In the United States and many parts of Europe, gastrointestinal (GI) endoscopy under awake sedation is standard practice. This is usually achieved by intravenous administration of benzodiazepines, initially diazepam and now more commonly midazolam, as well as opioids such as pethidine (delorol) or fentanyl. However, morbidity (1:200 to 1:2000) and occasional mortality with the use of these drugs are not reported to be significant, usually due to cardiopulmonary complications.

As a result, stricter awake sedation guidelines have been implemented, including the use of supplemental oxygen and revised administration guidelines. A task force of the American Society of Anesthesiologists (ASA) decreed that titration of sedatives was preferable to the use of push doses, and these recommendations were supported by the American Society for Gastrointestinal Endoscopy (ASGE).

Midazolam has anti-anxiety and anti-amnesia effects, both of which are required for standard endoscopy. There is no doubt that patients are more tolerant to endoscopy when sedation is combined with analgesia.

However, residual sedation and anterograde amnesia are issues with midazolam use.

Several studies have shown that propofol has significant advantages over benzodiazepines and opioids when it comes to lucid sedation.

Propofol (2, 6-diisopropyl phenol) is an intravenous anesthetic commonly used in conjunction with other drugs, such as nitrous oxide and muscle relaxants, for general anesthesia. However, when used in lower doses, it induces lucid sedation. Propofol has several advantages. It has a short half-life (t½ is distributed for 2-4 minutes, compared to 30 minutes for midazolam) and therefore recovers from sedation much faster than midazolam.

In addition, propofol has no active metabolites and will quickly clear the liver after intravenous administration.

Despite these advantages, there are still questions about the safety of propofol used by non-anesthesiologists.