Factors associated with euphoria in a large subset of cases using propofol sedation during gastrointestinal endoscopy

Kaixuan Zhao; Ning Yang; Jingli Yue; Ying Han; Xiaoxiao Wang; Ning Kang; Tianhao Zhang; Xiangyang Guo; Mao Xu

doi:10.3389/fpsyt.2023.1001626

Factors associated with euphoria in a large subset of cases using propofol sedation during gastrointestinal endoscopy

Front Psychiatry. 2023 Apr 27:14:1001626. doi: 10.3389/fpsyt.2023.1001626. eCollection 2023.

Authors

Kaixuan Zhao¹, Ning Yang¹, Jingli Yue², Ying Han³, Xiaoxiao Wang⁴, Ning Kang¹, Tianhao Zhang¹, Xiangyang Guo¹, Mao Xu¹

Affiliations

¹ Department of Anesthesiology, Peking University Third Hospital, Beijing, China.
² Department of Psychiatry and Clinical Psychology, Peking University Sixth Hospital, Beijing, China.
³ National Institute of Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.
⁴ Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.

Abstract

Background: The utilization of Propofol, a widely used intravenous sedative or anesthetic, is characterized by its quick onset, predictable control, and fleeting half-life during both general anesthesia and intensive care unit sedation. Recent evidence, however, has highlighted propofol's propensity to induce euphoria, particularly in patients undergoing painless procedures such as gastrointestinal or gastric endoscopy. Given its widespread use in patients undergoing such procedures, this study aims to investigate the clinical evidence and factors that may influence propofol-induced euphoria in these settings.

Methods: The Addiction Research Center Inventory-Chinese Version (ARCI-CV) scale was administered to 360 patients undergoing gastric or gastrointestinal endoscopy using propofol as a sedative. Patient characteristics including past medical history, depression, anxiety, alcohol abuse, and sleep disturbance were recorded through history taking and assessment using various questionnaires prior to the examination. The euphoric and sedative statuses were assessed at 30 min and 1 week post-examination.

Results: The experimental results of a survey of 360 patients who underwent gastric or gastrointestinal endoscopy using propofol showed that the mean Morphine-Benzedrine Group (MBG) score before the procedure and after 30 min of the procedure was 4.23 and 8.67, respectively. The mean Pentobarbital-Chlorpromazine-Alcohol Group (PCAG) score before the procedure and after 30 min of the procedure was 3.24 and 6.22, respectively. These results showed that both MBG and PCAG scores increased significantly after the procedure. Certain factors, such as dreaming, propofol dose, duration of anesthesia, and etomidate dose, were all correlated with MBG both at 30 min and 1 week after the examination. In addition, etomidate had an effect of decreasing MBG scores and increasing PCAG scores both at 30 min and 1 week after the examination.

Conclusion: Taken together, propofol may elicit euphoria and potentially contribute to propofol addiction. There are several risk factors for the development of propofol addiction, including dreaming, propofol dose, duration of anesthesia, and etomidate dose. These findings suggest that propofol may have a euphoric effect and may have the potential for drug addiction and abuse.

Keywords: drug abuse and addictive potential; euphoria; gastrointestinal endoscopy; propofol; sedative.