Year 2019 / Volume 111 / Number 7
Original
Effect of conscious sedation with midazolam and fentanyl on the overall quality of colonoscopy: a prospective and randomized study

507-513

DOI: 10.17235/reed.2019.5735/2018

Juan Salvador Baudet, Armando Aguirre-Jaime,

Abstract
Introduction: a prospective, randomized study was performed to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on the scientific quality, perceived quality and patient safety. Methods: patients referred for a colonoscopy were included in the study and were randomized to receive or not receive sedation. Demographic data, indication for colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during the exploration were collected. Thirty days later, a satisfaction questionnaire was performed (GHAA 9-me) and patients were asked about complications after the examination. Results: a total of 5,328 patients were included, the average age was 62 ± 15.22 years, 47% were male, 3,734 were sedated and 1,594 were not sedated. The sedated patients had a shorter endoscope insertion time (7'20 ± 2'15 min vs 6'15 ± 3'12 min, p < 0.019), a higher rate of cecal intubations (96% vs 88%, p < 0.05), longer withdrawal time (7'20 ± 2'15 min vs 6'15 ± 3'12 min, p < 0.01) and higher adenoma detection rates (22% vs 17%, p < 0.05). The use of sedation reduced discomfort during and after the exploration, without increasing the complications. The satisfaction questionnaire score was higher (23.6 ± 1.5 vs 16.6 ± 4.8, p < 0.001) in the sedated patients. Conclusions: superficial sedation not only reduces patient discomfort but also improves the overall quality of the colonoscopy. Therefore, we must consider the use of sedation as an essential part of colonoscopy.
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Comments

11/07/2019 9:16:58
Muy buen trabajo y magníficos resultados, todo lo cual nos aporta una evidencia más de las ventajas en cuanto a eficacia y seguridad clínica de la sedación en la colonoscopia. FELICIDADES A TODO EL EQUIPO


References
1. Terruzzi V, Meucci G, Radaelli F, et al. Routine vs “on demand” sedation and analgesia for colonoscopy: A prospective randomized controlled trial. Gastrointest endosc 2001; 54: 169-74.
2. Sipe BW, Rex DK, Latinovich D, et al. Propofol vs midazolam/meperidine for outpatient colonoscopy administration by nurses supervised by endoscopists. Gastrointest endosc 2002; 55: 815-25.
3. Lanzzaroni M, Bianchi Porro G. Preparation, premedication and surveillance. Endoscopy 2003; 35: 103-11.
4. Baudet JS, Borque P, Borja E, et al. Use of sedation in gastrointestinal endoscopy: a nationwide survey in Spain. Eur J Gastroenterol Hepatol. 2009; 2: 882-8.
5. Lucendo AJ, González-Huix F, Tenias JM, et al; Spanish Society of Digestive Diseases, the Spanish Society of Digestive Endoscopy, and the Spanish Association of Gastroenterology. Gastrointestinal endoscopy sedation and monitoring practices in Spain: a nationwide survey in the year 2014. Endoscopy. 2015; 47: 383-90.
6. Froehlich F, Harris JK, Wietlisbach V, et al; EPAGE Study Group. Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE). Endoscopy. 2006; 38: 461-9.
7. Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. 2006; 10: 967-74
8. Chelazzi C, Consales G, Boninsegni P, et al. Propofol sedation in a colorectal cancer screening outpatient cohort. Minerva Anestesiol. 2009; 75: 677-83.
9. Bair D, Pham J, Seaton MB, et al. The quality of screening colonoscopies in an office-based endoscopy clinic. Can J Gastroenterol. 2009; 23: 41-7.
10. Cardin F, Minicuci N, Andreotti A, et al. Maximizing the general success of cecal intubation during propofol sedation in a multi-endoscopist academic centre. BMC Gastroenterol. 2010 20;10: 123.
11. Bannert C, Reinhart K, Dunkler D, et al. Sedation in screening colonoscopy: impact on quality indicators and complications. Am J Gastroenterol. 2012; 107: 1837-48.
12. Boroff ES, Gurudu SR, Hentz JG, et al. Polyp and adenoma detection rates in the proximal and distal colon. Am J Gastroenterol. 2013; 108: 993-9.
13. Kilgert B1, Rybizki L, Grottke M, et al. Prospective long-term assessment of sedation-related adverse events and patient satisfaction for upper endoscopy and colonoscopy. Digestion. 2014; 90: 42-8.
14. Aljebreen AM, Almadi MA, Leung FW. Sedated vs unsedated colonoscopy: a prospective study. World J Gastroenterol. 2014; 20: 5113-8.
15. Baudet JS, Aguirre-Jaime A. The sedation increases the acceptance of repeat colonoscopies. Eur J Gastroenterol Hepatol. 2012; 24: 775-80.
16. Cohen LB1, Hightower CD, Wood DA, et al.Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam. Gastrointest Endosc. 2004; 59: 795-803.
17. González-Santiago JM, Martín-Noguerol E, Vinagre-Rodríguez G, et al. Intermittent boluses versus pump continuous infusion for endoscopist-directed propofol administration in colonoscopy. Rev Esp Enferm Dig. 2013; 105: 378-84.
18. Baudet JS, Diaz-Bethencourt D, Avilés J, et al. Minor adverse events of colonoscopy on ambulatory patients: the impact of moderate sedation. Eur J Gastroenterol Hepatol. 2009; 21: 656-61.
19. Friedrich K, Scholl SG, Beck S, et al. Respiratory complications in outpatient endoscopy with endoscopist-directed sedation. J Gastrointestin Liver Dis. 2014; 23: 255-9.
20. Repici A, Pagano N, Hassan C, et al. Balanced propofol sedation administered by nonanesthesiologists: The first Italian experience. World J Gastroenterol. 2011; 17: 3818-23.
21. Jover R, Herráiz M, Alarcón O, et al; Spanish Society of Gastroenterology; Spanish Society of Gastrointestinal Endoscopy Working Group. Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy. 2012; 44: 444-51.
22. Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970; 49: 924-34.
23. Johanson JF, Schmitt CM, Deas TM, et al. Quality and outcomes assessment in gastrointestinal endoscopy. Gastrointest Endosc 2000; 9: 827-30.
24. Sánchez del Río A, Alarcón Fernández O, Baudet JS, et al. Reliability of the Spanish version of a brief questionnaire on patient satisfaction with gastrointestinal endoscopy. Rev Esp Enferm Dig. 2005; 97: 554-61.
25. Del Río AS, Baudet JS, Fernández OA, et al. Evaluation of patient satisfaction in gastrointestinal endoscopy. Eur J Gastroenterol Hepatol. 2007; 19: 896-900.
26. Paggi S, Radaelli F, Amato A, et al. Unsedated colonoscopy: an option for some but not for all. Gastrointest Endosc. 2012; 75: 392-8.
27. Nakao SK, Fassler S, Sucandy I, et al. Colorectal cancer following negative colonoscopy: is 5-year screening the correct interval to recommend? Surg Endosc. 2013; 27: 768-73.
28. Shergill AK, Conners EE, McQuaid KR, et al. Protective association of colonoscopy against proximal and distal colon cancer and patterns in interval cancer. Gastrointest Endosc. 2015; 82: 529-37.
29. IJspeert JE, van Doorn SC, van der Brug YM, et al. The proximal serrated polyp detection rate is an easy-to-measure proxy for the detection rate of clinically relevant serrated polyps. Gastrointest Endosc. 2015; 82: 870-7.
30. Kahi CJ. How does the serrated polyp pathway alter CRC screening and surveillance? Dig Dis Sci. 2015; 60: 773-80.
31. Igea F, Casellas JA, González-Huix F, et al; Spanish Society of Digestive Endoscopy. Sedation for gastrointestinal endoscopy. Endoscopy. 2014; 46: 720-31.
32. López Muñoz C, Sánchez Yagüe A, Canca Sánchez JC, et al. Quality of sedation with propofol administred by non-anesthetists in a digestive endoscopy unit: the results of a one year experience.. Rev Esp Enferm Dig. 2018; 110: 231-236.
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Baudet J, Aguirre-Jaime A. Effect of conscious sedation with midazolam and fentanyl on the overall quality of colonoscopy: a prospective and randomized study. 5735/2018


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Publication history

Received: 19/05/2018

Accepted: 20/12/2018

Online First: 22/05/2019

Published: 04/07/2019

Article revision time: 213 days

Article Online First time: 368 days

Article editing time: 411 days


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