Alfentanil for Conscious Sedation During Colonoscopy

Ja, DiPalma; Jl, Herrera Pombo; Fr, Weis; Dl, Dark-Mezick; Rs, Brown

doi:10.1097/00007611-199506000-00006

Cited by 32 publications

(19 citation statements)

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“…In colonoscopy, which is more frequently accompanied by pain than upper GI endoscopy, pethidine hydrochloride is sometimes used in combination with a benzodiazepine, but no RCT has compared a benzodiazepine alone with a benzodiazepine/analgesic combination. One small‐sized RCT (evidence level, II) has compared an analgesic (alfentanil) alone with a midazolam/analgesic (alfentanil) combination, and there was no significant difference in patient satisfaction or the frequency of cardiorespiratory depression. In addition, a meta‐analysis (evidence level, I) showed that when weighting was applied to all RCT arms according to the sample size, there were no significant differences in satisfaction for patients or endoscopists, or in cardiorespiratory depression between the benzodiazepine‐alone group and the benzodiazepine/analgesic combination group .…”

Section: Statements On Sedation In Gastroenterological Endoscopymentioning

confidence: 99%

Guidelines for sedation in gastroenterological endoscopy

Obara

Haruma

Irisawa

et al. 2015

Digestive Endoscopy

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Recently, the need for sedation in gastrointestinal endoscopy has been increasing. However, the National Health Insurance Drug Price list in Japan does not include any drug specifically used for the sedation. Although benzodiazepines are the main medication, their use in cases of gastrointestinal endoscopy has not been approved. This has led the Japan Gastrointestinal Endoscopy Society to develop the first set of guidelines for sedation in gastrointestinal endoscopy on the basis of evidence‐based medicine in collaboration with the Japanese Society for Anesthesiologists. The present guidelines comprise 14 statements, five of which were judged to be valid on the highest evidence level and three on the second highest level. The guidelines are not intended to strongly recommend the use of sedation for gastrointestinal endoscopy, but rather to indicate the policy as to the choice of appropriate procedures when such sedation is deemed necessary. In clinical practice, the final decision as to the use of sedation should be made by physicians considering patient willingness and physical condition.

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Section: Statements On Sedation In Gastroenterological Endoscopymentioning

confidence: 99%

Guidelines for sedation in gastroenterological endoscopy

Obara

Haruma

Irisawa

et al. 2015

Digestive Endoscopy

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“…Based on studies from Ristikankare et al (30) and DiPalma et al (7) in which patient cooperation is listed as one of the aspects of tolerance, our study classifies it (patient cooperation) into three groups (cooperative, non-cooperative and indifferent). The first author evaluated the effects of age and gender concerning tolerance of patients undergoing colonoscopy.…”

Section: Patient Cooperation During the Examinationmentioning

confidence: 99%

What Are the Most Important Factors Regarding Acceptance to the Colonoscopy?

Ussui

Silva

Borges

et al. 2013

Arq. Gastroenterol.

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-Context -Colonoscopy plays an indubitable role in the setting of clinical practice, however, it is an invasive exam; complex, lengthy, embarrassing, not devoid of risks and discomfort that yields fear and anxiety in the majority of patients. In a new era of rising competition between health institutions, where the quality of health care and client satisfaction are praised, studies regarding tolerance-related colonoscopy issues yield great potential to be explored. In the present study, tolerance is defined as willingness to repeat the exam. Objectives -Evaluate information associated to bowel preparation, the exam itself and post-examination period that might interfere with the tolerance to the colonoscopy. Methods -Analysis of the tolerance to the colonoscopy at three stages (pre, post, and during) through a checklist: patient's questionnaire and a medical assessment form were used. Results -In this present study, 91.2% of 373 patients exhibited positive tolerance to the colonoscopy. Aspects related to a negative level of tolerance were patient gender (12.9% of women versus 3.2% of men would not repeat the exam), age extremes (less than 20 years and greater than 80 years of age), and abdominal pain, both during the bowel preparation and after the procedure. Conclusions -Gender, age, patient cooperation and abdominal pain were the decisive components regarding tolerance to the colonoscopy. Notably, in two phases of the exam, the abdominal pain was the most important feature associated to a lessened tolerance. HEADINGS -Colonoscopy. Patient satisfaction. Abdominal pain.

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“…According to Riphaus et al [8] and several other studies [18,24,25], the utilization of a combination of sedation agents yielded more often respiratory and cardiovascular side effects than monotherapy. As cardiovascular events and side effects decrease patient satisfaction and the acceptance for repeat endoscopies, the rate for cardiovascular events should be held as low as possible [11].…”

Section: Discussionmentioning

confidence: 99%

Prospective Long-Term Assessment of Sedation-Related Adverse Events and Patient Satisfaction for Upper Endoscopy and Colonoscopy

Kilgert

Rybizki²,

Grottke³

et al. 2014

Digestion

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Background: Fear of pain and sedation-related adverse events are impediments for patients to attend endoscopic screening or surveillance programs. Objective: To investigate the long-term effect of different sedation protocols in patients undergoing screening or surveillance endoscopy. Moreover, motivation of patients to decline endoscopic procedures was evaluated by focusing on the patient's satisfaction, fear and pain in relation to type of sedation used. Methods: Design: A prospective, double-blind controlled trial data collection was performed by using a standardized clinical questionnaire followed by a telephone interview 3-4 weeks after the initial endoscopic procedure. Setting: The study was conducted at the Department of Medicine I at the University Hospital of Erlangen-Nuremberg. Data collection was performed during June 2012 till April 2013. Patients: Overall, 307 patients were prospectively evaluated (44.3% female, mean age 51 ± 17.4 years; mean BMI 25.5 ± 5.7). 247 patients (80.5%) were outpatients, 60 inpatients (19.5%). Interventions: Endoscopic procedures were divided into five groups: (i) procedures in the upper gastrointestinal tract, (ii) complete colonoscopies, (iii) ileocolonoscopies, (iv) incomplete colonoscopies, and (v) other procedures. Main outcome measurements: Patient satisfaction, fear and pain were measured in a structured and standardized clinical interview using a 6-point numerical rating scale, where 1 was ‘very satisfied/no pain' and 6 was ‘very unsatisfied/unsupportable pain'. Results: Different types of sedation were assessed: propofol in monosedation (6.5%), combination of propofol + meperidine (41.0%), combination of midazolam + meperidine (48.5%) and other combinations (3.9%). Patient satisfaction was significantly reduced regarding fear and pain during the endoscopic procedure (p = 0.001 and p = 0.0001, respectively). All patients receiving propofol monosedation indicated significantly less pain in comparison to other sedation groups (p < 0.0001). Moreover, sedation with midazolam + meperidine increased the fear during the procedure significantly in comparison to monosedation with propofol (p = 0.082). Propofol/meperidine in combination and midazolam/meperidine increased the probability for cardiovascular events in comparison to monosedation with propofol (p = 0.005; p = 0.039). Finally, we observed significantly lower doses of propofol when used in monosedation than propofol in combination with meperidine (p = 0.066). Limitation: Single-center study at a tertiary referral center. Conclusions: Propofol in monosedation should preferably be used for patient sedation in screening and surveillance endoscopies. Whether this approach could also improve participation rates in screening and surveillance endoscopies requires further investigations.

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Alfentanil for Conscious Sedation During Colonoscopy

Cited by 32 publications

References 0 publications

Guidelines for sedation in gastroenterological endoscopy

Guidelines for sedation in gastroenterological endoscopy

What Are the Most Important Factors Regarding Acceptance to the Colonoscopy?

Prospective Long-Term Assessment of Sedation-Related Adverse Events and Patient Satisfaction for Upper Endoscopy and Colonoscopy

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