Adequacy of Anesthesia Guidance for Colonoscopy Procedures.

Michał Jan Stasiowski,Kaja Marczak,Aleksandra Pluta,Jakub Żak,Przemysław Jałowiecki,Michał Nycz,Lech Krawczyk,Ewa Niewiadomska,Anna Missir,Izabela Szumera,Małgorzata Starzewska,Seweryn Król,Jerzy Eszyk,Beniamin Oskar Grabarek

doi:10.3390/ph14050464

Abstract

In patients undergoing colonoscopy procedures (CPs), inadequate dosing of hypnotic drugs (HD) and opioid analgesics (OA) during intravenous sedoanalgesia (ISA) may lead to intraprocedural awareness with recall (IAwR), intraprocedural (IPP) and postprocedural pain (PPP), as well as postoperative nausea and vomiting (PONV). The aim of this study was to evaluate whether the titration of HD and OA based on the observance of changing values of state entropy (SE) and surgical pleth index (SPI) (adequacy of anesthesia—AoA), state entropy alone, or standard practice may reduce the number of adverse events. One hundred and fifty-eight patients were included in the final analysis. The rate of IAwR and IPP was statistically more frequent in patients from the C group in comparison with the AoA and SE groups (p < 0.01 and p < 0.05, respectively). In turn, the rate of PPP, PONV, and patients’ and operators’ satisfaction with ISA between groups was not statistically significant (p > 0.05). Changes in hemodynamic parameters, demand for HD, and OA were statistically significant, but of no clinical value. In patients undergoing CPs under ISA using propofol and FNT, as compared to standard practice, intraprocedural SE monitoring reduced the rate of IAwR and IPP, with no influence on the rate of PPP, PONV, or patients’ and endoscopists’ satisfaction. AoA guidance on propofol and FNT titration, as compared to SE monitoring only, did not reduce the occurrence of the aforementioned studied parameters, imposing an unnecessary extra cost.

Highlights

Endoscopic procedures of the gastrointestinal tract are associated with considerable patient discomfort and pain [1,2,3]
Out of 166 patients assessed for eligibility, 158 were included in the final analysis (Figure S1 and Table S1; p > 0.05)
No statistically significant differences between the mean values of studied parameters in the postanesthesia care unit (PACU) in patients allocated to the AoA and state entropy (SE) groups were found

Summary

Introduction

Endoscopic procedures of the gastrointestinal tract are associated with considerable patient discomfort and pain [1,2,3]. In gastrointestinal endoscopy highlight the need to provide safe, painless, and anxiety-free procedures for patients, which involves sedation whenever needed [2]. The number of sedated colonoscopy procedures (CPs) is increasing [3]. It is worth mentioning that the need for ISA during CPs in the literature is still a matter of debate [4]. While ISA for CPs is a standard procedure in some countries, in others an unsedated procedure is preferred. The fact is that, in some groups of patients, sedation will always be the method of choice [5], which is especially true for patients who are younger, female, and characterized as having a difficult CP, specific indications, cardiopulmonary complications, or using opioids or benzodiazepines [6]

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Conclusion