Practice recommendations for the use of sedation in routine hospital-based colonoscopy

Abstract

ObjectiveAlthough sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice.DesignWe recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus.ResultsTwenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients.ConclusionThe recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.

Women require routine opioids to prevent painful colonoscopies: a randomised controlled trial

“…Improved pain relief could, besides improved administration of moderate sedation, include either deeper sedation or better colonoscopy technique, like improved intubation technique (keeping straight scope), use of water-exchange technique and small-calibre, more flexible colonoscopes [48,49]. Though, deep sedation is not recommended for routine colonoscopies according to current consensus-based recommendations for clinical practice [12], propofol is widely used and has been shown to be associated with high patient satisfaction and short recovery [50]. Still, deep sedation has major drawbacks.…”

“…Moderate sedation combining opioids and benzodiazepines is generally recommended [9] while unsedated colonoscopy or sedation on-demand has been recommended in selected patients [10]. Nevertheless, deep propofol sedation is the standard in some parts of the world, while in other parts sedation strategies differ widely [11][12][13]. Most colonoscopies are performed sedation-free in several countries [14][15][16][17].…”

“…In addition, cultural differences may influence the endoscopist's attitude and the patient's expectation regarding medication use. A recent review of current sedation recommendations concluded that there is a lack of harmonisation regarding the recommended level of sedation and type of drugs [12].…”

Non-pharmacological interventions to improve the patient experience of colonoscopy under moderate or no sedation: a systematic review protocol

“…Additionally, the findings of our study will be of particular relevance to jurisdictions facing increasing costs of colonoscopy secondary to increased use of deep sedation. One potential driver of deep sedation use is the small patient satisfaction advantage it confers over moderate sedation 8 —synthesising the evidence and raising awareness around non-pharmacological interventions to improve the patient experience may reduce dependence on deep sedation to optimise the patient experience for routine colonoscopy.…”

“… 7 Despite the added cost, deep sedation does not provide significantly improved safety, effectiveness or efficiency for routine colonoscopy. 8 Addressing the appropriate use of deep sedation for routine colonoscopy will require additional research directed at addressing barriers to change.…”