular adverse events, depth of sedation and nociception-related indices, and endoscopist satisfaction.