Routine versus as needed sedation for colonoscopy (CS) in self-selected Americans

D. Rex, V. L. Portish

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Background: Sedation (S) causes most of the adverse reactions to CS and increases its cost. Anecdotal reports indicate that unsedated CS is successful in some pts, but U.S. physicians seem reluctant to offer it. We initiated a randomized controlled trial to compare pain and satisfaction scores and willingness to return to the same MD after an attempt at unsedated CS in pts willing to consider it. Methods: Over a 14 week interval, one MD performed 294 CS. 54 pts were excluded (17inpts, 26 same day CS & EGD, 11 miscellaneous reasons) The remaining 240 patients, were invited to be randomized to routine sedation (RS), consisting of S before CS with additional S as needed vs S only as needed (PRN). 65 (27%) (49 males) gave consent and 33 were randomized to RS, 32 to PRN. 158 (61 males) refused, stating they preferred S. 17 refused (12 males) preferring no S and 16 of these completed CS to the cecum without S. Results: Males were more likely than females to consent (45% vs 14%; p<.0011. 4 in RS and 3 in PRN had segmental colon resections. All 65 CS were complete to the cecum. Two PRN pts required S. RS pts received a mean dose of 58mg Demerol and 2.6mg Versed. Mean time to cecum was shorter in RS (4.6min) than PRN (8min)(p<.001). In the RS arm, 2,5 and 9 pts did not remember the exam immediately after, at discharge and 48 h later. Mean pain scores (1=don't remember; 2=minimal; 7=intolerable) immediately after CS, at discharge and 48 h later were 2.03, 1.84, 1.78 in RS and 2.45, 2.39, 2.34 in PRN. Excluding pts who did not remember, mean scores at all 3 time points were lower in RS (p=.007, .002, and .03), although no pt had a score above 3 (moderate discomfort; could repeat with same S) at discharge or 48h. MD's mean pain score (1=none; 5=pt complained bitterly) in RS was 2 and PRN 2.5 (p=.002). Diaphoresis occurred in 3 in RS, 2 in PRN. Mean max drop in SBP was 21 mmHg in RS and 12 in PRN (p=.003). In RS 8 needed supplemental O2 vs. none in PRN(p=.003). Mean time to discharge after CS was 10.6 min in PRN and 54.3 min in RS (p<.001). Charges for RS averaged $103.00 higher than PRN. At 48h 33 RS pts were "very satisfied". In PRN 30 were "very satisfied" and 2 were "somewhat satisfied". All 65 said they would return to same MD. Summary: About 1/3 of Americans will consider CS without S (27%) or request it (7%). Men are more likely to be willing to try unsedated CS. Willing pts complete CS without S in > 90% of attempts. Unsedated CS results in more pain but comparable satisfaction, less hypoxemia and hypotension and lower charges. Conclusion: An attempt at unsedated CS is acceptable to a significant minority of Americans, particularly males. In such pts unsedated CS can be attempted with minimal loss of satisfaction, with lower charges and without fear of losing the pt to another practice.

Original languageEnglish (US)
Pages (from-to)AB58
JournalGastrointestinal endoscopy
Volume47
Issue number4
StatePublished - Dec 1 1998

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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