&lt;p&gt;Propofol sedation in colonoscopy: from satisfied patients to improved quality indicators&lt;/p&gt;

Baker, Fadi Abu; Mari, Amir; Aamarney, Kamal; Hakeem, Abu Ras; Ovadia, Baruch; Kopelman, Yael

doi:10.2147/ceg.s186393

“…However, there is still much controversy surrounding the effect of sedation on quality of colonoscopy. Some previous studies showed that patients who received sedation were more likely to have an enhanced CIR [ 23 – 26 ], but the other study demonstrated similar rates of cecal intubation among sedated and unsedated colonoscopy [ 27 ]. In our results, the colonoscopy with sedation was significantly associated with higher CIR when controlling for other patient and endoscopist factors, which confirms positive results from previous studies.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Sedation on Adenoma Detection Rate and Cecal Intubation Rate in Colonoscopy

Zhang

¹

,

Dong

²

,

Jiang

³

et al. 2020

Gastroenterology Research and Practice

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Purpose. To explore the effect of sedation on the quality of colonoscopy. Methods. The data collected from the Digestive Endoscopy Center of Shanghai Tongji Hospital from March 2012 to June 2019 were retrospectively analyzed. The rate of sedation and quality metrics of colonoscopy such as adenoma detection rate (ADR) and cecal intubation rate (CIR) were calculated. The logistic regression model was used to explore the relationship between sedation and quality metrics of colonoscopy. The interaction effects between experience of endoscopists and sedation on quality of colonoscopy was also investigated in subgroups stratified by total number of colonoscopies during career using the logistic regression model. Results. A total of 63,417 colonoscopies including 11,417 colonoscopies without sedation and 52,000 colonoscopies with sedation were enrolled in our study. The proportion of colonoscopy with sedation was 82.0%. The ADR and CIR were all significantly higher in cases with sedation compared with cases without sedation (ADR, 22.5% vs. 17.0%, p < 0.001 ; CIR, 94.7% vs. 91.2%, p < 0.001 ). Multivariate analysis showed that the sedation was an independent factor associated with adenoma detection ( OR = 1.448 , 95% CI: 1.372~1.529, p < 0.001 ) and cecal intubation ( OR = 1.560 , 95% CI: 1.446~1.683, p < 0.001 ). A total of 14 endoscopists with complete colonoscopy data in our database and corresponding 20,949 colonoscopies data were enrolled for further analysis. The logistic regression model yielded a similar result that sedation was an independent factor on adenoma detection and cecal intubation when the factor, experience of endoscopists, was also entered into the model as a confounder (adenoma detection, OR = 1.408 , 95% CI: 1.333~1.487, p < 0.001 ; cecal intubation, OR = 1.601 , 95% CI: 1.482-1.729, p < 0.001 ). Conclusion. Colonoscopy with sedation has a positive effect on ADR and CIR in all endoscopists with different experience of colonoscopy, which makes the quality of colonoscopy better.

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“…Power spectra (dB) were computed over 2-minute long epoch of EEG, partitioned into 512-point epochs, and averaged, yielding a temporal resolution of 2 Hz. Normalized power was calculated as the fraction of a specific frequency power, including delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), spindle (12)(13)(14)(15), beta (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and gamma (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), in the total power over all frequency bands from 0.5-40 Hz. The mean powers in percent for pre (1), post saline or caffeine injection (2), during 1.2% isoflurane (3) and before RORR (4) were computed by the MATLAB program.…”

Section: Power Spectramentioning

confidence: 99%

“…Our earlier studies in rats showed that caffeine was equally effective at accelerating emergence from propofol anesthesia as it was in isoflurane anesthesia [15]. Light propofol anesthesia is commonly used in a variety of procedures including colonoscopies and to prevent movement in MRI exams [18][19][20][21]. It will be important to determine whether caffeine can reverse the effects of other anesthetics, like propofol and dexmedetomidine, in a similar manner to that observed for isoflurane, as these drugs and their effects can stay in the body long after the termination of the anesthetic agent.…”

Section: Plos Onementioning

confidence: 99%

“…Light propofol anesthesia (i.e. sedation) is commonly used in a variety of procedures including colonoscopies and to prevent movement in MRI exams in adults and children [18][19][20][21]. In other procedures, moderate to heavy doses of anesthetic are employed during the beginning and midportion of the procedure with a lighter plane of anesthesia applied at the end.…”

Section: Introductionmentioning

confidence: 99%

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Caffeine reverses the unconsciousness produced by light anesthesia in the continued presence of isoflurane in rats

Fox

¹

,

Wagner

²

,

Towle

³

et al. 2020

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Currently no drugs are employed clinically to reverse the unconsciousness induced by general anesthetics. Our previous studies showed that caffeine, when given near the end of an anesthesia session, accelerated emergence from isoflurane anesthesia, likely caused by caffeine’s ability to elevate intracellular cAMP levels and to block adenosine receptors. These earlier studies showed that caffeine did not rouse either rats or humans from deep anesthesia (≥ 1 minimum alveolar concentration, MAC). In this current crossover study, we examined whether caffeine reversed the unconsciousness produced by light anesthesia (< 1 MAC) in the continued presence of isoflurane. The primary endpoint of this study was to measure isoflurane levels at the time of recovery of righting reflex, which was a proxy for consciousness. Rats were deeply anesthetized with 2% isoflurane (~1.5 MAC) for 20 minutes. Subsequently, isoflurane was reduced to 1.2% for 10 minutes, then by 0.2% every 10 min; animals were monitored until the recovery of righting reflex occurred, in the continued presence of isoflurane. Respiration rate, heart rate and electroencephalogram (EEG) were monitored. Our results show that caffeine-treated rats recovered their righting reflex at a significantly higher inspired isoflurane concentration, corresponding to light anesthesia, than the same rats treated with saline (control). Respiration rate and heart rate increased initially after caffeine injection but were then unchanged for the rest of the anesthesia session. Deep anesthesia is correlated with burst suppression in EEG recordings. Our data showed that caffeine transiently reduced the burst suppression time produced by deep anesthesia, suggesting that caffeine altered neuronal circuit function but not to a point where it caused arousal. In contrast, under light anesthesia, caffeine shifted the EEG power to high frequency beta and gamma bands. These data suggest that caffeine may represent a clinically viable drug to reverse the unconsciousness produced by light anesthesia.

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“…Airway management is, therefore, vital to avoid airway obstruction and associated respiratory complications. [ 3 ]…”

mentioning

confidence: 99%

Can Bispectral Index Monitoring (EEG) be an early predictor of respiratory depression under deep sedation during endoscopic retrograde cholangiopancreatography?

Kılıç

¹

,

Sayar

²

2020

Sisli Etfal

1

0

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Objectives: The more often the endoscopy sedation is performed, the more the risk of adverse events, and therefore, advanced monitoring becomes more and more essential in endoscopy units. The present study aims to evaluate whether the Bispectral Index (BIS) monitoring is an early predictor of respiratory depression and to determine the compliance between commonly used clinical sedation score. Methods: This study was approved by the ethics committee. The sample consisted of 60 patients aged 18 to 50 years with an American Society of Anesthesiologists (ASA) physical status of I scheduled for endoscopic retrograde cholangiopancreatography (ERCP). All patients received propofol mediated sedation. Ramsay sedation score (RSS) was used as a clinical sedation score to assess the depth of sedation. Participants were attached to a BIS monitor. Perioperative hemodynamics, BIS values, the mean dose of propofol, procedure duration, apnea, frequency of oxygen desaturation and airway-related interventions, as well as demographic parameters, were recorded. BIS scores were blinded to RSS data. Results: The study sample consisted of 60 patients (36 females) aged 18 to 50 years (mean: 36.10±8.02). The mean procedure time and the dose of propofol were 32.70±1.79 min and 287.17±59.66 mg, respectively. The cut-off values for respiratory depression were as follows. At the 15th min of measurement, the BIS score of 60 had 96.2% sensitivity and 42.9% specificity. At the 20th min of measurement, the BIS score of 59.50 had 98.2% sensitivity and 100.0% specificity. At the 25th min of measurement, the BIS score of 59.00 had 98.3% sensitivity and 50.0% specificity. Regression analysis showed that the mean BIS score (p=0.000, 95%CI-0.110-0.043) increased by 0.076 with a unit increase in the RSS. Conclusion: BIS was highly correlated with RSS, and therefore, can be used to avoid respiratory depression during sedation.

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<p>Propofol sedation in colonoscopy: from satisfied patients to improved quality indicators</p>

Cited by 17 publications

References 22 publications

The Impact of Sedation on Adenoma Detection Rate and Cecal Intubation Rate in Colonoscopy

The Impact of Sedation on Adenoma Detection Rate and Cecal Intubation Rate in Colonoscopy

Caffeine reverses the unconsciousness produced by light anesthesia in the continued presence of isoflurane in rats

Can Bispectral Index Monitoring (EEG) be an early predictor of respiratory depression under deep sedation during endoscopic retrograde cholangiopancreatography?

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