CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: a randomized controlled trial

Riss, Stefan; Akan, Belgin; Mikola, Barbara; Rieder, Erwin; Karner‐Hanusch, Judith; Dirlea, Dragos; Mittlböck, Martina; Weiser, F. A.

doi:10.1007/s00508-009-1202-y

Cited by 44 publications

(47 citation statements)

References 21 publications

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“…As for the time of cecal intubation and sedation doses used, there was no difference between using CO 2 or air, in agreement with other previously published studies (9,12,14) and in disagreement with others that have reported a lesser cecal intubation time (8,18) or lower doses of midazolam in patients who underwent endoscopic submucosal dissection (22). We also found no differences between groups in terms of time spent in the recovery room after the colonoscopy, which was probably due to the high workload of the nurse in charge of this room.…”

Section: Discussionsupporting

confidence: 91%

“…While no group has reported a contrary result, in these studies, the use of CO 2 caused significantly less pain compared with air between 10 minutes (9) and 6 hours of a completed colonoscopy (6)(7)(8)11,14), although in some cases the difference is not significant one hour later (12) or 6 hours after (18) and in others remains so until 24 hours after the procedure (6,8). Two of these studies performed an abdominal radiograph at the time of completion of the exploration, finding less residual intestinal air with CO 2 insufflation (6,7).…”

Section: Discussionmentioning

confidence: 76%

“…Another benefit we observed in our study, although not quantified, was the realization that the patient who had undergone a colonoscopy with CO 2 felt less shame when experiencing less flatulence, which made them have an immediate perception of comfort and tolerance to exploration. Both the decrease in pain experienced and the feeling of shame is likely to have a positive impact on the increasing acceptance of colonoscopy, although this aspect could not be confirmed by studies that tried unsuccessfully to find differences in the percentages of patients who said they were willing to accept a colonoscopy of screening of colorectal cancer in the future, few minutes after undergoing a colonoscopy with CO 2 or air (12,14). Certainty of safety is a fundamental aspect when recommending the use of CO 2 insufflation during a colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

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Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol

Díez-Redondo

Gil-Simon

Alcaide-Suárez

et al. 2012

Rev. esp. enferm. dig.

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Objectives: compare the intensity of pain experienced after colonoscopy with air or with CO 2 and evaluate the safety of CO 2 in colonoscopies performed with moderate/deep sedation.Materials and methods: individuals undergoing ambulatory colonoscopy without exclusion criteria (severe respiratory disease, morbid obesity) were randomized in air or CO 2 group. We recorded different variables prior to, during and upon completion of the colonoscopy, performing monitoring using pulse oximetry and capnography. Each patient rated, using a visual numeric scale, the intensity of post-colonoscopy pain at different moments.Results: 141 individuals in the air group (sex M/F 63/78, age 24-83) and the CO 2 group (sex M/F 59/70, age 24-82). No significant differences existed in the recorded variables in both groups except for the greater number of explorations performed by an endoscopist in training (TE) in the air group compared to those by a more experienced endoscopist (SE). CO 2 in expired air, episodes of oxygen desaturation and of apnoea and dose of propofol, of midazolam were similar in both groups. No episodes of hypercapnea or any complication requiring cardiopulmonary resuscitation measures were recorded. The pain in the air group was significantly higher at 15 minutes and at 1, 3 and 6 hours after the endoscopy, equalising at 24 hours. After multivariant adjustment for type of doctor (TE vs. SE) the differences observed in pain intensity for each group were maintained.Conclusions: a) the use of CO 2 in colonoscopy causes significantly less pain in the first 6 hours after the procedure; b) its use in patients with moderate/deep sedation is safe; and c) performance of the endoscopic technique is not modified, nor are times reduced.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol

Díez-Redondo

Gil-Simon

Alcaide-Suárez

et al. 2012

Rev. esp. enferm. dig.

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“…A considerable number of RCT in unsedated or sedated patients summarized in a review of methods of reducing discomfort during colonoscopy 1 and in more recent reports [8][9][10] showed that CO 2 instead of air insufflations decreases pain scores and increases the proportion of patients with no pain after colonoscopy. The mechanism is based on 'rapid' absorption of CO 2 from the lumen, decreasing distention and associated pain.…”

Section: Biographymentioning

confidence: 99%

DDW "Cutting Edge" Colonoscopy Techniques 2011 State-of-the-Art Lecture: Warm water infusion/CO2 insufflation for colonoscopy

Leung¹,

Leung²,

Mann³

et al. 2011

jig

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“…Endoscopist-controlled (as needed sedation), patient-controlled (on demand sedation), or extended flexible sigmoidoscopy were additional approaches discussed. 37 Four papers reviewed by Leung in 2008 37 and two recent studies 31,38 reported that carbon dioxide insufflation reduced pain "after" but "not during" colonoscopy. Only one report described a reduction of pain after as well as during colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

The water method is effective in difficult colonoscopy—it enhances cecal intubation in unsedated patients with a history of abdominal surgery

Leung¹,

Mann²,

Leung³

et al. 2011

jig

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Background: colonoscopy in unsedated patients in the Us is considered to be difficult. success rate of cecal intubation is limited by discomfort. colonoscopy in patients with a history of abdominal surgery is also considered to be difficult due to adhesion-related bowel angulations. The water method has been shown to significantly reduce pain during colonoscopy. Objective: To test the hypothesis that the water method enhances the completion of colonoscopy in unsedated patients with a history of abdominal surgery. Design: The data bases of two parallel RcT were combined and analyzed. Setting: Two Veterans affairs endoscopy units. Patient and Methods:The water and air methods were compared in these two parallel RcT examining unsedated patients. Those with a history of abdominal surgery were selected for evaluation. Main Outcome Measurements: completion of unsedated colonoscopy. Results: among patients with a history of abdominal surgery, the proportion completing unsedated colonoscopy in the water group (19 of 22) was significantly higher than that (11 of 22) in the air group (p=0.0217, Fisher's exact test). Limitations: small number of predominantly male veterans, unblinded colonoscopists, not all types of abdominal surgery (e.g. hysterectomy, gastrectomy) predisposing to difficult colonoscopy were represented. Conclusion: This proof-of-principle assessment confirms that in patients with a history of abdominal surgery the water method significantly increases the proportion able to complete unsedated colonoscopy. The water method deserves to be evaluated in patients with other factors associated with difficult colonoscopy.

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CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: a randomized controlled trial

Cited by 44 publications

References 21 publications

Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol

Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol

DDW "Cutting Edge" Colonoscopy Techniques 2011 State-of-the-Art Lecture: Warm water infusion/CO2 insufflation for colonoscopy

The water method is effective in difficult colonoscopy—it enhances cecal intubation in unsedated patients with a history of abdominal surgery

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