Chronic Opioid Users Require More Medication to Achieve Conscious Sedation During Colonoscopy

Abstract

Introduction: Diagnostic and therapeutic colonoscopy is performed employing conscious sedation. Inadequate sedation during colonoscopy results in suboptimal examinations, dissatisfied patients, and aborted procedures. Excessive alcohol users, chronic benzodiazepine and opioid users, and poly-substance abusers are commonly cited as being difficult to sedate. Few studies have compared and analyzed medication dosages to achieve sedation in these groups. The aim of this study was to compare the medication dosages to achieve conscious sedation during colonoscopy among patient groups deemed difficult to sedate. Methods: The endoscopic database was searched for patients who underwent colonoscopy. Then, a chart review was performed to determine if each patient was either an abuser/chronic user of opioids, benzodiazepines, marijuana, alcohol, or combinations of the above. The mean dose of fentanyl and versed administered in each group were compared. Results: There were 239 patients enrolled in the study. Table 1 describes the demographic data for the six different groups. The opioid group, as compared to both the alcohol group and the group with no substance use, used a statistically higher mean medication dosage to achieve sedation, detailed in table 2.Table 1: Demographics for Study GroupConclusion: Identifying patients who are difficult to sedate prior to colonoscopy is important because adequate sedation is associated with better adenoma detection, procedural completion rate, and patient satisfaction. In our study, daily opioid users required an increased amount of sedation compared to nonsubstance users and alcohol users in patients deemed difficult to sedate. Therefore, in patients using daily opioids, it is important to anticipate the need for higher doses of medication to achieve adequate sedation during colonoscopy.Table 2: Mean Medication Dosage and Statistical Analysis of Study Groups