Sex Differences in Conscious Sedation During Upper Gastrointestinal Panendoscopic Examination

Yen, Yu-Hsuan; Lin, Tzu-Fu; Lin, Chun-Chih; Lee, Yi–Chia; Lau, Hon-Ping; Yeh, Ho‐Ming

doi:10.1016/s0929-6646(11)60007-7

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…Our results for the impact of gender and fellow involvement are consistent with the relatively limited literature regarding conscious sedation for colonoscopy. Previous studies, including one from our institution, have previously shown women require higher doses of sedative medications for both upper and lower endoscopy and are more likely to report abdominal discomfort during colonoscopy 10,[14][15][16] . The study by Czwornog also showed longer procedure time for female patients, which could also explain the need for higher doses of sedative medications.…”

Section: Discussionmentioning

confidence: 93%

Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate

Cassell

Ross

Chang

et al. 2020

Sci Rep

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Guidelines to triage patients to conscious sedation (cS) or monitored anaesthesia care (MAc) for colonoscopy do not exist. We aimed to identify the cS failure rate, predictors of failure, and its impact on the adenoma detection rate (ADR). Strict (based on patient experience) and expanded (based on doses of sedative medications) definitions of CS failure were used. Patient and procedure-related variables were extracted. Multivariable logistic regression identified predictors for CS failure and the ADR. Among 766 patients, 29 (3.8%) and 175 (22.8%) patients failed CS by strict and expanded definitions, respectively. Female gender (OR 3.50; 95% CI: 1.37-8.94) and fellow involvement (OR 4.15; 95% CI: 1.79-9.58) were associated with failed CS by the strict definition. Younger age (OR 1.27, 95% CI: 1.07-1.49), outpatient opiate use (OR 1.71; 95% CI 1.03-2.84), use of an adjunct medication (OR 3.34; 95% CI: 1.94-5.73), and fellow involvement (OR 2.20; 95% CI: 1.31-3.71) were associated with failed CS by the expanded definition. Patients meeting strict failure criteria had a lower ADR (OR 0.30; 95% CI: 0.12-0.77). Several clinical factors may be useful for triaging to MAC. The ADR is lower in patients meeting strict criteria for failed cS.

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Section: Discussionmentioning

confidence: 93%

Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate

Cassell

Ross

Chang

et al. 2020

Sci Rep

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“…Thus, the same dose per body weight will result in a lower initial plasma concentration of lipophilic drugs in females [ 14 ]. It has been previously reported that females recover more quickly from anesthesia and analgesics than males [ 15 ], and Yen et al [ 16 ] noted that females required more sedatives than males to achieve optimal sedation. Some authors, however, have reported that males may be more likely to exhibit agitation during conscious sedation [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study

et al. 2017

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BackgroundConscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery.MethodsThis prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS) recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis.ResultsAlcohol intake and female sex were positively associated with the mean BIS (P<0.01). Age was negatively associated with the mean BIS (P<0.01). Body mass index (P=0.263), creatinine clearance (P=0.832), smoking history (P=0.398), glucose (P=0.718), AST (P=0.729), and ALT (P=0.423) were not associated with the BIS.ConclusionsOlder patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation.

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“…However, some data indicate that even when accounting for differences in body weight by gender, women require more sedatives during endoscopy than men to achieve similar comfort levels. 24 Further study of potential differences in sedation needs during colonoscopy between women and men are needed to clarify ideal dosing parameters for both genders, which may improve colonoscopy utilization.…”

Section: Discussionmentioning

confidence: 99%

Practice patterns of sedation for colonoscopy

Childers

Williams

Sonnenberg

2015

Gastrointestinal Endoscopy

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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.

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Sex Differences in Conscious Sedation During Upper Gastrointestinal Panendoscopic Examination

Abstract: Women need more analgesic agents than men during panendoscopic examination. There was no significant difference between men and women with regard to anesthetic depth and response to noxious stimuli, as revealed by similar SE and RE values.

Cited by 8 publications

References 18 publications

Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate

Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate

Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study

Practice patterns of sedation for colonoscopy

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