Practice patterns of sedation for colonoscopy

Abstract

Background Sedative and analgesic medications have been routinely used for decades to provide patient comfort, reduce procedure time, and improve examination quality during colonoscopy. Objective To evaluate trends of sedation during colonoscopy in the United States Setting Endoscopic data repository of U.S. gastroenterology practices (Clinical Outcomes Research Initiative, CORI database from 2000 until 2013). Patients The study population comprised patients undergoing a total of 1,385,436 colonoscopies. Interventions Colonoscopy without any intervention or with mucosal biopsy, polypectomy, various means of hemostasis, luminal dilation, stent placement, or ablation. Main Outcome Measurements Dose of midazolam, diazepam, fentanyl, meperidine, diphenhydramine, promethazine, and propofol used for sedation during colonoscopy. Results During the past 14 years, midazolam, fentanyl and propofol have become the most commonly used sedatives for colonoscopy. Except for benzodiapenzines, which were dosed higher in women than men, equal doses of sedation were given to female and male patients. Whites were given higher doses than other ethnic groups undergoing sedation for colonoscopy. Except for histamine-1 receptor antagonists, all sedative medications were given at lower doses to patients with increasing age. The dose of sedatives was higher in colonoscopies associated with procedural interventions or of long duration. Conclusions The findings reflect on colonoscopy practice in the United States during the last 14 years, and provide an incentive for future research on how gender and ethnicity influence sedation practices.

Factors associated with polyp detection during colonoscopy: A retrospective observational study

“…In patients who require sedation during colonoscopy, propofol is used for deep sedation and midazolam/fentanyl is used for moderate sedation . Although propofol has some advantages, such as rapid induction and quick recovery, it requires administration by trained general anesthetists who can monitor the patient's clinical condition throughout the procedure .…”

“…7 In patients who require sedation during colonoscopy, propofol is used for deep sedation and midazolam/fentanyl is used for moderate sedation. 8 Although propofol has some advantages, such as rapid induction and quick recovery, it requires administration by trained general anesthetists who can monitor the patient's clinical condition throughout the procedure. 7 In contrast to propofol-based deep sedation, midazolam/fentanyl-based moderate sedation usually allows patients to maintain cardiovascular and ventilator function as well as responses to verbal or light tactile stimuli.…”

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

“…Traditionally, benzodiazepines have been used as the ondemand sedative. Despite its increasing acceptance among colonoscopists, 35 propofol has not been evaluated as the sedative agent for on-demand sedation as far as we know. Propofol has a rapid onset (< 1 min), which comes in handy for patients suffering from pain during colonoscopy.…”

Autonomous Retroflexion of a Magnetic Flexible Endoscope

“…We note that the tissue appears to fully expand into the diameter of the tube, and thus approximate the inner diameter of the colon to be that of the tube, or 47 mm. As seen in the last row of Table I, a 100% success rate was achieved with a mean maneuver duration of 19.7 s. This is approximately 1.6% of the average duration of adult colonoscopy with no intervention (21.1 ± 10.4 min [26]). During one of the trials inside the 60 mm ID tube at a no-cross height of 50 mm, the endoscope slipped and the external magnet was forced to make motions that were out of the ordinary to eventually achieve a successful retroflexion.…”