Background: ESWL is a standard treatment for kidney and ureteric calculi. At Rajavithi Hospital, monitored anesthetic care (MAC) is utilized for this procedure, but patient movement occasionally occurs. Propofol TCI is an alternative technique that helps to maintain patient position and also decrease the total dose of fentanyl used.

Objective: To study the efficacy of propofol TCI compared with midazolam in patients undergoing ESWL for kidney or proximal ureteric calculi.

Materials and Methods: A total of 140 patients who underwent ESWL were randomized into 2 groups. Patients in group 1 received midazolam 0.05 mg/kg intravenously while those in group 2 were given propofol TCI at plasma concentration 1.2 mcg/ml, and doses were adjusted to maintain a sedation score of 4. Both groups received intravenous fentanyl 1 mcg/kg to relief pain, and fentanyl 25
mcg intravenously was added if pain score was greater than 4 or if the patients could not tolerate the pain. The primary outcome was a stone-free rate at 1 month after procedure and secondary endpoints were to compare patient movement, total dose of fentanyl used, time to discharge, and patient and technician satisfaction in the two groups.

Results: The stone-free rate was 56.9% in group 2 (Propofol TCI) and 50.7% in group 1 (Midazolam) (p = 0.477). Patient and technician levels of satisfaction in group 2 were higher than in group 1 (p<0.001 and p<0.001, respectively). In group 1, the total dose of fentanyl used was higher than in group 2 (p<0.001).

Conclusion: The stone-free rate was higher in patients who received propofol TCI than in those who were given midazolam, but the differences were not statistically significant. Patient and technician satisfaction in the propofol TCI group were greater than in the midazolam group, and this difference was statistically significant.

Keywords: Propofol TCI, Midazolam, ESWL