RESUMEN
BACKGROUND: Patients who have a colonoscopy performed in the United States are usually given moderate to deep sedation. OBJECTIVE: We report our prospective experience with patients willing to have colonoscopy performed without analgesia or sedation. DESIGN: From June 6, 2006, to December 7, 2006, a total of 2091 patients underwent colonoscopy in our ambulatory endoscopy unit and were offered their procedure with sedation or no sedation. SETTING: Single-center outpatient ambulatory surgery unit. PATIENTS: Consecutive patients who had colonoscopy in our outpatient unit, excluding those who had combined-procedure EGD and colonoscopy. INTERVENTIONS: Patients who elected to start colonoscopy without medications could request medication at any point during the procedure. Those who requested medication received narcotics or benzodiazepines. MAIN OUTCOMES MEASUREMENTS: Time to cecum, extent of examination, pain level experienced, and willingness to have the procedure with the same, more, or less medication in the future were evaluated. RESULTS: A total of 578 patients (27.6%) chose to start without sedation; 470 of those (81.1%, 95% CI, 77.9%-89.3%) completed the examination without medication, 353 men (85%, 95% CI, 84.0%-90.5%) and 117 women (67%, 95% CI, 59.6%-73.4%). Cecal intubation was 1501 of 1512 (99.3%, 95% CI, 98.7%-99.6%) for medicated, 467 of 470 (99.4%, 95% CI, 98.1%-99.8%) for unsedated, and 107 of 108 (99.1%, 95% CI, 93.5%-99.5%) for those who were medicated during the procedure. A total of 458 of the 470 unsedated patients (97.4%, 95% CI, 95.6%-98.5%) were satisfied with their comfort level during the procedure and are willing to have their next colonoscopies without sedation. LIMITATIONS: The study is not randomized or blinded. CONCLUSIONS: Colonoscopy without sedation is feasible, effective, and well tolerated in a typical U. S. population.
Asunto(s)
Colonoscopía/métodos , Satisfacción del Paciente , Sedación Consciente , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Endoscopía Gastrointestinal , Pancreatitis Crónica/terapia , Cálculos/complicaciones , Cálculos/terapia , Colestasis/etiología , Constricción Patológica , Endosonografía , Humanos , Litotricia , Conductos Pancreáticos/patología , Seudoquiste Pancreático/etiología , Seudoquiste Pancreático/terapia , Pancreatitis Crónica/complicaciones , StentsRESUMEN
Because the definition of standard of care changes with time, it is difficult to predict whether any given technique or practice will be ultimately viewed as the next advance in care or will be discarded as unnecessary or cumbersome. It is too early to tell whether deep sedation/analgesia with propofol or some other ultrashort acting anesthetic will emerge as the sedative/analgesic of choice for routine endoscopic practice. It seems that deep sedation with propofol provides some advantages over current narcotic/benzodiazepine combinations in many circumstances, but potential risks exist. Further information, including careful documentation of the complications that occur with this and similar agents, be they attributable to the drug or the level of sedation, are eagerly awaited. For now, it seems prudent to continue to recommend that the level of sedation/analgesia be appropriate to the perceived need and that patients continue to have their procedures performed with safety, comfort, and competence as the overriding concerns.