الفهرس 
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Abstract
This prospective, randomized, double blinded, and placebo controlled study was conducted in Minia University Hospital during the period from August 2019 to march 2020. A total of 90 patients of both gender aged between 18 and 70 years with American Society of Anesthesiologists grade I and II patients scheduled to undergo colonoscopy with PSA were included in the study, after approval of the University ethical committee and obtaining informed consent from all patients.
This study aimed to To evaluate and compare the efficacy and safety of IV infusion of lidocaine versus magnesium sulfate as procedural sedation and analgesia (PSA) in combination with propofol in colonoscopy.
Ninty (90) patients of both sexes were randomly allocated into three study groups each contains (30) patients. • group L received 1.5 mg/ kg of lidocaine IV, ( lidocaine 2%( completed to 50 ml volume by normal saline 0.9% Sodium Chloride over 15 minutes as a loading dose 15 minutes before induction by propofol, and continuous infusion of lidocaine 4 mg kg/ h after induction using syringe pump in combination with propofol shots 20-30 mg.
• group M received 50 mg/ kg of magnesium sulphate (1gm/10ml ampoule )completed to 50 ml volume by normal saline 0.9% Sodium chloride as a loading dose 15 minutes before induction
by propofol, and continuous infusion of magnesium 8 mg/ kg/h after induction using syringe pump in combination with propofol shots 20-30 mg.
• group O (placebo) as control group received 50 ml of normal saline 0.9% Sodium Chloride over 15 minutes before induction by propofol, and continuous infusion of free normal saline 0.9% Sodium Chloride using syringe pump in combination with propofol shots 20-30 mg.
All patients were divided in terms of:
• Hemodynamics: MAP, HR, RR and SPO2 before sedation as a base line, immediately after induction, every minute of the first 5 minutes then every 5 minute intra operatively till the end of the procedure and 15, 30, 45, 60 minutes after procedure.
• Episodes of desaturation: number of decrease SPO2 below 90%.
• Depth of consciousness: using Bispectral index (BIS) monitor.
• Propofol requirements: Total amount of propofol used during procedure; induction and maintenance.
• Visual analoge scale (VAS): Patients were asked to make a horizontal mark across the line at the place that indicated the amount of their pain sensation. The pain severity was assessed at the recovery room, 15, 30, 45, 60 minutes after procedure.
• Patient satisfaction: according to patient satisfaction score by asking the patients to rate their satisfaction level based on score
1-4 score; Excellent = 4, Good = 3, Fair = 2, Poor = 1.
• Request of analgesia: i.v paracetamol given up on request of the patient and recorded if patient took or not.
Our results recorded that the patient characteristics (age, gender, weight, ASA classification, procedure time) and SPO2 were comparable between three studied groups.
lidocaine infusion by dose 1.5 mg/kg loading and 4 mg/kg/ h as maintenance is more effective than magnesium sulfate by dose 50 mg/kg loading and 8 mg/kg/ h maintenance in decreasing total amount of propofol, post procedural pain and analgesic demand, and improving patient satisfaction in patient undergoing colonoscopy under sedation with propofol.
Conclusion
our present study shows that the use of lidocaine infusion and magnesium sulfate infusion with propofol in patients undergo colonoscopy under sedation decrease total amount of propofol used, decrease post procedural pain, also improve patient satisfaction and decrease post procedural analgesic demand.
Last conclusion was that using lidocaine infusion by dose 1.5 mg/kg loading and 4 mg/kg/ h as maintenance is more effective than magnesium sulfate by dose 50 mg/kg loading and 8 mg/kg/ h maintenance in decreasing total amount of propofol, post procedural pain and analgesic demand, and improving patient satisfaction in patient undergoing
colonoscopy under sedation with propofol. This makes the costs are getting lower without impacting working conditions for the endoscopists. Also improves post-colonoscopy pain which improves procedure outcome.