medigraphic.com
ISSN 1726-6718 (Electronic)
Revista Cubana de Anestesiología y Reanimación

2015, Number 1

<< Back Next >>

Revista Cubana de Anestesiología y Reanimación 2015; 14 (1)

Conscious sedation for outpatient colonoscopy

Hernández CJJ, Cordero EI, Rivero MM, Fernández NMA, Mora DI

Language: Spanish
References: 44
Page: 13-28
PDF size: 155.62 Kb.


ABSTRACT

Introduction: endoscopic procedures with conscious sedation play an important role in the diagnosis and treatment of digestive system diseases.
Objectives: identify whether there are differences between the use of ketamine or fentanyl associated with propofol in outpatient colonoscopy.
Methods: a case series study was conducted in patients for elective outpatient colonoscopy. They were divided into two groups. In both, propofol was administered in induction. In Group F, 50 µg of fentanyl was administered and patients in Group K had ketamine 0.3 mg / kg-1. Maintenance was performed with continuous infusions. The intraoperative hemodynamic performance was evaluated in five moments. Recovery characteristics, patient satisfaction and postoperative side effects were determined.
Results: age and sex behaved homogeneously. ASA II was more frequent. Heart rate showed significant differences with respect to time and group. SBP and DBP were stable. Recovery was rapid both groups; however, Group K had much better quality. The degree of satisfaction was not significantly different between groups (p= 0.337). Adverse effects were mild and more frequent in Group F.
Conclusions: colonoscopy is a procedure to be performed under conscious sedation, as there is stability in heart rate and blood pressure. Anesthetic recovery was faster and better satisfaction in Group K. Postoperative side effects and complications were more frequent in Group F.


REFERENCES

  1. Ferran González-Huix L, Giné Galab JJ, Loras Alastrueyc C, Martinez Bauerd E, Dolz Abadia C, Gómez Olivaf C, Llach Vilag J. Position statement of the Catalan Society of Digestology on sedation in gastrointestinal endoscopy. Gastroenterol Hepatol. 2012. Elsevier España. pp. 12-35.

  2. Pasricha PJ. Gastrointestinal endoscopy. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia. Saunders Elsevier; 2011:chap 136. pp. 89-122.

  3. Carter D, Lahat A, Papageorgiou NP, Goldstein S, Eliakim R, Bardan E. Comparison of procedural sequence in same-day consecutive bidirectional endoscopy using moderate sedation: A prospective randomized study. J Clin Gastroenterol. 2013;24(1):51-62.

  4. Weinstock LB, Cohen AM, Volotsky GR. How deep should "deep sedation" be? Am J Gastroenterol. 2007;102(4):906-7.

  5. Mishra LD, Bharati S. Monitored anaesthesia care for colonoscopies. Acta Anaesthesiol Scand. 2007;51(3):382.

  6. Crandall WV, Halterman TE, Mackner LM. Anxiety and pain symptoms in children with inflammatory bowel disease and functional gastrointestinal disorders undergoing colonoscopy. J Pediatr Gastroenterol Nutr. 2007;44(1):63-7.

  7. Van Natta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol. 2006;101(10):2209-17.

  8. Olivé González JB, Machado Álvarez M, Olazábal García E, Nodal Ortega J, Quintana Pajón I, Sánchez Hernández E. Anestesia para colonoscopia diagnóstica y terapéutica. Resultados de 9 años de trabajo. Rev Cubana Anest Rean. 2012 [Citado: 2 diciembre 2013];11(3): Disponible en: http://bvs.sld.cu/revistas/scar/vol11_3_12/ane07312.htm

  9. López-Andrade A, Prieto-Cuéllar M, García-Sánchez MJ, Martín-Ruiz JL. Sedación de pacientes en las técnicas dolorosas diagnósticas y terapéuticas: supuestos clínicos. Rev Soc Esp Dolor. 2004;8:15-23.

  10. Weinstock LB, Cohen AM, Volotsky GR. How deep should "deep sedation" be? Am J Gastroenterol 2007;102(4):906-7.

  11. Chatman N, Sutherland JR, van der Zwan R, Abraham N. A survey of patient understanding and expectations of sedation/anaesthesia for colonoscopy. Anaesth Intensive Care. 2013;41(3):369-73.

  12. Koshy G, Nair S, Norkus EP, Hertan HI, Pitchumoni CS. Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. Am J Gastroenterol. 2000;95:1476-9.

  13. Poulos JE, Kalogerinis PT, Caudle JN. Propofol compared with combination propofol or midazolam/fentanyl for endoscopy in a community setting. AANA J. 2013;81(1):31-6.

  14. Wernli KJ, Inadomi JM. Anesthesia for colonoscopy: too much of a good thing? JAMA Intern Med. 2013;173(7):556-8.

  15. Chelazzi C, Consales G, Boninsegni P, Bonanomi GA, Castiglione G, De Gaudio AR. Propofol sedation in a colorectal cancer screening outpatient cohort. Minerva Anestesiol. 2009;75(12):677-83.

  16. Tzabar Y, Brydon C, Gillies GW. Induction of anesthesia with midazolam and a target-controlled propofol infusion. Anaesthesia. 2005;51:536-8.

  17. Chiang MH, Wu SC, You CH, Wu KL, Chiu YC, Ma CW, Kao CW, Lin KC, Chen KH, Wang PC, Chou AK. Target-controlled infusion vs. manually controlled infusion of propofol with alfentanyl for bidirectional endoscopy: a randomized controlled trial. Endoscopy 2013;45(11):907-14.

  18. Van Natta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol. 2006;101(10):2209-17.

  19. Akcaboy ZN, Akcaboy EY, Albayrak D, Altinoren B, Dikmen B, Gogus N. Can remifentanyl be a better choice than propofol for colonoscopy during monitored anesthesia care? Acta Anaesthesiol Scand. 2006;50(6):736-41.

  20. Mishra LD, Bharati S. Monitored anaesthesia care for colonoscopies. Acta Anaesthesiol Scand. 2007;51(3):382.

  21. Crandall WV, Halterman TE, Mackner LM. Anxiety and pain symptoms in children with inflammatory bowel disease and functional gastrointestinal disorders undergoing colonoscopy. J Pediatr Gastroenterol Nutr. 2007;44(1):63-7.

  22. Bielawska B, Day AG, Lieberman DA, Hookey LC. Risk factors for early colonoscopic perforation include non-gastroenterologist endoscopists: a multivariable analysis. Clin Gastroenterol Hepatol. 2014;12(1):85-92.

  23. Banqueri MR. Anestesia y colonoscopia. En línea. [Consultado: 8 enero 2014]. Disponible en: http://www.anestesiados.com/anestesia-y-colonoscopia/

  24. Pecasse L. La colonoscopia y la sedación con midazolam. En línea. [Consultado: 28 de diciembre de 2013]. Disponible en: http://www.zonade.com/accues/accusev/cronica/colonosc.htm

  25. Wernli KJ, Inadomi JM. Anesthesia for colonoscopy: too much of a good thing? JAMA Intern Med. 2013;173(7):556-8.

  26. Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med. 2013;173(7):551-6.

  27. Roigé J, Sabaté S, Villalonga A, Canet J, Escolano F, Pacheco M. Anestesia para exploraciones y procedimientos no quirúrgicos en Cataluña, año 2003 . Medicina Clínica. 2006 [Citado: 09 de enero de 2013];126(2):1-79. Disponible en: http://www.sciencedirect.com/science/article/pii/S0025775306721248

  28. Plummer JM, Mitchell DI, Ferron-Boothe D, Meeks-Aitken N, Reid M. Colonoscopy in central Jamaica: results and implications. West Indian Med J. 2012;61(6):610-4.

  29. Mulhall AM, Jindal SK. Massive gastrointestinal hemorrhage as a complication of the Flexi-Seal fecal management system. Am J Crit Care. 2013;22(6):537-43.

  30. Cooper GS. Cardiac arrests during endoscopy with anesthesia assistance -reply. JAMA Intern Med. 2013;173(17):1660.

  31. Goudra BG, Singh PM. Cardiac arrests during endoscopy with anesthesia assistance. JAMA Intern Med. 2013;173(17):1659-60.

  32. de Roux SJ, Sgarlato A. Upper and lower gastrointestinal endoscopy mortality: the medical examiner's perspective. Forensic Sci Med Pathol. 2012;8(1):4-12.

  33. Auroy Y, Benhamou D, Péquignot F, Jougla E, Lienhart A. [Survey of anaesthesia-related mortality in France: the role of aspiration of gastric contents]. Ann Fr Anesth Reanim. 2009;28(3):200-5.

  34. Araujo SE, Degrandi R, Martins JA. Fatal complication of gastric tear at diagnostic colonoscopy with deep sedation. Endoscopy. 2007;39 Suppl 1:E75-6.

  35. Bielawska B, Day AG, Lieberman DA, Hookey LC. Risk factors for early colonoscopic perforation include non-gastroenterologist endoscopists: a multivariable analysis. Clin Gastroenterol Hepatol. 2014;12(1):85-922.

  36. Dominitz JA, Baldwin LM, Green P, Kreuter WI, Ko CW. Regional variation in anesthesia assistance during outpatient colonoscopy is not associated with differences in polyp detection or complication rates. Gastroenterology. 2013;144(2):298-306.

  37. Hsieh TK , Hung L, Kang FC, Lan KM, Poon PW, So EC.Anesthesia does not increase the rate of bowel perforation during colonoscopy: a retrospective study. Acta Anaesthesiol Taiwan. 2009;47(4):162-6.

  38. Boustière C. Complications of routine digestive endoscopy. Rev Prat. 2008;58(7):701-5.

  39. Pham BV, Raju GS, Ahmed I, Brining D, Chung S, Cotton P, Gostout CJ, Hawes RH, Kalloo AN, Kantsevoy SV, Pasricha PJ. Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device: feasibility and outcome in a porcine model (with video). Gastrointest Endosc. 2006;64(1):113-9.

  40. Kimmey MB. Complications of gastrointestinal endoscopy. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010. chap 40. Pp. 120-33.

  41. Kipple JC. Bilateral tension pneumothoraces and subcutaneous emphysema following colonoscopic polypectomy: a case report and discussion of anesthesia considerations. AANA J. 2010;78(6):462-7.

  42. Nagler J, Hammarth PM, Poppers DM. Seizures in an Alzheimer's disease patient as a complication of colonoscopy premedication with meperidine. Dig Dis Sci. 2008;53(1):62-4.

  43. Koniaris LG, Wilson S, Drugas G, Simmons W. Capnographic monitoring of ventilatory status during moderate (conscious) sedation. Surg Endosc. 2003;17(8):1261-5.

  44. Fagà E, De Cento M, Giordanino C, Barletti C, Bruno M, Carucci P, De Angelis C, Venon WD, Musso A, Reggio D, Fagoonee S, Pellicano R, Ceretto S, Ciccone G, Rizzetto M, Saracco G. Safety of propofol in cirrhotic patients undergoing colonoscopy and endoscopic retrograde cholangiography: results of a prospective controlled study. Eur J Gastroenterol Hepatol. 2012;24(1):70-6.




2020     |     www.medigraphic.com