Tuesday, October 04, 2011

How to keep the French calm during colonoscopies

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.

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 colonoscopykaleidoscope and cloudscape.  Both seem apt terms for someone who has been sedated.

* 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.


Anonymous said...

From a gastroenterologist at the VA in Los Angeles:

Anonymous said...

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.