Psychological effects of propofol sedation during gastrointestinal endoscopy.

What is it about?

Propofol is widely used for sedation during gastrointestinal endoscopy, but evidence for addictive potentials is rising. In a prospective multi-centre study we have shown that nearly of the patients who have undergone gastrointestinal endoscopy under propofol sedation develop a euphoric reaction pattern that is well - and even enhanced - remembered a week later. Though similar in both groups the endoscopy's results were rated more positively.

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Why is it important?

According to present theories, drug addiction develops in several steps: at first there is the experience of a reinforcing effect of a drug, e.g. a positive hedonic effect like euphoria or the reduction of an aversive affective state, such as anxiety. Both effects were documented in our study. In the next step a regular use is established which in turn induces via biological changes, e.g., in the reward system, changes in mental functioning, e.g., attention bias to drug-related stimuli, decreased ability to inhibit drug use behaviour. Eventually, addictive use of a drug is established which is characterized by a strong urge to use a drug even it is damaging the social and health situation (´wanting´) instead of the initial experience of a positive drug effect (´liking´). For certain, the reminiscence of a positive effect of propofol as found in the present cohort is a basic risk factor in the development of drug addiction. In addition, it is known that propofol manipulates the dopaminergic reward system which is a basic common property of drugs able to induce the development of an addiction.

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