Minimizing postcolonoscopy abdominal pain by using CO2 insufflation: A prospective, randomized, double blind, controlled trial evaluating a new commercially available CO2 delivery system

Sumanac, Katica; Zealley, Ian; Fox, Bruce; Rawlinson, J.; Salena, Bruno J.; Marshall, John K.; Stevenson, Giles W.; Hunt, Richard H.

doi:10.1016/s0016-5107(02)70176-4

Cited by 137 publications

(62 citation statements)

References 18 publications

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“…While no group has reported a contrary result, in these studies, the use of CO 2 caused significantly less pain compared with air between 10 minutes (9) and 6 hours of a completed colonoscopy (6)(7)(8)11,14), although in some cases the difference is not significant one hour later (12) or 6 hours after (18) and in others remains so until 24 hours after the procedure (6,8). Two of these studies performed an abdominal radiograph at the time of completion of the exploration, finding less residual intestinal air with CO 2 insufflation (6,7).…”

Section: Discussionmentioning

confidence: 82%

“…It has been recorded all the values of pO 2 , pCO 2 and HR before, during and after the procedure. We have not found any other published study, since most of them collect data from patients who have not been sedated or have been superficially sedated (6)(7)(8)(9)(10)12,18) or in the case of patients undergoing a colonoscopy with deep sedation using propofol, pCO 2 (14) was not collected.…”

Section: Discussionmentioning

confidence: 99%

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Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol

Díez-Redondo

Gil-Simon

Alcaide-Suárez

et al. 2012

Rev. esp. enferm. dig.

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Objectives: compare the intensity of pain experienced after colonoscopy with air or with CO 2 and evaluate the safety of CO 2 in colonoscopies performed with moderate/deep sedation.Materials and methods: individuals undergoing ambulatory colonoscopy without exclusion criteria (severe respiratory disease, morbid obesity) were randomized in air or CO 2 group. We recorded different variables prior to, during and upon completion of the colonoscopy, performing monitoring using pulse oximetry and capnography. Each patient rated, using a visual numeric scale, the intensity of post-colonoscopy pain at different moments.Results: 141 individuals in the air group (sex M/F 63/78, age 24-83) and the CO 2 group (sex M/F 59/70, age 24-82). No significant differences existed in the recorded variables in both groups except for the greater number of explorations performed by an endoscopist in training (TE) in the air group compared to those by a more experienced endoscopist (SE). CO 2 in expired air, episodes of oxygen desaturation and of apnoea and dose of propofol, of midazolam were similar in both groups. No episodes of hypercapnea or any complication requiring cardiopulmonary resuscitation measures were recorded. The pain in the air group was significantly higher at 15 minutes and at 1, 3 and 6 hours after the endoscopy, equalising at 24 hours. After multivariant adjustment for type of doctor (TE vs. SE) the differences observed in pain intensity for each group were maintained.Conclusions: a) the use of CO 2 in colonoscopy causes significantly less pain in the first 6 hours after the procedure; b) its use in patients with moderate/deep sedation is safe; and c) performance of the endoscopic technique is not modified, nor are times reduced.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol

Díez-Redondo

Gil-Simon

Alcaide-Suárez

et al. 2012

Rev. esp. enferm. dig.

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“…years (2,(10)(11)(12)(14)(15)(16). These studies suggest that pain following colonoscopy might be significantly milder should insufflation result from CO 2 rather than environmental air (2,(10)(11)(12)(14)(15)(16).…”

mentioning

confidence: 88%

“…These studies suggest that pain following colonoscopy might be significantly milder should insufflation result from CO 2 rather than environmental air (2,(10)(11)(12)(14)(15)(16). Other authors have suggested that faster CO 2 elimination may reduce the need for sedation, and both exploration and patient recovery time (16).…”

mentioning

confidence: 99%

Carbon dioxide insufflation in endoscopy: Luxury or need?

Vázquez-Sequeiros

2012

Rev. esp. enferm. dig.

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“…Several studies have shown that use of carbon dioxide (CO 2 ) for insufflation during colonoscopy and endoscopic retrograde cholangiopancreatography (ERCP) reduces abdominal distension compared with insufflation of air [1,2,3]. After insufflation, air is not absorbed and must be passed from the gastrointestinal tract, which can lead to bowel distension.…”

Section: Introductionmentioning

confidence: 99%

Capnographic Monitoring during Endoscopic Submucosal Dissection with Patients under Deep Sedation: A Prospective, Crossover Trial of Air and Carbon Dioxide Insufflations

et al. 2011

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Background and Aims: The safety of carbon dioxide (CO₂) insufflation has not been fully established for esophageal and gastric endoscopic submucosal dissection (ESD) under deep sedation, because CO₂ retention is not only caused by CO₂ insufflation but also by the sedation level and the patient’s respiratory status. To clarify the clinical safety of CO₂ insufflation, we conducted a crossover trial of air and CO₂ insufflations. Methods: A total of 60 patients with early esophageal or gastric cancers underwent ESD during which insufflation was switched from CO₂ to air or from air to CO₂; transcutaneous partial pressure CO₂ (PtcCO₂) was monitored in all patients. We also assessed respiratory function, arterial blood gas analysis, and smoking history. Results: Although significant increases in PtcCO₂ from baseline were observed, there were no significant differences in PtcCO₂ levels during CO₂ insufflation compared with levels during air insufflation in groups that received CO₂ preceding air or air preceding CO₂. All patients underwent ESD safely without adverse events, including 20 patients with subclinical respiratory dysfunction. The sedation protocol was the only significant predictor of CO₂ retention, independent of CO₂ insufflation. Conclusions: CO₂ insufflation can be used as safely as air insufflation during ESD under deep sedation.

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Minimizing postcolonoscopy abdominal pain by using CO2 insufflation: A prospective, randomized, double blind, controlled trial evaluating a new commercially available CO2 delivery system

Cited by 137 publications

References 18 publications

Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol

Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol

Carbon dioxide insufflation in endoscopy: Luxury or need?

Capnographic Monitoring during Endoscopic Submucosal Dissection with Patients under Deep Sedation: A Prospective, Crossover Trial of Air and Carbon Dioxide Insufflations

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