Case: A 57-year-old male is admitted to the ICU with severe lower gastrointestinal bleed (LGIB). Patient is not intubated. GI service requested assistance in procedural anesthesia and preferred to use propofol because they wanted better sedation to evaluate as many serrated lesions during colonoscopy. The intensivist is worried about apnea and decided to use the lowest possible dose. The patient was thought to be awake but started having a fit of coughing and wheezing.
Discussion: It has become almost standard practice to use propofol for colonoscopy sedation, particularly when the colonoscopist wants to improve surveillance of serrated lesions (reference # 4). Also, it improves patient satisfaction and reduces nausea and vomiting, as propofol has anti-emetic properties.
The intensivist's dilemma is finding the right balance during administration, as apnea can be unpredictable with any dosing. Unfortunately, suboptimal propofol dosing can cause coughing and/or laryngospasm. The best strategy is to stay prepared before the procedure for intubation and for hemodynamic instability, with constant close monitoring.
#procedures
#pharmacology
#GI
References:
1. Johnson G, Okoli GN, Askin N, et al. Propofol for sedation during colonoscopy. Cochrane Database Syst Rev 2025; 10:CD006268.
2. Padmanabhan A, Frangopoulos C, Shaffer LET. Patient Satisfaction With Propofol for Outpatient Colonoscopy: A Prospective, Randomized, Double-Blind Study. Dis Colon Rectum 2017; 60:1102.
3. Gan TJ, Jin Z, Ayad S, et al. Fifth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: Executive Summary. Anesth Analg 2025.
4. Quaye AN, Hisey WM, Mackenzie TA, et al. Association of Sedation Depth With Detection of Small Serrated Polyps and Serrated Polyp Counts During Colonoscopy: A Registry-Based Cohort Study. Anesth Analg 2026; 142:617.
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