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| Appendiceal orifice |
I was intrigued by a tweet from @amcunningham referring to a French study of patient-controlled sedation during colonoscopies. The article is a bit dated, from 2005, but nonetheless interesting. Here are some excerpts:
Patients aged from 18 to 80 scheduled for elective colonoscopy were prospectively randomized to receive either standard sedation (control group) or patient-controlled-sedation (PCS). In the control group, patients received a continuous infusion of propofol. Patients in the PCS group were connected to an infusion pump containing propofol and self-administered 20-mg boluses as often as they required.
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| Ileocecal valve |
Mean doses of propofol (60 mg vs. 248 mg, depth of sedation and time before discharge (1.75 hours vs. 4.45 hours) were significantly lower for patients in the PCS group; nine of them (25.7%) did not use the pump and had total colonoscopy without sedation.
Two weeks after the procedure, 96.5% of patients in the PCS group were willing to repeat the examination under the same conditions vs. 72.5% of patients in the control group.
The conclusion: Our results demonstrate that need of sedation is widely overestimated in France.
During my 2009 colonoscopy (pictures included here), fentanyl was the sedative of choice. I remember feeling after-effects even the next day and recall wondering at the time whether there could be a way I could participate in the dosing.*
By the way, the spell-check on blogger.com gives the following substitutes for colonoscopy: kaleidoscope and cloudscape. Both seem apt terms for someone who has been sedated.
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* I understand that there are strong feelings about the relative merits of propofol versus midazolam plus fentanyl. Here is one study on the matter, and here is an on-line chat, which also gets into whether any sedation is necessary at all.
2 comments:
From a gastroenterologist at the VA in Los Angeles:
http://www.ncbi.nlm.nih.gov/pubmed?term=sedationless%20colonoscopy
It all depends on what cecal intubation rate is acceptable. I have done over 15,000 colonoscopies, a few dozen of which have been sedationless. With a highly motivated patient who has a great degree of self-control, along with favorable anatomy, it is not a problem. For most people, sedation makes the procedure faster, with a higher rate of cecal intubation.
No studies dispute this point. The study we need is a comparison of adenoma detection rates in sedated versus unsedated patients.
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