Intravenous access during routine conscious sedated endoscopy

Jones, Michael P.; Cooper, Rita; Manka, Michael; Haviley, Corinne

doi:10.1111/j.1572-0241.2002.05633.x

Cited by 1 publication

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“…Clinically measureable adverse outcomes of fasting and bowel preparation (such as hypotension, drowsiness, nausea, vomiting, dehydration, dizziness and thirst) have been widely documented [5-8], but there is limited data from randomized studies examining routine fluid management practices during colonoscopy, and the role of fluid prescription in the prevention of such events continues to be poorly understood [9,10]. There is additional cost and workload if fluid is to be routinely administered to all patients [11], and emerging evidence that fluid administration to patients undergoing colonoscopy may not reduce peri-procedural adverse events [4]. Routine fluid administration may have significant pharmaco-economic implications taking into consideration the cost of the fluid flasks and giving sets.…”

Section: Introductionmentioning

confidence: 99%

Fluid prescription practices of anesthesiologists managing patients undergoing elective colonoscopy: an observational study

et al. 2014

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BackgroundRoutine fluid prescription is common practice amongst anesthesiologists caring for patients undergoing colonoscopy. However there is limited information about routine procedural fluid prescription practices of anesthesiologists in this setting. Routine fluid administration may also have important pharmaco-economic implications for the health care budget. Therefore we performed a prospective observational study assessing the fluid prescription practices of anesthesiologists caring for patients undergoing elective colonoscopy.MethodsWith Institutional Review Board approval, adult patients receiving procedural fluid intervention during elective colonoscopy were included. Data collected: size of intravenous cannula inserted, volumes of fluid administered, adverse events, procedure duration, and pharmaco-economic costs associated with fluid prescription. Anesthesiologists and gastroenterologists were blinded to the study.ResultsWe collected data on 289 patients who received fluid prescription by their attending anesthesiologist. Median patient age: 48 yrs (range 18–83), gender: 174 (60%) female; median duration of procedure: 24 minutes (range 12–48). Cannula size: 181 (63%) patients received a 22G cannula or smaller. Median volume of fluid administered during the colonoscopy was 325 ml (range 0 to 1000 ml). Median duration of the procedure: 25 minutes (range 12 to 48 minutes). Median volume of fluid administered in the post anaesthesia recovery unit: 450 ml (range 0 to 1000 ml). Fifteen patients (5%) became hypotensive during the procedure and two patients (<1%) developed hypotension in the PACU. There was no difference in the median fluid requirements between patients with hypotension and those without. Fluid volumes were strongly associated with increasing cannula diameter (p = 0.0001), however there was no association between fluid volumes administered and vasopressor use, peri-procedural adverse events, or procedure duration. At our institution fluid therapy currently cost about AUD$4.90 per patient: 1 L crystalloid $1.18 and fluid delivery set $3.77 Our institution performs over 9000 endoscopic procedures annually with fluid therapy costing about $45,000/year.ConclusionsRoutine fluid prescription by anesthesiologists managing patients undergoing colonoscopy was ineffective with low actual fluid volumes delivered during the procedure. There was no association between volumes of fluid delivered and procedural hypotension, adverse events, or procedure duration. Anesthesiologists should question the clinical and pharmaco-economic value of routine fluid administration for patients undergoing elective endoscopy.

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