A randomized-controlled trial of high- or low-volume intravenous Plasma-Lyte® to prevent hypotension during sedation for colonoscopy

Abstract

Purpose The purpose of this study was to compare the incidence of hypotension during sedation in adults presenting for elective colonoscopy and randomized to intravenous Plasma-Lyte 148 Ò at either 2 mLÁkg -1 (low volume) or 20 mLÁkg -1 (high volume). Methods Patients aged C 18 yr presenting for elective colonoscopy, with or without gastroscopy, after oral bowel preparation were randomized to receive the intervention immediately before the start of the procedure. Hypotension was defined as a C 25% decrease in systolic blood pressure (SBP) from baseline during the procedure. Secondary outcomes included SBP \ 90 mmHg, lowest SBP during sedation, duration of hypotension, use of vasopressors, postoperative outcomes, and cost. Results Seventy-five patients were randomly allocated to either the low-volume or high-volume group, respectively (total n = 150). The incidence of hypotension was similar in the two groups (59% vs 56%, respectively; odds ratio, 0.90; 95% confidence interval, 0.47 to 1.71; P = 0.74). The incidence of SBP \ 90 mmHg, the lowest SBP during sedation, the duration of hypotension, the use of vasopressors, and postoperative outcomes were also similar in the two groups. Conclusions This study does not support the routine use of 20 mLÁkg -1 of intravenous Plasma-Lyte 148 to prevent hypotension and other complications during sedation for elective colonoscopy in adult patients. Clinical Trials Registry (ANZCTR 12615001288516). RésuméObjectif L'objectif de cette étude était de comparer l'incidence d'hypotension pendant la sédation chez des adultes se présentant pour une colonoscopie non urgente et randomisés à recevoir du Plasma-Lyte 148 Ò en solution intraveineuse à des concentrations de 2 mLÁkg -1 (volume faible) ou de 20 mLÁkg -1 (volume élevé). Méthode Des patients âgés C 18 ans se présentant pour une colonoscopie non urgente, avec ou sans gastroscopie, après une préparation intestinale par voie buccale, ont été randomisés à recevoir l'intervention à l'étude immédiatement avant le début de la procédure. L'hypotension était définie en tant qu'une réduction C 25 % de la tension artérielle systolique (TAS) depuis la valeur de

Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis

“…We performed a reanalysis of anonymised individual patient data from six published studies of propofol sedation for colonoscopy, including five RCTs 11 , 12 , 13 , 14 , 15 and a retrospective cohort study. 16 Data from the five trials were shared under a data transfer agreement between Melbourne Health and the University of Plymouth.…”

“…These patients were aged 49 (16) yr and weighed 77 (17) kg; mean (standard deviation [SD]). For 340 patients, 14,16 the duration of sedation was not available, so we substituted duration of procedure. Calculated on this basis, the mean (SD) duration of sedation was 32 (21) min and the mean (SD) propofol infusion rate was 170 (150) mcg kg À1 min À1 .…”

The cardiovascular effects of crystalloid administration in endoscopy patients

“…3,4 Neither high (20 ml/kg) nor low (2 ml/kg) volume crystalloid infusion reliably reduced the incidence of hypotension, which occurred in almost 60% of patients. 1 Similarly, high or low volume crystalloid administration does not clearly reduce more subjective symptoms such as nausea, vomiting, headache and light-headedness. 5 However, fasting alone does not clearly reduce echocardiographic measures of haemodynamic state.…”

“…8,9 In addition, there is a not an insignificant financial cost with each litre of fluid (including IV administration equipment) costing roughly AUS$10. 1 In Australia, this would add over 10 million dollars annually to healthcare costs.…”

“…Gastrointestinal endoscopy is a commonly performed procedure with over a million cases performed annually in Australia. 1 The combined effect of fasting and bowel preparation has the potential to contribute to patients being intravascularly volume depleted, with weight loss, postural hypotension and elevations in serum creatinine. 2 Anaesthesiologists administer fluid in 64% of these cases with large variability in the volume given, despite there being no high quality data to support or refute this practice.…”