One year experience with computer-assisted propofol sedation for colonoscopy

Abstract

AIMTo report our one-year experience with computer assisted propofol sedation (CAPS) for colonoscopy as the first United States Medical Center to adopt CAPS technology for routine clinical use.METHODSBetween September 2014 and August 2015, 2677 patients underwent elective outpatient colonoscopy with CAPS at our center. All colonoscopies were performed by 1 of 17 gastroenterologists certified in the use of the CAPS system, with the assistance of a specially trained nurse. Procedural success rates, polyp detection rates, procedure times and recovery times were recorded and compared against corresponding historical measures from 2286 colonoscopies done with midazolam and fentanyl from September 2013 to August 2014. Adverse events in the CAPS group were recorded.RESULTSThe mean age of the CAPS cohort was 59.9 years (48.7% male); 31.3% were ASA I, 67.3% ASA II and 1.4% ASA III. 45.1% of the colonoscopies were for screening, 31.5% for surveillance, and 23.4% for symptoms. The mean propofol dose administered was 250.7 mg (range 16-1470 mg), with a mean fentanyl dose of 34.1 mcg (0-100 mcg). The colonoscopy completion and polyp detection rates were similar to that of historical measures. Recovery times were markedly shorter (31 min vs 45.6 min, P < 0.001). In CAPS patients, there were 20 (0.7%) cases of mild desaturation (< 90%) treated with a chin lift and reduction or temporary discontinuation of the propofol infusion, 21 (0.8%) cases of asymptomatic hypotension (< 90 systolic blood pressure) treated with a reduction in the propofol rate, 4 (0.1%) cases of marked agitation or discomfort due to undersedation, and 2 cases of pronounced transient desaturation requiring brief (< 1 min) mask ventilation. There were no sedation-related serious adverse events such as emergent intubation, unanticipated hospitalization or permanent injury.CONCLUSIONCAPS appears to be a safe, effective and efficient means of providing moderate sedation for colonoscopy in relatively healthy patients. Recovery times were much shorter than historical measures. There were few adverse events, and no serious adverse events, related to CAPS.

Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis

“…Of the finalized studies, one was a RCT [8] and 10 were cohort studies [1,6,7,[9][10][11][12][13][14][15]. Risk of bias assessment is shown in Supplementary Table 2 and Supplementary Table 3 for RCT and cohort studies, respectively.…”

“…Eight studies used midazolam and fentanyl specifically for OBS. [1,6,[9][10][11][12][13]15] The total number of patients in both groups was 177,016 (148753 and 28263 in OBS and PS groups, respectively). Both groups (OBS vs PS) were similar in terms of age (range 55.4-64 and 56.7-67) and male gender (53.2 % vs 50.9 %).…”

“…[1,5] A recent meta-analysis that compared PS with OBS did not reveal any statistically significant increase in patient satisfaction (RR = 0.94, 95 % CI 0.86-1.04), physician satisfaction (RR = 0.35, 95 % CI 0.02-6.95), and recovery time (mean difference =-6.77, 95 % CI-16.21-2.67) [5]. Randomized controlled trials (RCTs) and cohort studies comparing use of OBS vs PS for colonoscopy have shown varying results in terms of differences in ADR, PDR, AADR, and CIR [6][7][8][9][10][11][12][13][14][15]. To further clarify these outcomes, we conducted a systematic review and meta-analysis of these studies to determine whether PS in comparison to OBS improves the aforementioned quality metrics.…”

Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study*

“…Among the studied models, propofol administration using target-controlled infusion (TCI) systems is emerging as an attractive alternative for anaesthetist-managed sedation. Through the use of microprocessor-controlled infusion pumps, the infusion rate is dynamically titrated to achieve plasmatic or effect site 'targeted' concentrations [10]. Over the past 5 years at our institution most gastrointestinal endoscopies have been performed under propofol TCI sedation administered by anaesthetists.…”

Are Gastrointestinal Endoscopic Procedures Performed by Anesthesiologists Safer Than When Sedation is Given by the Endoscopist?

“…We reported our early experience in an anesthesiology journal 30 and large series of patients undergoing colonoscopy and endoscopy demonstrating success and complication rates comparable with patients who had previously had procedures with MAC. 31,32 Patient and endoscopist satisfaction were dramatically higher, and recovery times were significantly shorter. In total, we used CAPS in more than 20,000 patients with no major anesthesia-related complications before its removal from the market.…”