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Name of Journal: World Journal of Clinical CasesManuscript NO: 42765Manuscript Type: ORIGINAL ARTICLERandomized Clinical TrialSafety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopyKayaalt? S et al. Safety of colonoscopy sedation by endoscopy nurseSelda Kayaalt?, ?mer Kayaalt?Selda Kayaalt?, Division of Anaesthesiology and Reanimation, Develi Public Hospital, Kayseri, Develi 38440, Turkey ?mer Kayaalt?, Computer Technology, Kayseri University, Develi Huseyin Sahin Vocational College, Kayseri, Develi 38440, TurkeyORCID number: Selda Kayaalt? (0000-0002-8176-0188); ?mer Kayaalt? (0000-0002-1630-1241).Author contributions: Kayaalt? S designed and performed research; Kayaalt? S and Kayaalt? ? analyzed data, wrote the paper and reviewed manuscript.Institutional review board statement: This study was reviewed and approved by the ethics committee of Erciyes Nuiversity Medical Faculty.Clinical trial registration statement: The registration identification number is 2018/rmed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after patient agreed to treatment by written consent.Conflict-of-interest statement: The author declared no conflicts of interest with respect to the authorship and/or publication of this article.Data sharing statement: No additional data are available.CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: HYPERLINK "" source: Unsolicited manuscriptCorresponding author to: Selda Kayaalt?, MD, PhD, Doctor, Specialist Doctor, Division of Anaesthesiology and Reanimation, Develi Public Hospital, Camicedit Mah. Hastane Cad. No: 14, Kayseri, Develi 38440, Turkey. drselda@Telephone: +90-352-6216020Fax: +90-352-6216223Received: October 9, 2018Peer-review started: October 10, 2018First decision: November 1, 2018 Revised: November 9, 2018Accepted: November 23, 2018Article in press: Published online:AbstractAIMTo compare the results of midazolam-ketamine-propofol sedation performed by endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODSAmerican Statistical Association (ASA) I-II 60 patients who underwent colonoscopy under sedation were randomly divided into two groups [sedation under the supervision of anaesthetist (SSA) and sedation under the supervision of endoscopy nurse (SSEN)]. Both groups were initially administered 1 mg of midazolam, 50 mg of ketamine and 30-50 mg of propofol. Continuation of sedation was performed by the anaesthetist in the SSA group and the nurse with patient-controlled analgesia (PCA) pump in the SSEN group. The total propofol consumption, the duration of the procedure, recovery times, the pain [visual analogue scale (VAS)] and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure, and whether they would re-prefer the same method in case of re-endoscopy.RESULTS The total propofol consumption in the SSEN group was found to be significantly higher (P???0.05) than that of the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences (P > 0.05) between the two groups. Any long-term and requiring intervention side effects were not observed in both groups.CONCLUSIONColonoscopy sedation in ASA I-II patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.Key words: Patient-controlled analgesia pump; Colonoscopy; Nurse-administered sedation; Midazolam-ketamine-propofol combination? The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.Core tip: Sedation is frequently performed during interventional procedures such as colonoscopy. In case there are not enough anaesthetists, there are a variety of sedation protocols also applied by educated non-anaesthesia personnel. In our study, we showed that midazolam-ketamine-propofol combination can be applied under the supervision of an endoscopy nurse.Kayaalt? S, Kayaalt? ?. The safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy. World J Clin Cases 2018; In pressINTRODUCTIONGastrointestinal endoscopy practices have been increasing worldwide. During colonoscopy, patients do not want to be awake because of severe abdominal pain, cramps and bloating as well as embarrassment ADDIN EN.CITE <EndNote><Cite><Author>Ghanouni</Author><Year>2016</Year><RecNum>25</RecNum><DisplayText><style face="superscript">[1]</style></DisplayText><record><rec-number>25</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068436">25</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Ghanouni, Alex</style></author><author>Plumb, Andrew</author><author>Hewitson, Paul</author><author>Nickerson, Claire</author><author>Rees, Colin J</author><author>von Wagner, Christian</author></authors></contributors><titles><title>Patients' experience of colonoscopy in the English Bowel Cancer Screening Programme</title><secondary-title>Endoscopy</secondary-title></titles><periodical><full-title>Endoscopy</full-title><abbr-1>Endoscopy</abbr-1></periodical><pages>232-240</pages><volume>48</volume><number>3</number><dates><year>2016</year></dates><isbn>1438-8812</isbn><urls></urls><custom2>26841268</custom2><electronic-resource-num>10.1055/s-0042-100613</electronic-resource-num></record></Cite></EndNote>[1]. The demand for sedation in colonoscopies is increasing because of the influence of image quality in colorectal cancers and the increase in expectation of painless treatment of patients ADDIN EN.CITE <EndNote><Cite><Author>Ferreira</Author><Year>2015</Year><RecNum>24</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>24</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068429">24</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Ferreira, Alexandre Oliveira</style></author><author>Cravo, Marília</author></authors></contributors><titles><title>Sedation in gastrointestinal endoscopy: Where are we at in 2014?</title><secondary-title>World journal of gastrointestinal endoscopy</secondary-title></titles><periodical><full-title>World journal of gastrointestinal endoscopy</full-title><abbr-1>World J Gastrointest Endosc</abbr-1></periodical><pages><style face="normal" font="default" size="100%">102</style><style face="normal" font="default" charset="162" size="100%">-109</style></pages><volume>7</volume><number>2</number><dates><year>2015</year></dates><urls></urls><custom2>25685266</custom2><electronic-resource-num>10.4253/wjge.v7.i2.102</electronic-resource-num></record></Cite></EndNote>[2].A variety of sedation techniques are used during colonoscopy. Sedoanalgesia, deep sedation under the supervision of anaesthetist (SSA), sedation under the supervision of nurse, and computer assisted sedation with target-controlled devices are among these techniques ADDIN EN.CITE <EndNote><Cite><Author>Lin</Author><Year>2017</Year><RecNum>23</RecNum><DisplayText><style face="superscript">[3]</style></DisplayText><record><rec-number>23</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068424">23</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Lin, Otto S</style></author></authors></contributors><titles><title>Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction</title><secondary-title>Intestinal research</secondary-title></titles><periodical><full-title>Intestinal research</full-title><abbr-1>Intest Res</abbr-1></periodical><pages>456-466</pages><volume>15</volume><number>4</number><dates><year>2017</year></dates><isbn>1598-9100</isbn><urls></urls><custom2>29142513</custom2><electronic-resource-num>10.5217/ir.2017.15.4.456</electronic-resource-num></record></Cite></EndNote>[3]. Medications used and applied techniques vary from clinic to clinic. The most commonly used agent is the midazolam. It is used alone or in combination with an opioid (meperidine, fentanyl or alfentanyl). The second most frequently used agent is propofol. Propofol may be used alone or in combination with an opioid analgesic agent or midazolam ADDIN EN.CITE <EndNote><Cite><Author>Ferreira</Author><Year>2015</Year><RecNum>24</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>24</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068429">24</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Ferreira, Alexandre Oliveira</style></author><author>Cravo, Marília</author></authors></contributors><titles><title>Sedation in gastrointestinal endoscopy: Where are we at in 2014?</title><secondary-title>World journal of gastrointestinal endoscopy</secondary-title></titles><periodical><full-title>World journal of gastrointestinal endoscopy</full-title><abbr-1>World J Gastrointest Endosc</abbr-1></periodical><pages><style face="normal" font="default" size="100%">102</style><style face="normal" font="default" charset="162" size="100%">-109</style></pages><volume>7</volume><number>2</number><dates><year>2015</year></dates><urls></urls><custom2>25685266</custom2><electronic-resource-num>10.4253/wjge.v7.i2.102</electronic-resource-num></record></Cite></EndNote>[2]. Propofol is a short-acting sedative agent without analgesic properties ADDIN EN.CITE <EndNote><Cite><Author>Faulx</Author><Year>2005</Year><RecNum>22</RecNum><DisplayText><style face="superscript">[4]</style></DisplayText><record><rec-number>22</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068420">22</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Faulx, Ashley L</style></author><author>Vela, Stacie</author><author>Das, Ananya</author><author>Cooper, Gregory</author><author>Sivak Jr, Michael V</author><author>Isenberg, Gerard</author><author>Chak, Amitabh</author></authors></contributors><titles><title>The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national Web survey</title><secondary-title>Gastrointestinal endoscopy</secondary-title></titles><periodical><full-title>Gastrointestinal endoscopy</full-title><abbr-1>Gastrointest Endosc</abbr-1></periodical><pages>9-15</pages><volume>62</volume><number>1</number><dates><year>2005</year></dates><isbn>0016-5107</isbn><urls></urls><custom2>15990813</custom2><electronic-resource-num>10.1016/S0016-5107(05)00518-3</electronic-resource-num></record></Cite></EndNote>[4]. Therefore, when propofol is used alone, high doses are required to tolerate some invasive procedures. This can lead to life-threatening conditions such as hypotension and respiratory depression ADDIN EN.CITE <EndNote><Cite><Author>Türk</Author><Year>2013</Year><RecNum>21</RecNum><DisplayText><style face="superscript">[5]</style></DisplayText><record><rec-number>21</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068414">21</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Türk, Hacer ?ebnem</style></author><author>Aydo?mu?, Meltem</author><author>?nsal, Oya</author><author>K?ksal, Hakan Mustafa</author><author>A?ik, Mehmet Eren</author><author>Oba, Sibel</author></authors></contributors><titles><title>Sedation-analgesia in elective colonoscopy: propofol-fentanyl versus propofol-alfentanil</title><secondary-title>Revista Brasileira de Anestesiologia</secondary-title></titles><periodical><full-title>Revista Brasileira de Anestesiologia</full-title><abbr-1>Rev Bras Anestesiol</abbr-1></periodical><pages>353-358</pages><volume>63</volume><number>4</number><dates><year>2013</year></dates><isbn>0034-7094</isbn><urls></urls><custom2>23931250</custom2><electronic-resource-num>10.1016/j.bjan.2012.07.006</electronic-resource-num></record></Cite></EndNote>[5]. Adding opioids to the propofol reduces the incidence of side effects and also allows patients to feel less pain during the procedure. It also reduces propofol injection pain ADDIN EN.CITE <EndNote><Cite><Author>Joo</Author><Year>2001</Year><RecNum>20</RecNum><DisplayText><style face="superscript">[6]</style></DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068409">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Joo, Hwan S</style></author><author>Perks, William J</author><author>Kataoka, Mark T</author><author>Errett, Lee</author><author>Pace, Kenneth</author><author>Honey, R John</author></authors></contributors><titles><title>A comparison of patient-controlled sedation using either remifentanil or remifentanil-propofol for shock wave lithotripsy</title><secondary-title>Anesthesia & Analgesia</secondary-title></titles><periodical><full-title>Anesthesia & Analgesia</full-title><abbr-1>Anesth Analg</abbr-1></periodical><pages>1227-1232</pages><volume>93</volume><number>5</number><dates><year>2001</year></dates><isbn>0003-2999</isbn><urls></urls><custom2>11682403</custom2><electronic-resource-num>10.1097/00000539-200111000-00037</electronic-resource-num></record></Cite></EndNote>[6]. Better results are obtained when combined with propofol and ketamine which provide dissociative anaesthesia ADDIN EN.CITE <EndNote><Cite><Author>Alletag</Author><Year>2012</Year><RecNum>19</RecNum><DisplayText><style face="superscript">[7]</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068401">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Alletag, Michelle J</style></author><author>Auerbach, Marc A</author><author>Baum, Carl R</author></authors></contributors><titles><title>Ketamine, propofol, and ketofol use for pediatric sedation</title><secondary-title>Pediatric emergency care</secondary-title></titles><periodical><full-title>Pediatric emergency care</full-title><abbr-1>Pediatr Emerg Care</abbr-1></periodical><pages>1391-1395</pages><volume>28</volume><number>12</number><dates><year>2012</year></dates><isbn>0749-5161</isbn><urls></urls><custom2>23222112</custom2><electronic-resource-num>10.1097/PEC.0b013e318276fde2</electronic-resource-num></record></Cite></EndNote>[7]. Both fentanyl and ketamine provide anaesthesia, analgesia, and anxiolysis. The delayed peak levels and prolonged duration of action of fentanyl are significant disadvantages. After intravenous administration, it reaches its peak level in 4-6 min and its duration of action ends in 20-40 min. Ketamine also has a good safety profile with the advantage of preserving spontaneous breathing and protective airway reflexesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmVlbjwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [10,11]. However, a worldwide study has shown that no major complications occur in patients (less than 1% of 142863 patients) ADDIN EN.CITE <EndNote><Cite><Author>Lienhart</Author><Year>2002</Year><RecNum>18</RecNum><DisplayText><style face="superscript">[12]</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068395">18</key></foreign-keys><ref-type name="Conference Proceedings">10</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Lienhart, A</style></author><author>Carli, P</author><author>Marty, J</author><author>Pourriat, JL</author></authors></contributors><titles><title>Digestive endoscopies: who does what?</title><secondary-title>Annales francaises d'anesthesie et de reanimation</secondary-title></titles><pages>343-346</pages><volume>21</volume><number>5</number><dates><year>2002</year></dates><isbn>0750-7658</isbn><urls></urls></record></Cite></EndNote>[12]. Patient-controlled analgesia (PCA) pump was developed for postoperative pain control. In this regard, the patient applies his own pain medication according to the need himself. The PCA pump was then used with the same logic to provide sedation rather than analgesia in several studies. There are also studies where sedation applications have been performed under the supervision of a nurse or endoscopist using these pre-programmed devices ADDIN EN.CITE <EndNote><Cite><Author>Crepeau</Author><Year>2005</Year><RecNum>17</RecNum><DisplayText><style face="superscript">[13]</style></DisplayText><record><rec-number>17</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068389">17</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Crepeau, Thomas</style></author><author>Poincloux, Laurent</author><author>Bonny, Corinne</author><author>Lighetto, Sylvie</author><author>Jaffeux, Patricia</author><author>Artigue, Fabrice</author><author>Walleckx, Pierre</author><author>Bazin, Jean Etienne</author><author>Dapoigny, Michel</author><author>Bommelaer, Gilles</author></authors></contributors><titles><title>Significance of patient-controlled sedation during colonoscopy: Results from a prospective randomized controlled study</title><secondary-title>Gastroentérologie clinique et biologique</secondary-title></titles><periodical><full-title>Gastroentérologie clinique et biologique</full-title><abbr-1>Gastroenterol Clin Biol</abbr-1></periodical><pages>1090-1096</pages><volume>29</volume><number>11</number><dates><year>2005</year></dates><isbn>0399-8320</isbn><urls></urls><custom2>16505753</custom2><electronic-resource-num>10.1016/S0399-8320(05)82172-4</electronic-resource-num></record></Cite></EndNote>[13]. In this study, we aim to compare the application of midazolam-ketamine-propofol combination by endoscopy nurse with PCA pump and anaesthetist in terms of patient satisfaction and side effect (safety).MATERIALS AND METHODSAfter receiving the approval of the ethical committee of the Medical School of Erciyes University and the informed consent of the patients, the study included the American Statistical Association (ASA) I-II 60 patients who underwent the elective colonoscopy between 18 and 75 years of age. The study protocol was registered at (NCT03607110, ). ASA III-IV-V patients, who have uncontrolled chronic disease (uncontrolled diabetes mellitus and hypertension), severe respiratory and cardiopulmonary insufficiency or liver, and kidney failure who did not accept the method were not included in the study. Patients with long-term analgesic, opioid, and sedative history of use, with hypersensitivity to soybean oil or eggs, and drugs used in our study, with pregnancy or pregnancy suspected or lactating, and with the use of antipsychotic or antidepressant drugs were also excluded in the examination.Before the procedure, the group in which the patients would be included was randomly determined by the endoscopy nurse. The patients were given a proper diet before the procedure and the intestinal cleansing was -implemented. After 8 h of fasting, the peripheral vascular route was opened with a 20G cannula and 8 mL kg/h crystalloid solution was performed. Prior to sedation, all patients were monitored for heart rate, mean arterial pressure, and peripheral oxygen saturation (SpO2) measurements. All patients were given 5 lt/min oxygen with nasal cannula. Colonoscopy; was performed by two experienced endoscopists who were trained in the same center on the same dates.During the procedure, the monitored data and the cardiopulmonary side effects were recorded once in a minute for the first 5-min period and once in every 5 min in the next period. In the SSA group, the anaesthetist was at the bedside of the patient. A total of two nurses, one was trained for sedation and the other of whom would assist the endoscopist during the colonoscopy, were presented in the supervision of endoscopy nurse (SSEN) group. The nurse trained for sedation was informed about possible side effects such as desaturation (< 90%), hypotension (systolic < 90 mm-Hg), and bradycardia (< 50) during the procedure and was also trained to perform the necessary interventions (such as jaw-thrust and head tilt chin lift manoeuvres or using oropharyngeal airway in case of desaturation or atropine administration in case of bradycardia or 250 cc of fluid loading in case of hypotension). If hypotension is continued, 5-10 mg IV ephedrine will be administered. In cases where peripheral oxygen saturation don’t increase or continue to decline (below 85) the anaesthetist will intervene. In the case of long-term desaturation, the materials required for emergency airway management (bag mask ventilation, intubation, etc.) will be available in the endoscopy room to provide respiratory support. The anaesthetist was not at the bedside of the patient in the group SSA. However, the anaesthetist was ready in the endoscopy unit for intervention in emergency situations such as intubation and cardiopulmonary resuscitation.Sedation protocol: Both groups were initially administered 1 mg of midazolam, 50 mg of ketamine, and 30-50 mg of propofol (30 mg in patients over 65 years old and 50 mg in patients under 65 years old). Afterwards, the propofol required for the SSA group was determined and administered by the anaesthetist to provide adequate sedation and patient comfort. For SSEN group, the continuation of sedation was performed by endoscopy nurse using PCA pump (Accumate 1100; Woo Young Medical, Seoul, Korea). Each time the endoscopy nurse pressed the PCA pump according to the patient’s clinical response or tolerance, the patient was administered propofol 10-20 mg (10 mg in patients over 65 years old, 20 mg in patients under 65 years) with a delay of about 10-20 s. At the end of the procedure, the total drug consumption, the duration of the procedure, and the patients’ eye opening/recovery times were recorded.Patient Satisfaction: Patients were monitored until the Aldrete Recovery Score (ARS) was ≥ 9. Patients with the ARS ≥ 9 were transferred to another eligible unit. In order to evaluate patient satisfaction, the patients were asked of questions about the procedure in this unit. A visual analogue scale (VAS) was used to evaluate the pain after the procedure. Patients were asked to rate their pain on a scale of 0-10. Zero (0) would mean “no pain” and ten (10) would mean “worst imaginable pain”.Patients were also questioned about whether they remembered the operation and side effects. Side effects such as hypotension, bradycardia and desaturation, which require serious and rapid intervention, and frequently encountered side effects such as nausea, vomiting, and headache, which may adversely affect patient satisfaction, included in the patient follow-up form as main substances. Apart from these side effects, endoscopy nurse was especially informed about complications related to ketamine such as emergence reactions, hypertension, tachycardia, visual hallucinations, vivid dreams, tonic-clonic movements, diplopia, and nystagmus. However, in the patient follow-up form, these side effects were not mentioned separately, were included under the title of other side effects. In addition, patient satisfaction was determined by satisfaction score of 4 (1 very good, 2 good, 3 not bad, 4 bad). Two days after the procedure, the patients were asked whether they would re-prefer for the same method in case of re-endoscopy and their answers were recorded. Patients were questioned for possible delayed side effects when they were contacted 2 d after the colonoscopy to determine method preference.Statistical methodMean SD, median lowest, highest, frequency, and ratio values were used in the descriptive statistics of the data. The distribution of the variables was measured by the Kolmogorov Smirnov test. Mann-Whitney U test was utilized in the analysis of quantitative independent data. Chi-square test was -employed to analyse qualitative independent data, and Fischer test was used when chi-square test conditions were not met. In all analyses, the P-value < 0.05 was considered as statistically significant. SPSS 22.0 program was used in the analyses.RESULTSThere was no significant difference (P > 0.05) between SSA group and SSEN group in terms of demographic data such as age, gender distribution, and ASA distribution. Patients’ demographic data is given in Table 1.The total propofol used in the SSEN group was found to be significantly higher (P < 0.05) than the SSA group. Reaching the cecum and total procedure time in the SSEN group were found to be significantly higher (P < 0.05) than in the SSA group (Table 2).When patients were asked about their satisfaction, 1 patient in the SSEN group and 5 patients in the SSA group expressed their satisfaction as “not bad”, the rest of patients expressed their satisfaction with “good” or “very good”. In each groups, 3 patients said that they remembered the procedure. All patients in both groups except 2 patients in the SSA group stated that they would re-prefer the same method for the second time. However, when the groups were compared in terms of patient satisfaction, recall of the procedure, and re-preferring the same method in case of re-endoscopy, there was no significant difference (P > 0.05) between the two groups (Table 2).Patients’ pain was evaluated by VAS score after the procedure. The highest recorded VAS value is 4. In each groups, only one patient had a VAS score of 4. The mean value of the VAS score is 1 in each group. Recovery times are also similar between the two groups. There was no statistically significant difference (P > 0.05) between the two groups in terms of VAS score and recovery time.Two groups were also compared in terms of hemodynamic parameters recorded during the procedure. Pulse values taken at the baseline, 1st minute, 2nd minute, 3rd minute, 4th minute, 5th minute, 8th minute, and afterwards did not differ significantly between the two groups (P > 0.05). While the systolic and diastolic pressure values of the SSA and SSEN groups did not differ significantly (P > 0.05) at the baseline, 1st minute, 2nd minute, 3rd minute, and 4th minute, Systolic and diastolic pressure values were found to be significantly lower (P < 0.05) in the SSEN group than in the SSA group in the 5th minute, 8th minute, and afterwards. SPO2 values for the baseline and 1st minute in the SSEN group were found to be significantly higher (P < 0.05) than in the SSA group, There was no significant (P > 0.05) difference in SPO2 values for 2nd minute, 3rd minute, 4th minute, 8th minutes and afterwards between the two groups (Table 3).The groups were also compared in terms of the side effects that might occur during the procedure. In each groups, hypotension and headache occurred in 2 patients. Bradycardia was observed in only 1 patient in the SSEN group. When the groups were compared in terms of desaturation, 4 patients in the SSEN group and 1 patient in the SSA group had desaturation. Nausea and vomiting were not seen in either group. However, there was no statistically significant difference (P > 0.05) between the two groups (Table 4).DISCUSSIONIn the majority of developed countries, various sedation applications are made for endoscopic procedures in low-risk patients. When we examine the agents used for analgesia and sedation in endoscopic procedures over time; meperidine was first used as an analgesic, followed by extensive use of the meperidine diazepam combination. This combination, which is often preferred, is accepted as a traditional sedation method. Later, midazolam was preferred in endoscopy sedation with shorter duration of action and higher efficacy than diazepam. A few years after midazolam, propofol, an ultra-short acting hypnotic agent, started to be used ADDIN EN.CITE <EndNote><Cite><Author>Ferreira</Author><Year>2015</Year><RecNum>24</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>24</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068429">24</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Ferreira, Alexandre Oliveira</style></author><author>Cravo, Marília</author></authors></contributors><titles><title>Sedation in gastrointestinal endoscopy: Where are we at in 2014?</title><secondary-title>World journal of gastrointestinal endoscopy</secondary-title></titles><periodical><full-title>World journal of gastrointestinal endoscopy</full-title><abbr-1>World J Gastrointest Endosc</abbr-1></periodical><pages><style face="normal" font="default" size="100%">102</style><style face="normal" font="default" charset="162" size="100%">-109</style></pages><volume>7</volume><number>2</number><dates><year>2015</year></dates><urls></urls><custom2>25685266</custom2><electronic-resource-num>10.4253/wjge.v7.i2.102</electronic-resource-num></record></Cite></EndNote>[2].Propofol sedation is becoming more popular day by day due to its features such as pain relief during endoscopy and the ability to have a quick recovery time ADDIN EN.CITE <EndNote><Cite><Author>Lin</Author><Year>2017</Year><RecNum>23</RecNum><DisplayText><style face="superscript">[3]</style></DisplayText><record><rec-number>23</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068424">23</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Lin, Otto S</style></author></authors></contributors><titles><title>Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction</title><secondary-title>Intestinal research</secondary-title></titles><periodical><full-title>Intestinal research</full-title><abbr-1>Intest Res</abbr-1></periodical><pages>456-466</pages><volume>15</volume><number>4</number><dates><year>2017</year></dates><isbn>1598-9100</isbn><urls></urls><custom2>29142513</custom2><electronic-resource-num>10.5217/ir.2017.15.4.456</electronic-resource-num></record></Cite></EndNote>[3]. However, it is controversial whether the propofol should be applied by anaesthesia personnel or educated non-anaesthesia personnel. In European and American guidelines, it is stated that sedation applied by non-anaesthesia personnel should be applied only in low-risk patients and that sedation personnel should be qualified to rescue patients from any level of sedation including general anaesthesia ADDIN EN.CITE <EndNote><Cite><Author>Gross</Author><Year>2002</Year><RecNum>27</RecNum><DisplayText><style face="superscript">[14]</style></DisplayText><record><rec-number>27</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534137192">27</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Jeffrey B Gross</style></author><author><style face="normal" font="default" charset="162" size="100%">F</style><style face="normal" font="default" size="100%">armington, CT</style></author><author> Peter L. Bailey</author><author>Richard T. Connis</author><author>Charles J. Cote</author><author>Fred G. Davis</author><author>Burton S. Epstein</author><author>Lesley Gilbertson</author><author>David G. Nickinovich</author><author>John M. Zerwas</author><author>Gregory Zuccaro</author></authors></contributors><titles><title>Practice guidelines for sedation and analgesia by non-anesthesiologists</title><secondary-title>Anesthesiology</secondary-title></titles><periodical><full-title>Anesthesiology</full-title><abbr-1>Anesthesiology</abbr-1></periodical><pages><style face="normal" font="default" size="100%">1004-</style><style face="normal" font="default" charset="162" size="100%">10</style><style face="normal" font="default" size="100%">17</style></pages><volume>96</volume><number>4</number><dates><year>2002</year></dates><urls></urls><custom2>11964611</custom2></record></Cite></EndNote>[14]. 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ADDIN EN.CITE.DATA [15-18]. Walker et al ADDIN EN.CITE <EndNote><Cite><Author>Walker</Author><Year>2003</Year><RecNum>10</RecNum><DisplayText><style face="superscript">[19]</style></DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068304">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Walker, John A</style></author><author>McIntyre, Robert D</author><author>Schleinitz, Paul F</author><author>Jacobson, Kris N</author><author>Haulk, Anthony A</author><author>Adesman, Peter</author><author>Tolleson, Shelley</author><author>Parent, Robyn</author><author>Donnelly, Rosie</author><author>Rex, Douglas K</author></authors></contributors><titles><title>Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center</title><secondary-title>The American journal of gastroenterology</secondary-title></titles><periodical><full-title>The American journal of gastroenterology</full-title><abbr-1>Am J Gastroenterol</abbr-1></periodical><pages>1744-1750</pages><volume>98</volume><number>8</number><dates><year>2003</year></dates><isbn>0002-9270</isbn><urls></urls><custom2>12907328</custom2><electronic-resource-num>10.1111/j.1572-0241.2003.07605.x</electronic-resource-num></record></Cite></EndNote>[19] showed that sedation performed by non-anaesthesia personnel in colonoscopy can be applied more easily and with lower risk than esophagogastroduodenoscopy. In a study/review by Rex et al ADDIN EN.CITE <EndNote><Cite><Author>Rex</Author><Year>2009</Year><RecNum>8</RecNum><DisplayText><style face="superscript">[16]</style></DisplayText><record><rec-number>8</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068292">8</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Rex, Douglas K</style></author><author>Deenadayalu, Viju P</author><author>Eid, Emely</author><author>Imperiale, Thomas F</author><author>Walker, John A</author><author>Sandhu, Kuldip</author><author>Clarke, Anthony C</author><author>Hillman, Lybus C</author><author>Horiuchi, Akira</author><author>Cohen, Lawrence B</author></authors></contributors><titles><title>Endoscopist-directed administration of propofol: a worldwide safety experience</title><secondary-title>Gastroenterology</secondary-title></titles><periodical><full-title>Gastroenterology</full-title><abbr-1>Gastroenterology</abbr-1></periodical><pages>1229-1237</pages><volume>137</volume><number>4</number><dates><year>2009</year></dates><isbn>0016-5085</isbn><urls></urls><custom2>19549528</custom2><electronic-resource-num>10.1053/j.gastro.2009.06.042</electronic-resource-num></record></Cite></EndNote>[16], records of sedation applications performed by non-anaesthesia personnel from various centers around the world have been reviewed and evaluated. In this review/study involving 646080 patients, only 11 cases of emergency endotracheal intubation and 4 deaths were reported.In guidelines for propofol administration of non-anaesthesia personnel, it has been stated that ASA III and over patient procedures, long complex procedures, and difficult airway conditions require an anaesthetic personnelPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hcm9zczwvQXV0aG9yPjxZZWFyPjIwMDI8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [14,20]. In our study, ASA I-II patients were included in the study. There are a variety of studies on sedation applications without anaesthesia personnel in patients undergoing the colonoscopy. Patient-controlled sedation (PCS) studies were conducted in which the patient determined his/her own sedation level with PCA pumpPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DcmVwZWF1PC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48
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ADDIN EN.CITE.DATA [13,21]. In this method, the patients press the button when they feel uncomfortable. A certain period of time passes until they are sedated. In these studies, it is mentioned that patients suffer from pain, although not severe. Feeling pain and time to get sedated may cause patients to opt out the method. For this reason, sedation practices under the SSEN are increasing rapidly in recent years. It has been shown in several studies that sedation and colonoscopy practices under the SSEN are safe and effectivePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaWVnPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [19,22,23]. In a study comparing PCS with SSEN, it has been shown that many patients prefer SSEN instead of PCS because of the anxiety they feel ADDIN EN.CITE <EndNote><Cite><Author>Heuss</Author><Year>2004</Year><RecNum>28</RecNum><DisplayText><style face="superscript">[24]</style></DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534271690">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Heuss, Ludwig T</style></author><author>Drewe, Juergen</author><author>Schnieper, Patrizia</author><author>Tapparelli, Claudia B</author><author>Pflimlin, Eric</author><author>Beglinger, Christoph</author></authors></contributors><titles><title>Patient-controlled versus nurse-administered sedation with propofol during colonoscopy. A prospective randomized trial</title><secondary-title>The American journal of gastroenterology</secondary-title></titles><periodical><full-title>The American journal of gastroenterology</full-title><abbr-1>Am J Gastroenterol</abbr-1></periodical><pages><style face="normal" font="default" size="100%">511</style><style face="normal" font="default" charset="162" size="100%">-518</style></pages><volume>99</volume><number>3</number><dates><year>2004</year></dates><isbn>1572-0241</isbn><urls></urls><custom2>15056094</custom2><electronic-resource-num>10.1111/j.1572-0241.2004.04088.x</electronic-resource-num></record></Cite></EndNote>[24]. We also preferred SSEN instead of PCS in our study. We applied propofol with the PCA pump in order to reduce the human-caused mistakes. The PCA pump allows us to easily dispense the right dose of medicine repeatedly without requiring our attention.In the study by Poon et al ADDIN EN.CITE <EndNote><Cite><Author>Poon</Author><Year>2007</Year><RecNum>29</RecNum><DisplayText><style face="superscript">[25]</style></DisplayText><record><rec-number>29</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534271766">29</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Poon, Chi-Ming</style></author><author>Leung, Tak-Lun</author><author>Wong, Chui-Wah</author><author>Chan, Yuk-Ling</author><author>Leung, Tin-Chun</author><author>Leong, Heng-Tat</author></authors></contributors><titles><title>Safety of nurse-administered propofol sedation using PCA pump for outpatient colonoscopy in Chinese patients: a pilot study</title><secondary-title><style face="normal" font="default" size="100%">Asian Journal of </style><style face="normal" font="default" charset="162" size="100%">S</style><style face="normal" font="default" size="100%">urgery</style></secondary-title></titles><periodical><full-title>Asian Journal of surgery</full-title><abbr-1>Asian J Surg</abbr-1></periodical><pages>239-243</pages><volume>30</volume><number>4</number><dates><year>2007</year></dates><isbn>1015-9584</isbn><urls></urls><custom2>17962125 </custom2><electronic-resource-num>10.1016/S1015-9584(08)60032-9</electronic-resource-num></record></Cite></EndNote>[25], it was found that SSEN with PCA pump was effective and safe in healthy individuals who would undergo colonoscopy. In another study by Liu et al ADDIN EN.CITE <EndNote><Cite><Author>Liu</Author><Year>2009</Year><RecNum>15</RecNum><DisplayText><style face="superscript">[26]</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068334">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Liu, SYW</style></author><author>Poon, CM</author><author>Leung, TL</author><author>Wong, CW</author><author>Chan, YL</author><author>Leong, HT</author></authors></contributors><titles><title>Nurse-administered propofol–alfentanil sedation using a patient-controlled analgesia pump compared with opioid–benzodiazepine sedation for outpatient colonoscopy</title><secondary-title>Endoscopy</secondary-title></titles><periodical><full-title>Endoscopy</full-title><abbr-1>Endoscopy</abbr-1></periodical><pages>522-528</pages><volume>41</volume><number>6</number><dates><year>2009</year></dates><isbn>0013-726X</isbn><urls></urls><custom2>19440955</custom2><electronic-resource-num>10.1055/s-0029-1214711</electronic-resource-num></record></Cite></EndNote>[26], while a group was administered propofol-alfentanil by method of SSEN with PCA pump, opioid-benzodiazepine was administered to the other group by the anaesthetist. As a result of the study, there was no significant difference between groups in terms of side effects, pain scores, and the willingness to repeat the colonoscopy with the same sedation method. In the SSEN group, it was stated that only deeper sedation was obtained. Since two sets of sedation protocols were applied, it was thought that this situation was caused by the difference in drug combinations used rather than SSEN method.In a sedation protocol, the total amount of drug used is reduced due to the synergistic effect of drugs on each other formed by adding adjuvant drugs in addition to propofol ADDIN EN.CITE <EndNote><Cite><Author>Joo</Author><Year>2001</Year><RecNum>20</RecNum><DisplayText><style face="superscript">[6]</style></DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068409">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Joo, Hwan S</style></author><author>Perks, William J</author><author>Kataoka, Mark T</author><author>Errett, Lee</author><author>Pace, Kenneth</author><author>Honey, R John</author></authors></contributors><titles><title>A comparison of patient-controlled sedation using either remifentanil or remifentanil-propofol for shock wave lithotripsy</title><secondary-title>Anesthesia & Analgesia</secondary-title></titles><periodical><full-title>Anesthesia & Analgesia</full-title><abbr-1>Anesth Analg</abbr-1></periodical><pages>1227-1232</pages><volume>93</volume><number>5</number><dates><year>2001</year></dates><isbn>0003-2999</isbn><urls></urls><custom2>11682403</custom2><electronic-resource-num>10.1097/00000539-200111000-00037</electronic-resource-num></record></Cite></EndNote>[6]. 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ADDIN EN.CITE.DATA [19,27,28]. In our study, the consumption of propofol decreased as expected by the addition of ketamine, which provides analgesia and dissociative anaesthesia, and midazolam, which has amnesic and sedative properties, to the sedation protocol. The total amount of propofol used in both groups was significantly lower than the previous studies in which the SSEN method was applied. (The consumption of propofol in the SSEN group and SSA group was 83.0 ± 57.1, 59.7 ± 17.5 respectively). In our study, propofol consumption was significantly higher in the SSEN group. The reason for this significant difference in propofol consumption was thought to be the longer duration of the operations in the SSEN group. The duration of the procedure is significantly higher in the SSEN group than in the SSA group. When interviewed with the endoscopist, it was stated that two sedation methods did not affect the difficulty of operation. Therefore, this difference may be due to the small number of patients or the fact that the procedure was performed by two different endoscopists.Cardiovascular and respiratory depression can be observed during sedation. Our most important goal in colonoscopy sedation is to ensure the safety of patients as well as comfort. For this reason, we aimed to have less cardiovascular and respiratory side effects by using lower doses of propofol with a combined sedation protocol. There is no analgesic activity of propofol. However, it has a synergistic effect when used with analgesic agents ADDIN EN.CITE <EndNote><Cite><Author>Horn</Author><Year>2004</Year><RecNum>13</RecNum><DisplayText><style face="superscript">[29]</style></DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068322">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Horn, Ed</style></author><author>Nesbit, Suzanne Amato</author></authors></contributors><titles><title>Pharmacology and pharmacokinetics of sedatives and analgesics</title><secondary-title>Gastrointestinal endoscopy clinics of North America</secondary-title></titles><periodical><full-title>Gastrointestinal endoscopy clinics of North America</full-title><abbr-1>Gastrointest Endosc Clin N Am</abbr-1></periodical><pages>247-268</pages><volume>14</volume><number>2</number><dates><year>2004</year></dates><isbn>1052-5157</isbn><urls></urls><custom2>15121142</custom2><electronic-resource-num>10.1016/j.giec.2004.01.001</electronic-resource-num></record></Cite></EndNote>[29]. In a study by Hsu et al ADDIN EN.CITE <EndNote><Cite><Author>Hsu</Author><Year>2015</Year><RecNum>14</RecNum><DisplayText><style face="superscript">[30]</style></DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068330">14</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Hsu, Chiung-Dan</style></author><author>Huang, Jui-Mei</author><author>Chuang, Ya-Ping</author><author>Wei, Hua-Yi</author><author>Su, Yu-Chung</author><author>Wu, Jeng-Yih</author><author>Wang, Wen-Ming</author><author>Hsu, Hung-Te</author><author>Huang, Hui-Fang</author><author>Lu, I-Cheng</author></authors></contributors><titles><title>Propofol target-controlled infusion for sedated gastrointestinal endoscopy: A comparison of propofol alone versus propofol–fentanyl–midazolam</title><secondary-title>The Kaohsiung journal of medical sciences</secondary-title></titles><periodical><full-title>The Kaohsiung journal of medical sciences</full-title><abbr-1>Kaohsiung J Med Sci</abbr-1></periodical><pages>580-584</pages><volume>31</volume><number>11</number><dates><year>2015</year></dates><isbn>1607-551X</isbn><urls></urls><custom2>26678938</custom2><electronic-resource-num>10.1016/j.kjms.2015.09.004</electronic-resource-num></record></Cite></EndNote>[30], one group of patients who underwent gastrointestinal endoscopy were performed sedation with propofol alone and the other group with propofol-midazolam-fentanyl combination. As a result, it was stated that propofol alone group had higher total propofol consumption and incidence of hypotension; the recovery time of this group was also longer. Some clinicians avoid propofol administration without anaesthetist because of the absence of propofol antidote in a possible cardiopulmonary complication. However, the short duration of the propofol balances this negative feature. In our study, no serious long-term side effects were observed in any of the patients. All of the cardiopulmonary side effects that occurred were ended shortly (less than 30 s) without the need for intervention. Of course, a much safer SSEN application can be achieved by the fact that the patient is closely followed up with monitored and sedation practitioners is trained in cardiopulmonary resuscitation. Only low-risk patients with ASA I-II were included in our study, but Heuss et al ADDIN EN.CITE <EndNote><Cite><Author>Heuss</Author><Year>2003</Year><RecNum>30</RecNum><DisplayText><style face="superscript">[31]</style></DisplayText><record><rec-number>30</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534272041">30</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Heuss, Ludwig T</style></author><author>Schnieper, Patrizia</author><author>Drewe, Juergen</author><author>Pflimlin, Eric</author><author>Beglinger, Christoph</author></authors></contributors><titles><title>Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients–a prospective, controlled study</title><secondary-title>The American journal of gastroenterology</secondary-title></titles><periodical><full-title>The American journal of gastroenterology</full-title><abbr-1>Am J Gastroenterol</abbr-1></periodical><pages>1751-1757</pages><volume>98</volume><number>8</number><dates><year>2003</year></dates><isbn>0002-9270</isbn><urls></urls><custom2>12907329</custom2><electronic-resource-num>10.1111/j.1572-0241.2003.07596.x</electronic-resource-num></record></Cite></EndNote>[31] showed that propofol can be safely applied in gastrointestinal endoscopy even in high-risk patients. They stated that these patients should be more closely monitored in terms of desaturation and propofol use in these patients would be appropriate at doses of 10%-20% lower than in ASA I-II plications such as emergence reactions, hypertension, tachycardia, visual hallucinations, vivid dreams, tonic-clonic movements, diplopia, nystagmus, increased intracranial pressure, and increased intraocular pressure are among the complications associated with ketamine ADDIN EN.CITE <EndNote><Cite><RecNum>41</RecNum><DisplayText><style face="superscript">[32]</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1541699103">41</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors></contributors><titles><title>ketamine (Rx)</title></titles><number><style face="normal" font="default" charset="162" size="100%">8 Nov 2018</style></number><dates></dates><urls><related-urls><url>;[32]. Even 24 h after application, side effects such as severe confusion, hallucinations, unusual thoughts, or extreme fear can be seen ADDIN EN.CITE <EndNote><Cite><RecNum>42</RecNum><DisplayText><style face="superscript">[33]</style></DisplayText><record><rec-number>42</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1541699524">42</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><secondary-authors><author>Medical Editor: John P. Cunha, DO, FACOEP</author></secondary-authors></contributors><titles><title>Ketamine Hydrochloride(Ketamine HCl) side effects drug center</title></titles><number><style face="normal" font="default" charset="162" size="100%">8 Nov 2018</style></number><dates></dates><urls><related-urls><url>;[33]. In our study, nausea, vomiting, and agitation that were the possible side effects due to ketamine added to the sedation protocol were not observed in any of the patients in both groups ADDIN EN.CITE <EndNote><Cite><Author>Shah</Author><Year>2011</Year><RecNum>32</RecNum><DisplayText><style face="superscript">[34]</style></DisplayText><record><rec-number>32</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534361308">32</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Shah, Amit</style></author><author>Mosdossy, Gregory</author><author>McLeod, Shelley</author><author>Lehnhardt, Kris</author><author>Peddle, Michael</author><author>Rieder, Michael</author></authors></contributors><titles><title>A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children</title><secondary-title>Annals of emergency medicine</secondary-title></titles><periodical><full-title>Annals of emergency medicine</full-title><abbr-1>Ann Emerg Med</abbr-1></periodical><pages>425-433. e2</pages><volume>57</volume><number>5</number><dates><year>2011</year></dates><isbn>0196-0644</isbn><urls></urls><custom2>20947210</custom2><electronic-resource-num>10.1016/j.annemergmed.2010.08.032</electronic-resource-num></record></Cite></EndNote>[34]. The use of ketamine in combination with low doses of propofol and midazolam may have reduced the incidence of side effects. Guit et al ADDIN EN.CITE <EndNote><Cite><Author>Guit</Author><Year>1991</Year><RecNum>31</RecNum><DisplayText><style face="superscript">[35]</style></DisplayText><record><rec-number>31</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534352243">31</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Guit, JBM</style></author><author>Koning, HM</author><author>Coster, ML</author><author>Niemeijer, RPE</author><author>Mackie, DP</author></authors></contributors><titles><title>Ketamine as analgesic for total intravenous anaesthesia with propofol</title><secondary-title>Anaesthesia</secondary-title></titles><periodical><full-title>Anaesthesia</full-title><abbr-1>Anaesthesia</abbr-1></periodical><pages>24-27</pages><volume>46</volume><number>1</number><dates><year>1991</year></dates><isbn>0003-2409</isbn><urls></urls><custom2>1996747</custom2><electronic-resource-num>10.1111/j.1365-2044.1991.tb09308.x </electronic-resource-num></record></Cite></EndNote>[35] showed that ketamine-related side effects are reduced, when ketamine is combined with propofol.In our study, several questions were asked to patients in order to determine patient satisfaction, which is one of our primary goals. There was no significant difference between the groups in terms of patient satisfaction score and re-preference for the same sedation method in case of re-endoscopy. All of the patients in the SSEN group and 93.3% of the patients in the SSA group stated that they would re-prefer the same sedation method in case of re-endoscopy. Poon et al. reported that 92% of patients would re-prefer the same sedation method in a new endoscopy procedure ADDIN EN.CITE <EndNote><Cite><Author>Poon</Author><Year>2007</Year><RecNum>29</RecNum><DisplayText><style face="superscript">[25]</style></DisplayText><record><rec-number>29</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534271766">29</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Poon, Chi-Ming</style></author><author>Leung, Tak-Lun</author><author>Wong, Chui-Wah</author><author>Chan, Yuk-Ling</author><author>Leung, Tin-Chun</author><author>Leong, Heng-Tat</author></authors></contributors><titles><title>Safety of nurse-administered propofol sedation using PCA pump for outpatient colonoscopy in Chinese patients: a pilot study</title><secondary-title><style face="normal" font="default" size="100%">Asian Journal of </style><style face="normal" font="default" charset="162" size="100%">S</style><style face="normal" font="default" size="100%">urgery</style></secondary-title></titles><periodical><full-title>Asian Journal of surgery</full-title><abbr-1>Asian J Surg</abbr-1></periodical><pages>239-243</pages><volume>30</volume><number>4</number><dates><year>2007</year></dates><isbn>1015-9584</isbn><urls></urls><custom2>17962125 </custom2><electronic-resource-num>10.1016/S1015-9584(08)60032-9</electronic-resource-num></record></Cite></EndNote>[25]. The result of our study is similar to the results of this study. One of the questions asked to evaluate patient satisfaction is whether the patient remembered the operation. There was no significant difference between the groups in terms of recall of the procedure. Adequate sedation and pain control provides a comfortable and successful colonoscopy. When the pain status of the patients was questioned in our study, 96.6% of the patients in the SSEN group and 86.6% of the patients in the SSA group were found to have a VAS below 1. Liu et al ADDIN EN.CITE <EndNote><Cite><Author>Liu</Author><Year>2009</Year><RecNum>15</RecNum><DisplayText><style face="superscript">[26]</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="90rw0wsvpe5dxaeavr6vsx92et255x52p59v" timestamp="1534068334">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="bold" font="default" size="100%">Liu, SYW</style></author><author>Poon, CM</author><author>Leung, TL</author><author>Wong, CW</author><author>Chan, YL</author><author>Leong, HT</author></authors></contributors><titles><title>Nurse-administered propofol–alfentanil sedation using a patient-controlled analgesia pump compared with opioid–benzodiazepine sedation for outpatient colonoscopy</title><secondary-title>Endoscopy</secondary-title></titles><periodical><full-title>Endoscopy</full-title><abbr-1>Endoscopy</abbr-1></periodical><pages>522-528</pages><volume>41</volume><number>6</number><dates><year>2009</year></dates><isbn>0013-726X</isbn><urls></urls><custom2>19440955</custom2><electronic-resource-num>10.1055/s-0029-1214711</electronic-resource-num></record></Cite></EndNote>[26] also compared the two sedation methods under the supervision of an anaesthetist/nurse using PCA pump. In their study, there was no significant difference between the groups in terms of patient satisfaction and VAS values.In conclusion, this study demonstrated that the combination of midazolam-ketamine-propofol could be performed under the supervision of both anaesthetist and endoscopy nurse with a PCA device in colonoscopy sedation of low-risk (ASA I-II) patients with similar side effects. There is a need for further studies with ASA III-IV patients and also with more patients.A small sample size ASA I-II patients with low cardiovascular risk were included in the study. The expected incidence of adverse events is less than 0.01%, and studies with a small sample size may reduce this rate.Article HighlightsResearch backgroundSedation is performed in many centers during the colonoscopy procedure. However, since there are a limited number of anesthesiologists, there are centers where colonoscopy is performed without sedation. In the literature, there are several studies in which colonoscopy sedation is performed without anesthesia personnel. In this study, we aim to evaluate the patient satisfaction and the side effects of colonoscopy sedation performed by endoscopy nurse with patient-controlled analgesia (PCA) pump.Research motivationIn studies where colonoscopy sedation was performed under the supervision of a nurse, propofol is often used alone or in combination with agents such as fentanyl, meperidine or midazolam. Ketamine, which protects spontaneous breathing and protective airway reflexes by providing dissociative anesthesia, was not used in colonoscopy in adult patients. In our study, we wanted to determine the advantages and disadvantages of ketamine in combination with propofol and midazolam without anesthesia personnel in colonoscopy.Research objectivesIt is aimed to perform ketamine-midazolam-propofol sedation with minimum side effects and to obtain the best patient satisfaction under the supervision of a nurse in low risk patients in colonoscopy. Individual dose errors were tried to be minimized by using PCA pump.Research methods60 American Statistical Association (ASA) I-II patients who underwent colonoscopy were included in the study. Patients were randomly divided into two groups [sedation under the supervision of anaesthetist (SSA) and sedation under the supervision of endoscopy nurse (SSEN)]. Both groups were initially administered 1 mg of midazolam, 50 mg of ketamine, and 30-50 mg of propofol. Then the required dose of propofol in SSA group was determined and administered by anesthesiologist. In SSEN group, the continuation of sedation was carried out by the nurse with PCA pump. Data such as patient satisfaction, incidence of side effects, total drug consumption, and duration of procedure were recorded and differences among the groups were evaluated.Research resultsThere were no statistically significant differences (P ? 0.05) between the two groups in terms of patient satisfaction, the rate of re-preference for the same method in case of re-endoscopy, and the side effects. The total propofol consumption in the SSEN group was significantly higher (P < 0.05), whereas the systolic and diastolic pressure values were found to be significantly lower (P < 0.05) at 5 min, and after 8 min. Reaching the cecum and total procedure time were significantly longer (P < 0.05) in the SSEN group. No significant prolonged side effects were observed in both groups.Research conclusionsIn ASA I-II patients, sedation under the supervision of nurses with PCA pump in colonoscopy has similar side effects and patient satisfaction levels as sedation under SSA.Research perspectivesThere is a need for further studies with ASA III-IV patients and also with more patients.ACKNOWLEDGEMENTWe would like to sincerely thank general surgery specialists, Dr. Abdullah Haluk ?irin and Dr. Muhammed Emin Yenen, for their cooperation.REFERENCES1 Ghanouni A, Plumb A, Hewitson P, Nickerson C, Rees CJ, von Wagner C. Patients' experience of colonoscopy in the English Bowel Cancer Screening Programme. Endoscopy 2016; 48: 232-240 [PMID: 26841268 DOI: 10.1055/s-0042-100613]2 Ferreira AO, Cravo M. Sedation in gastrointestinal endoscopy: Where are we at in 2014? World J Gastrointest Endosc 2015; 7: 102-109 [PMID: 25685266 DOI: 10.4253/wjge.v7.i2.102]3 Lin OS. Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction. Intest Res 2017; 15: 456-466 [PMID: 29142513 DOI: 10.5217/ir.2017.15.4.456]4 Faulx AL, Vela S, Das A, Cooper G, Sivak MV, Isenberg G, Chak A. The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national Web survey. Gastrointest Endosc 2005; 62: 9-15 [PMID: 15990813 DOI: 10.1016/S0016-5107(05)00518-3]5 Türk H?, Aydo?mu? M, ?nsal O, K?ksal HM, A?ik ME, Oba S. Sedation-analgesia in elective colonoscopy: propofol-fentanyl versus propofol-alfentanil. Braz J Anesthesiol 2013; 63: 352-357 [PMID: 23931250 DOI: 10.1016/j.bjan.2012.07.006]6 Joo HS, Perks WJ, Kataoka MT, Errett L, Pace K, Honey RJ. A comparison of patient-controlled sedation using either remifentanil or remifentanil-propofol for shock wave lithotripsy. Anesth Analg 2001; 93: 1227-1232 [PMID: 11682403 DOI: 10.1097/00000539-200111000-00037]7 Alletag MJ, Auerbach MA, Baum CR. Ketamine, propofol, and ketofol use for pediatric sedation. Pediatr Emerg Care 2012; 28: 1391-5; quiz 1396-8 [PMID: 23222112 DOI: 10.1097/PEC.0b013e318276fde2]8 Green SM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation in children. Ann Emerg Med 2004; 44: 460-471 [PMID: 15520705 DOI: 10.1016/S0196064404006365]9 Strayer RJ, Nelson LS. Adverse events associated with ketamine for procedural sedation in adults. Am J Emerg Med 2008; 26: 985-1028 [PMID: 19091264 DOI: 10.1016/j.ajem.2007.12.005]10 Rex DK. Effect of the Centers for Medicare & Medicaid Services policy about deep sedation on use of propofol. Ann Intern Med 2011; 154: 622-626 [PMID: 21536938 DOI: 10.7326/0003-4819-154-9-201105030-00007]11 Aisenberg J, Cohen LB, Piorkowski JD Jr. Propofol use under the direction of trained gastroenterologists: an analysis of the medicolegal implications. Am J Gastroenterol 2007; 102: 707-713 [PMID: 17397402 DOI: 10.1111/j.1572-0241.2006.00955.x]12 Lienhart A, Carli P, Marty J, Pourriat J. Digestive endoscopies: who does what? Proceedings of the Annales francaises d'anesthesie et de reanimation 2002: 343-34613 Crepeau T, Poincloux L, Bonny C, Lighetto S, Jaffeux P, Artigue F, Walleckx P, Bazin JE, Dapoigny M, Bommelaer G. Significance of patient-controlled sedation during colonoscopy. Results from a prospective randomized controlled study. Gastroenterol Clin Biol 2005; 29: 1090-1096 [PMID: 16505753 DOI: 10.1016/S0399-8320(05)82172-4]14 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists.. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96: 1004-1017 [PMID: 11964611 DOI: 10.1097/00000542-200204000-00031]15 Sieg A; bng-Study-Group, Beck S, Scholl SG, Heil FJ, Gotthardt DN, Stremmel W, Rex DK, Friedrich K. Safety analysis of endoscopist-directed propofol sedation: a prospective, national multicenter study of 24?441 patients in German outpatient practices. J Gastroenterol Hepatol 2014; 29: 517-523 [PMID: 24716213 DOI: 10.1111/jgh.12458]16 Rex DK, Deenadayalu VP, Eid E, Imperiale TF, Walker JA, Sandhu K, Clarke AC, Hillman LC, Horiuchi A, Cohen LB, Heuss LT, Peter S, Beglinger C, Sinnott JA, Welton T, Rofail M, Subei I, Sleven R, Jordan P, Goff J, Gerstenberger PD, Munnings H, Tagle M, Sipe BW, Wehrmann T, Di Palma JA, Occhipinti KE, Barbi E, Riphaus A, Amann ST, Tohda G, McClellan T, Thueson C, Morse J, Meah N. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology 2009; 137: 1229-37; quiz 1518-9 [PMID: 19549528 DOI: 10.1053/j.gastro.2009.06.042]17 Rex DK, Heuss LT, Walker JA, Qi R. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy. Gastroenterology 2005; 129: 1384-1391 [PMID: 16285939 DOI: 10.1053/j.gastro.2005.08.014]18 Sathananthan D, Young E, Nind G, George B, Ashby A, Drummond S, Redel K, Green N, Singh R. Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy. Endosc Int Open 2017; 5: E110-E115 [PMID: 28210707 DOI: 10.1055/s-0042-121667]19 Walker JA, McIntyre RD, Schleinitz PF, Jacobson KN, Haulk AA, Adesman P, Tolleson S, Parent R, Donnelly R, Rex DK. Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center. Am J Gastroenterol 2003; 98: 1744-1750 [PMID: 12907328 DOI: 10.1111/j.1572-0241.2003.07605.x]20 Dumonceau JM, Riphaus A, Beilenhoff U, Vilmann P, Hornslet P, Aparicio JR, Dinis-Ribeiro M, Giostra E, Ortmann M, Knape JT, Ladas S, Paspatis G, Ponsioen CY, Racz I, Wehrmann T, Walder B. European curriculum for sedation training in gastrointestinal endoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA). Endoscopy 2013; 45: 496-504 [PMID: 23702777 DOI: 10.1055/s-0033-1344142]21 Sultan SS. Patient-controlled sedation with propofol/remifentanil versus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study. Saudi J Anaesth 2014; 8: S36-S40 [PMID: 25538518 DOI: 10.4103/1658-354X.144068]22 Sieg A. Propofol sedation in outpatient colonoscopy by trained practice nurses supervised by the gastroenterologist: a prospective evaluation of over 3000 cases. Z Gastroenterol 2007; 45: 697-701 [PMID: 17701858 DOI: 10.1055/s-2007-963349]23 Tohda G, Higashi S, Wakahara S, Morikawa M, Sakumoto H, Kane T. Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists. Endoscopy 2006; 38: 360-367 [PMID: 16680635 DOI: 10.1055/s-2005-921192]24 Heuss LT, Drewe J, Schnieper P, Tapparelli CB, Pflimlin E, Beglinger C. Patient-controlled versus nurse-administered sedation with propofol during colonoscopy. A prospective randomized trial. Am J Gastroenterol 2004; 99: 511-518 [PMID: 15056094 DOI: 10.1111/j.1572-0241.2004.04088.x]25 Poon CM, Leung TL, Wong CW, Chan YL, Leung TC, Leong HT. Safety of nurse-administered propofol sedation using PCA pump for outpatient colonoscopy in Chinese patients: a pilot study. Asian J Surg 2007; 30: 239-243 [PMID: 17962125 DOI: 10.1016/S1015-9584(08)60032-9]26 Liu SY, Poon CM, Leung TL, Wong CW, Chan YL, Leung TC, Leong HT. Nurse-administered propofol-alfentanil sedation using a patient-controlled analgesia pump compared with opioid-benzodiazepine sedation for outpatient colonoscopy. Endoscopy 2009; 41: 522-528 [PMID: 19440955 DOI: 10.1055/s-0029-1214711]27 Sipe BW, Rex DK, Latinovich D, Overley C, Kinser K, Bratcher L, Kareken D. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc 2002; 55: 815-825 [PMID: 12024134 DOI: 10.1067/mge.2002.124636]28 Külling D, Rothenbühler R, Inauen W. Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy. Endoscopy 2003; 35: 679-682 [PMID: 12929064 DOI: 10.1055/s-2003-41518]29 Horn E, Nesbit SA. Pharmacology and pharmacokinetics of sedatives and analgesics. Gastrointest Endosc Clin N Am 2004; 14: 247-268 [PMID: 15121142 DOI: 10.1016/j.giec.2004.01.001]30 Hsu CD, Huang JM, Chuang YP, Wei HY, Su YC, Wu JY, Wang WM, Hsu HT, Huang HF, Lu IC, Lu DV. Propofol target-controlled infusion for sedated gastrointestinal endoscopy: A comparison of propofol alone versus propofol-fentanyl-midazolam. Kaohsiung J Med Sci 2015; 31: 580-584 [PMID: 26678938 DOI: 10.1016/j.kjms.2015.09.004]31 Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients-a prospective, controlled study. Am J Gastroenterol 2003; 98: 1751-1757 [PMID: 12907329 DOI: 10.1111/j.1572-0241.2003.07596.x]32 ketamine (Rx) [cited 8 Nov 2018]. Available from: Ketamine Hydrochloride (Ketamine HCl) side effects drug center [cited 8 Nov 2018]. Available from: Shah A, Mosdossy G, McLeod S, Lehnhardt K, Peddle M, Rieder M. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med 2011; 57: 425-33.e2 [PMID: 20947210 DOI: 10.1016/j.annemergmed.2010.08.032]35 Guit JB, Koning HM, Coster ML, Niemeijer RP, Mackie DP. Ketamine as analgesic for total intravenous anaesthesia with propofol. Anaesthesia 1991; 46: 24-27 [PMID: 1996747 DOI: 10.1111/j.1365-2044.1991.tb09308.x]P-Reviewer: de Quadros LG, Teramoto-Matsubara OTS-Editor: Dou Y L-Editor: E-Editor:Specialty type: Medicine, research and experimentalCountry of origin: TurkeyPeer-review report classificationGrade A (Excellent): 0Grade B (Very good): 0Grade C (Good): C, CGrade D (Fair): 0Grade E (Poor): 0Table 1 Patients’ demographic data n (%)EndoscopistAnaesthetistPmean ± SDMedianmean ± SDMedianAge53.6 ± 15.557.559.9 ± 11.862.00.1131SexFemale18 (60.0)17 (56.7)0.7932Male12 (40.0)13 (43.3)ASAI18 (60.0)11 (36.7)0.0712II12 (40.0)19 (63.3)1Mann-Whitney U test; 2Chi-square test. ASA: American Statistical Association.Table 2 Information of propofol consumption, durations (reaching the cecum, operation, and recovery), patient satisfaction, operation re-preference, and recall of the procedure n (%)EndoscopistAnaesthetistPmean ± SDMedianmean ± SDMedianPropofol consumption dose83.0 ± 57.170.059.7 ± 17.550.00.0141Reaching the cecum (min) 5.8 ± 4.95.54.9 ± 2.24.00.0041Total operation (min) 13.7 ± 7.213.09.5 ± 3.68.50.0221Eye opening/Recovery (min) 1.6 ± 1.21.02.0 ± 0.82.01.0001VAS0.5 ± 0.80.00.5 ± 0.90.00.8031Patient SatisfactionI19 (63.3) 12 (40.0) 0.0982II10 (33.3) 13 (43.3) III1 (3.3) 5 (16.7) Operation re-preference?30 (100.0) 28 (93.3) 0.4922Recall of the procedure(-) 27 (90.0) 27 (90.0) 1.0002(+) 3 (10.0) 3 (10.0) 1Mann-Whitney U test; 2Chi-square test. VAS: Visual analogue scale.Table 3 Hemodynamic changes during the procedureEndoscopistAnaesthetistP1mean ± SDMedianmean ± SDMedianPulse (beats per minute)Baseline82.8 ± 13.382.584.2 ± 11.785.50.6731st min81.4 ± 13.379.085.7 ± 14.684.00.2512nd min80.9 ± 13.879.083.5 ± 17.981.00.7163rd min80.8 ± 13.579.080.7 ± 19.279.50.7044th min81.0 ± 15.380.080.1 ± 18.577.50.6655th min81.9 ± 14.681.080.5 ± 18.878.00.414≥ 8th min81.1 ± 14.778.577.5 ± 14.475.00.336Systolic blood pressure (mm Hg)Baseline131.0 ± 20.5131.5136.1 ± 22.3135.00.4121st min126.2 ± 17.6121.0129.9 ± 19.4132.50.5792nd min124.2 ± 13.6125.0125.7 ± 29.5121.50.5193rd min123.4 ± 13.9122.0126.5 ± 27.9123.00.9524th min126.5 ± 15.9125.0131.8 ± 30.3129.50.4485th min123.8 ± 13.4122.0139.3 ± 28.7141.00.014≥8th min124.1 ± 17.2120.5142.3 ± 26.7141.00.003Diastolic blood pressure (mm Hg)Baseline73.2 ± 12.370.573.4 ± 13.474.00.8711st min70.6 ± 10.269.574.7 ± 14.074.00.1832nd min71.1 ± 11.171.072.9 ± 18.369.00.9883rd min71.2 ± 11.170.076.3 ± 18.275.50.3594th min72.8 ± 11.172.078.7 ± 17.980.50.1755th min69.2 ± 11.569.581.9 ± 17.282.00.002≥8th min73.2 ± 11.870.583.4 ± 16.882.00.005SPO?Baseline96.7 ± 1.997.094.4 ± 2.794.00.0001st min96.0 ± 2.897.094.7 ± 2.495.00.0142nd min96.5 ± 3.597.095.3 ± 2.295.50.0713rd min96.2 ± 2.897.095.9 ± 2.095.50.3074th min96.4 ± 2.397.096.3 ± 1.996.00.5025th min95.1 ± 5.397.096.1 ± 1.796.00.685≥8th min96.1 ± 2.397.096.0 ± 1.496.00.4221Mann-Whitney U test.Table 4 Side effects experienced by patients during the procedure n (%)EndoscopistAnaesthetistP1Cardio pulmonaryHypotension2 (6.7)2 (6.7)1.000Bradycardia1 (3.3)0 (0.0)1.000Desaturation4 (13.3)1 (3.3)0.161Other side effectsNausea and Vomiting0 (0.0)0 (0.0)1.000Headache2 (6.7)2 (6.7)1.0001Chi-square test. ................
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