Total Intravenous versus Inhalational Anaesthesia for Colonoscopy: A Prospective Study of Clinical Recovery and Psychomotor Function

Abstract

A randomized, prospective study was conducted on 69 patients comparing recovery after two different anaesthetic techniques for ambulatory colonoscopy. Thirty-five patients received an intravenous fentanyl (1 µg/kg), midazolam (0.05 to 0.075 mg/kg) and propofol (10 to 20 mg boluses as required) combination. 34 patients received sevoflurane in 67% nitrous oxide. Drug administration was titrated to clinical signs. At baseline and 30, 60, 90 and 120 minutes after the procedure patient performance on a comprehensive battery of psychomotor tests was recorded. Emergence times were noted. Depth of sedation was assessed at 5 minute intervals for 30 minutes after the end of the procedure. Emergence times were faster in the fentanyl/midazolam/propofol group by 2.2 minutes. A lower sedation score was detected at 20 minutes in the sevoflurane/nitrous oxide group. Psychomotor impairment was of a greater magnitude and more prolonged by 30 to 90 minutes in the fentanyl/midazolam/propofol group. It is concluded that a sevoflurane/nitrous oxide anaesthetic has a suitable recovery profile for ambulatory colonoscopy and results in faster recovery of cognitive function compared with a fentanyl, midazolam and propofol combination.

Early Cognitive Impairment After Sedation for Colonoscopy: The Effect of Adding Midazolam and/or Fentanyl to Propofol

“…Theodorou et al 18 demonstrated impaired performance up to 120 min after propofol/ midazolam/fentanyl or nitrous oxide/sevoflurane sedation for colonoscopy. In contrast, Moerman et al 19 found no cognitive impairment after 15 min in colonoscopy patients sedated with propofol or remifentanil.…”

“…However, the changes in cognitive function between discharge and baseline were not significantly different between the two groups. At discharge, 18.5% of patients were cognitively impaired to an extent equivalent to a bloodalcohol concentration of 0.05%. Sedation with propofol plus midazolam and/or fentanyl produced better operating conditions than sedation with propofol alone and was associated with shorter procedure times.…”

Less patient discomfort by one-man colonoscopy examination

“…Patient non-compliance is an obstacle to screening and surveillance programs for colorectal cancer. Several methods had been developed to minimise patient discomfort during colonoscopic examination, such as use of relaxing music, electroacupuncture, conscious sedation and general anaesthesia (12)(13)(14)(15). Benzodiazepines and opiates are commonly used for sedation.…”

Statistical and conceptual issues in defining post-operative cognitive dysfunction

“…It may delay time to recovery landmarks such as discharge from intensive care to ward and home readiness, it may result in poorer pain management or failure to complete the important cardiac rehabilitation programs that follow CABG surgery. Consequently, the meaningfulness of POCD may be better understood by identifying relationships between POCD and factors such as extended hospitalization, prolonged recovery of function, poor compliance with post-operative instruction and even an increased likelihood of re-admission [15,26,31].…”