Significance of patient-controlled sedation during colonoscopy

Crepeau, Thomas; Poincloux, Laurent; Bonny, Corinne; Lighetto, Sylvie; Jaffeux, P.; Artigue, Fabrice; Walleckx, Pierre; Bazin, J. E.; Dapoigny, Michel; Bommelaer, Gilles

doi:10.1016/s0399-8320(05)82172-4

Cited by 45 publications

(6 citation statements)

References 21 publications

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“…There are a variety of studies on sedation applications without anaesthesia personnel in colonoscopy patients. Patient-controlled sedation (PCS) studies were conducted in which the patient determined his/her own sedation level with PCA pump[13,21]. In this method, the patients press the button when they feel uncomfortable.…”

Section: Discussionmentioning

confidence: 99%

“…The PCA pump has been used with the same logic to provide sedation rather than analgesia in several studies. There are also studies where sedation applications have been performed under the supervision of a nurse or endoscopist using these pre-programmed devices[13]. In this study, we aim to compare the application of midazolam-ketamine-propofol combination by endoscopy nurse with PCA pump and anaesthetist in terms of patient satisfaction, side effects and safety.…”

Section: Introductionmentioning

confidence: 99%

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Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy

Kayaalti

2018

WJCC

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AIMTo compare the results of midazolam-ketamine-propofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODSAmerican Statistical Association (ASA) I-II 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist (SSA) and sedation under the supervision of an endoscopy nurse (SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSA group and the nurse with a patient-controlled analgesia (PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale (VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.RESULTSTotal propofol consumption in the SSEN group was significantly higher (P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences (P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.CONCLUSIONColonoscopy sedation in ASA I-II patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy

Kayaalti

2018

WJCC

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“…The main reason for the choice of PCS is that the model includes built-in feedback, and patients adjust the doses according to their need. Self-dosing with sedatives tends to result in fewer doses of drugs being used than when anaesthetists give sedatives [16] [17]. However, overdosing can still occur with PCS.…”

Section: Discussionmentioning

confidence: 99%

Should Propofol and Alfentanil Be Combined in Patient-Controlled Sedation? A Randomised Controlled Trial Using Pharmacokinetic Simulation

Nilsson¹,

Nilsson²,

Schnider³

et al. 2015

OJAnes

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Background: Patient-controlled sedation (PCS) is increasingly used for moderate sedation. Detailed understanding is essential for maintaining safety and giving the most benefit. We wanted to explore the associations between patients' characteristics, perioperative pain and anxiety, the procedure, and the calculated concentrations at the effect site (Ce) of propofol. We also wanted to analyse the pharmacokinetic profiles of propofol and alfentanil during PCS, and their association with respiratory complications. Methods: 155 patients were double-blinded and randomised to have propofol or propofol and alfentanil for PCS during gynaecological surgery. Pharmacokinetic simulation of Ce and multiple regressions aided the search for correlations between explanatory variables and concentrations of drugs. Results: In group propofol, treatment for incontinence, anterior repair, and the patient's weight correlated the best (B-coef = 0.20, 0.20 and 0.01; r = 0.69; r 2 = 0.48). When alfentanil was added, alfentanil and the patient's weight were associated with Ce of propofol (B-coef = −0.40 and 0.01; r = 0.70; r 2 = 0.43). Logistic regression indicated that age and Ce of drugs were related to ten cases of respiratory complications. Conclusions: Patients' weights and the type of surgery performed were associated with the Ce of propofol; this knowledge could be used for refinement of the doses given during PCS. Because the pharmacokinetic profiles of propofol and alfentanil are different, the alfentanil effect becomes predominant during the time course of sedation. In order to reduce the risk of early and late respiratory depression, alfentanil should not be added to propofol in the same syringe. A. Nilsson et al.

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“…Fewer adverse events (oxygen desaturation or drop in blood pressure) were observed with PCS using propofol in comparison to diazepam 132 133 . In two of these studies, 97 % and 78 % of the patients who were sedated using PCS for colonoscopy said, if necessary, they would be willing to repeat this type of sedation 135 136 . Younger age, female sex, and lower patient satisfaction were independent factors for refusal of the PCS procedure.…”

Section: Guideline – Sedatives/analgesics/adjuvant Drugsmentioning

confidence: 99%

Updated S3 Guideline “Sedation for Gastrointestinal Endoscopy” of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) – June 2023 – AWMF-Register-No. 021/014

Wehrmann,

Riphaus,

Eckardt

et al. 2023

Z Gastroenterol

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Significance of patient-controlled sedation during colonoscopy

Cited by 45 publications

References 21 publications

Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy

Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy

Should Propofol and Alfentanil Be Combined in Patient-Controlled Sedation? A Randomised Controlled Trial Using Pharmacokinetic Simulation

Updated S3 Guideline “Sedation for Gastrointestinal Endoscopy” of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) – June 2023 – AWMF-Register-No. 021/014

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