Asunto(s)
Anticoagulantes/efectos adversos , Endoscopía Gastrointestinal/efectos adversos , Hemorragia Gastrointestinal/etiología , Inhibidores de Agregación Plaquetaria/efectos adversos , Hemorragia Posoperatoria/etiología , Anticoagulantes/administración & dosificación , Humanos , Inhibidores de Agregación Plaquetaria/administración & dosificaciónRESUMEN
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 ProspectivosRESUMEN
The practice of medicine places the practitioner at risk for accusations of malpractice. The exposure can be greater for gastroenterologists who work in a n ambulatory surgery center. Endoscopists are liable for cognitive misadventures and the risks of injury inherent in endoscopic practice. Working within a private surgery center compounds potential areas for liability. This article provides a brief overview of malpractice law and explores current data on malpractice suits against gastroenterologists. It also looks at areas that may be of potential concern to endoscopists working in ambulatory surgery centers.