Pain Relief for Outpatient Colonoscopy: A Comparison of Alfentanil with Fentanyl

Am, Holloway; Da, Logan

doi:10.1177/0310057x9001800209

Cited by 9 publications

(8 citation statements)

References 11 publications

(2 reference statements)

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“…In an earlier study, Holloway et al [18] showed that patients undergoing conscious sedation for colonoscopy with midazolam and alfentanil had better operating conditions compared with midazolam and fentanyl, but the recovery time was similar. The mean doses of alfentanil and fentanyl were low, 0.541 mg and 0.064 mg respectively.…”

Section: Discussionmentioning

confidence: 99%

Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Yen

Lan

et al. 2012

BMC Gastroenterol

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BackgroundThere is increasing interest in balanced propofol sedation (BPS) titrated to moderate sedation (conscious sedation) for endoscopic procedures. However, few controlled studies on BPS targeted to deep sedation for diagnostic endoscopy were found. Alfentanil, a rapid and short-acting synthetic analog of fentanyl, appears to offer clinically significant advantages over fentanyl during outpatient anesthesia.It is reasonable to hypothesize that low dose of alfentanil used in BPS might also result in more rapid recovery as compared with fentanyl.MethodsA prospective, randomized and double-blinded clinical trial of alfentanil, midazolam and propofol versus fentanyl, midazolam and propofol in 272 outpatients undergoing diagnostic esophagogastroduodenal endoscopy (EGD) and colonoscopy for health examination were enrolled. Randomization was achieved by using the computer-generated random sequence. Each combination regimen was titrated to deep sedation. The recovery time, patient satisfaction, safety and the efficacy and cost benefit between groups were compared.Results260 participants were analyzed, 129 in alfentanil group and 131 in fentanyl group. There is no significant difference in sex, age, body weight, BMI and ASA distribution between two groups. Also, there is no significant difference in recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between two groups. Though deep sedation was targeted, all cardiopulmonary complications were minor and transient (10.8%, 28/260). No serious adverse events including the use of flumazenil, assisted ventilation, permanent injury or death, and temporary or permanent interruption of procedure were found in both groups. However, fentanyl is New Taiwan Dollar (NT$) 103 (approximate US$ 4) cheaper than alfentanil, leading to a significant difference in total cost between two groups.ConclusionsThis randomized, double-blinded clinical trial showed that there is no significant difference in the recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between the two most common sedation regimens for EGD and colonoscopy in our hospital. However, fentanyl is NT$103 (US$ 4) cheaper than alfentanil in each case.Trial registrationInstitutional Review Board of Buddhist Tzu Chi General Hospital (IRB097-18) and Chinese Clinical Trial Registry (ChiCTR-TRC-12002575)

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Section: Discussionmentioning

confidence: 99%

Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Yen

Lan

et al. 2012

BMC Gastroenterol

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“…The dose of midazolam as recommended by Froehlich and colleagues was 0.035 mg kg 21 with or without opioids. We modified the regimen by adding alfentanil (8 mg kg 21 ) for prevention of the gag reflex in ODG and painful stimulation in colonoscopy [20][21][22]. Incremental bolus rather than target-controlled infusion was chosen because the procedures were relatively short.…”

Section: Discussionmentioning

confidence: 99%

Performance of AEP Monitor/2-derived composite index as an indicator for depth of sedation with midazolam and alfentanil during gastrointestinal endoscopy

Huang

Chu²,

Chang³

et al. 2007

European Journal of Anaesthesiology

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“…There have been no trials comparing pentazocine with other drugs. Some trials have compared analgesics that are not in standard use in colonoscopy examinations in Japan, e.g., sufentanil, 11,12 alfentanil, 13–17 remifentanil, 18,19 ketamine, 13,20 nalbuphine, 11 paracetamol, 21 and tramadol 19,22 . In three RCTs that compared midazolam + pethidine hydrochloride and midazolam + fentanyl, 8–10 safety and operator satisfaction were equivalent between the two groups.…”

Section: Cq 16: Is the Use Of Analgesics In Addition To Sedatives Effmentioning

confidence: 99%

Guidelines for sedation in gastroenterological endoscopy (second edition)

Gotoda

Akamatsu

Abe

et al. 2020

Digestive Endoscopy

103

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Sedation in gastroenterological endoscopy has become an important medical option in routine clinical care. Here, the Japan Gastroenterological Endoscopy Society and the Japanese Society of Anesthesiologists together provide the revised "Guidelines for sedation in gastroenterological endoscopy" as a second edition to address on-site clinical questions and issues raised for safe examination and treatment using sedated endoscopy. Twenty clinical questions were determined and the strength of recommendation and evidence quality (strength) were expressed according to the "MINDS Manual for Guideline Development 2017." We were able to release upto-date statements related to clinical questions and current issues relevant to sedation in gastroenterological endoscopy (henceforth, "endoscopy"). There are few reports from Japan in this field (e.g., meta-analyses), and many aspects have been based only on a specialist consensus. In the current scenario, benzodiazepine drugs primarily used for sedation during gastroenterological endoscopy are not approved by national health insurance in Japan, and investigations regarding expense-related disadvantages have not been conducted. Furthermore, including the perspective of beneficiaries (i.e., patients and citizens) during the creation of clinical guidelines should be considered. These guidelines are standardized based on up-to-date evidence quality (strength) and supports on-site clinical decision-making by patients and medical staff. Therefore, these guidelines need to be flexible with regard to the wishes, age, complications, and social conditions of the patient, as well as the conditions of the facility and discretion of the physician.

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Pain Relief for Outpatient Colonoscopy: A Comparison of Alfentanil with Fentanyl

Cited by 9 publications

References 11 publications

Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Performance of AEP Monitor/2-derived composite index as an indicator for depth of sedation with midazolam and alfentanil during gastrointestinal endoscopy

Guidelines for sedation in gastroenterological endoscopy (second edition)

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