Anesthesia Assistance in Outpatient Colonoscopy and Risk of Aspiration Pneumonia, Bowel Perforation, and Splenic Injury

Bielawska, Barbara; Hookey, Lawrence; Sutradhar, Rinku; Whitehead, Marlo; Xu, Jianfeng; Paszat, Lawrence; Rabeneck, Linda; Tinmouth, Jill

doi:10.1053/j.gastro.2017.08.043

Cited by 66 publications

(71 citation statements)

References 38 publications

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“…12,14 Besides, fear of sedation was cited as one of the barriers to participate in colonoscopy screening. However, sedation increases the cost and 30-day complications.…”

Section: Discussionmentioning

confidence: 99%

“…However, sedation increases the cost and 30-day complications. 12,14 Besides, fear of sedation was cited as one of the barriers to participate in colonoscopy screening. 28 In Taiwan, colonoscopy was usually performed without sedation or with minimal sedation in the past, while full sedation is rapidly gaining popularity in recent years.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,8 Water exchange (WE), an insertion method characterized by infusing water to guide scope advancement in an airless lumen with nearly complete removal of infused water during the insertion phase, 9 has been reported to reduce insertion pain. 12,13 In addition to the wellrecognized direct cost of sedation, 14 there are some indirect costs that are not as well-recognized, including the time burden of recovery at home (up to 17.7 h in one report), 15 missing work days in addition to the procedure day, 16 and the need for an escort. 5,10,11 The on-demand sedation option has certain advantages over full sedation.…”

Section: Introductionmentioning

confidence: 99%

“…Use of sedation is associated with a small but real risk of cardiopulmonary complications. 12,13 In addition to the wellrecognized direct cost of sedation, 14 there are some indirect costs that are not as well-recognized, including the time burden of recovery at home (up to 17.7 h in one report), 15 missing work days in addition to the procedure day, 16 and the need for an escort. By reducing the need for sedation, on-demand sedation curtails the sedation complications and some of the associated cost.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Hsieh

Tseng

Koo

et al. 2019

J of Gastro and Hepatol

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Background and Aim Completion of colonoscopy without sedation eliminates sedation cost and complications. Reported in the United States and Europe, on‐demand sedation is not routine practice in Taiwan. Water exchange (WE), characterized by infusion and nearly complete removal of infused water during insertion, reduces insertion pain compared to air insufflation (AI) during colonoscopy. We evaluated the feasibility of on‐demand sedation in Taiwan. In a randomized controlled trial of WE vs AI colonoscopy, we also aimed to determine if WE augmented the implementation by reducing insertion pain and decreasing sedation requirement. Methods This prospective patient‐blinded study randomized patients to AI or WE (75 patients/group) to aid insertion. The primary outcome was the proportion of patients completing without sedation. Results In the AI and WE groups, 76.0% and 93.3% (P = 0.006) completed without need for sedation, respectively. The WE group had lower insertion pain score (mean [SD]) (4.0 [2.9] vs 2.1 [2.6], P < 0.001), lower doses of propofol (25.7 [52.7] mg vs 9.1 [35.6] mg, P = 0.012), and less time in the recovery room (3.4 [7.4] vs 1.5 [5.5], P = 0.027) than the AI group. Patient satisfaction scores and willingness to repeat if needed in the future were similar. Conclusion On‐demand sedation was feasible in Taiwan. The completion rate without sedation was high in patients (76.0% with standard AI) open to the option (no prior intent to receive the standard of full or minimal sedation). WE augmented the implementation by reducing insertion pain and decreasing sedation requirement without adversely affecting patient satisfaction or willingness to repeat.

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“…12,14 Besides, fear of sedation was cited as one of the barriers to participate in colonoscopy screening. However, sedation increases the cost and 30-day complications.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Hsieh

Tseng

Koo

et al. 2019

J of Gastro and Hepatol

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show abstract

“…1 Furthermore, there is considerable variation in the performance and quality of colonoscopy, 2,3 with attendant consequences for the health care system and patients. For example, although colon oscopy can be safely and comfortably performed with moderate sedation administered by the endoscopist, increasingly in some jurisdictions, anesthesiologists are providing deep sedation for the procedure; [4][5][6] however, there are added costs 6 and potentially complications 7,8 associated with this practice. Patients are adversely affected by poor-quality colonoscopy; such procedures are associated with missed colorectal cancers and cancer-related death.…”

mentioning

confidence: 99%

Validation of 5 key colonoscopy-related data elements from Ontario health administrative databases compared to the clinical record: a cross-sectional study

Tinmouth

Sutradhar

Liu

et al. 2018

cmajo

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Screening for Thyroid Cancer

Lin

Bowles

Williams

et al. 2017

JAMA

525

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IMPORTANCEThe incidence of detected thyroid cancer cases has been increasing in the United States since 1975. The majority of thyroid cancers are differentiated cancers with excellent prognosis and long-term survival.OBJECTIVE To systematically review the benefits and harms associated with thyroid cancer screening and treatment of early thyroid cancer in asymptomatic adults to inform the US Preventive Services Task Force.

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Anesthesia Assistance in Outpatient Colonoscopy and Risk of Aspiration Pneumonia, Bowel Perforation, and Splenic Injury

Cited by 66 publications

References 38 publications

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Validation of 5 key colonoscopy-related data elements from Ontario health administrative databases compared to the clinical record: a cross-sectional study

Screening for Thyroid Cancer

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