Evaluation of Different Sedatives for Colonoscopy

Abstract

Background & Aims: Sedation and analgesia are important elements of endoscopic examinations; sedation for colonoscopy aims to relieve patient discomfort and anxiety, improve the outcome of the examination, diminish the patient’s memory of the event and achieve comfortable and technically successful endoscopic procedure. Methods: Our prospective study was carried out on 150 patients who were referred for colonoscopy; they were divided into two groups based on the pre-endoscopic sedation given for them: propofol fentanyl or propofol ketamine. Detailed histories, thorough physical examinations, and routine laboratory investigations were performed for all patients, along with monitoring of their vital signs and oxygen saturation levels (before, during and after colonoscopy), to assess safety, efficacy, recovery times, complications of the sedative drugs, comfort of the patients and endoscopists. Results: There was no statistically significant difference between the two groups in terms of age, sex and Body Mass Indexes (BMI). With respect to their Mean Arterial Blood Pressures (MAPs) and heart rates, there was high hemodynamic stability in the propofol ketamine group, and both the groups were efficacious, although the propofol fentanyl group had shorter recovery times than the propofol ketamine group (3±1.7 minutes and 4±2.8 minutes, respectively). However, nausea, vomiting and hypoxia were common in the propofol fentanyl group, while hallucinations were common in the propofol ketamine group. In propofol fentanyl group; there was a significant decrease in the heart rate more common in females (with age range 39-58 years) during and after colonoscopy [p value 0.01]. Conclusion: Sedation with propofol ketamine during colonoscopy was found to be safe and efficacious to achieve hemodynamic stability with fewer complications than propofol fentanyl.

Characteristics and main risk factors correlated to nausea and vomiting after painless digestive endoscopy

“…Among them,4.2% patients had nausea with or without vomiting and 2.9% patients had vomiting with or without nausea. The incidence of nausea or vomiting in our study is relatively lower than other similarly endoscopic studies [4,5]. It is obviously that the incidence of nausea is higher than the incidence of vomiting after this painless inspection.…”

The Efficacy and Safety of Remimazolam Tosilate versus Etomidate-Propofol in Elderly Outpatients Undergoing Colonoscopy: A Prospective, Randomized, Single-Blind, Non-Inferiority Trial

“…However, drug interactions may change the pharmacological effects of individual drugs and increase the occurrence of adverse reactions. 22 Remimazolam, a recently developed ultrashort-acting benzodiazepine, shows a high affinity to GABA receptors and increases the frequency of chloride channel opening in the cerebral cortex, limbic system, midbrain, brainstem, and spinal cord. 23,24 The pharmacokinetics and pharmacodynamics of RT are similar to those of remimazolam.…”

Adequacy of Anesthesia Guidance for Colonoscopy Procedures

“…In the current study, the risk of PONV was equal in each group, as expressed by the Apfel score ( Table 3 ), and despite the group allocation, only 3 patients out of 158 included in the final analysis suffered from PONV: two from the control group (3.8%), one from the AoA group (1.9%), and none from the SE group, which did not prove statistically significant ( p = 0.25). Seleem et al [ 38 ], in a study concerning different intravenous anesthesia modalities in patients undergoing CP, found that 28 out of 75 patients receiving propofol with FNT complained of PONV, as compared to 8 out of 75 patients receiving propofol with ketamine, which was statistically significant ( p = 0.0001). In comparison to the current study findings, they achieved poorer outcomes, probably due to the fact that they titrated FNT according to the observance of hemodynamic parameters, which may not necessarily properly reflect the demand for OA [ 38 ].…”

“…Seleem et al [ 38 ], in a study concerning different intravenous anesthesia modalities in patients undergoing CP, found that 28 out of 75 patients receiving propofol with FNT complained of PONV, as compared to 8 out of 75 patients receiving propofol with ketamine, which was statistically significant ( p = 0.0001). In comparison to the current study findings, they achieved poorer outcomes, probably due to the fact that they titrated FNT according to the observance of hemodynamic parameters, which may not necessarily properly reflect the demand for OA [ 38 ]. Bergmann et al [ 39 ] found no difference between the groups with regard to the rate of IawR using the anesthetic remifentanil/propofol-based modalities with SE only versus AoA guidance in outpatient arthroscopic orthopedic anesthesia.…”