Abstract
BackgroundRoutine fluid prescription is common practice amongst anesthesiologists caring for patients undergoing colonoscopy. However there is limited information about routine procedural fluid prescription practices of anesthesiologists in this setting. Routine fluid administration may also have important pharmaco-economic implications for the health care budget. Therefore we performed a prospective observational study assessing the fluid prescription practices of anesthesiologists caring for patients undergoing elective colonoscopy.MethodsWith Institutional Review Board approval, adult patients receiving procedural fluid intervention during elective colonoscopy were included. Data collected: size of intravenous cannula inserted, volumes of fluid administered, adverse events, procedure duration, and pharmaco-economic costs associated with fluid prescription. Anesthesiologists and gastroenterologists were blinded to the study.ResultsWe collected data on 289 patients who received fluid prescription by their attending anesthesiologist. Median patient age: 48 yrs (range 18–83), gender: 174 (60%) female; median duration of procedure: 24 minutes (range 12–48). Cannula size: 181 (63%) patients received a 22G cannula or smaller. Median volume of fluid administered during the colonoscopy was 325 ml (range 0 to 1000 ml). Median duration of the procedure: 25 minutes (range 12 to 48 minutes). Median volume of fluid administered in the post anaesthesia recovery unit: 450 ml (range 0 to 1000 ml). Fifteen patients (5%) became hypotensive during the procedure and two patients (<1%) developed hypotension in the PACU. There was no difference in the median fluid requirements between patients with hypotension and those without. Fluid volumes were strongly associated with increasing cannula diameter (p = 0.0001), however there was no association between fluid volumes administered and vasopressor use, peri-procedural adverse events, or procedure duration. At our institution fluid therapy currently cost about AUD$4.90 per patient: 1 L crystalloid $1.18 and fluid delivery set $3.77 Our institution performs over 9000 endoscopic procedures annually with fluid therapy costing about $45,000/year.ConclusionsRoutine fluid prescription by anesthesiologists managing patients undergoing colonoscopy was ineffective with low actual fluid volumes delivered during the procedure. There was no association between volumes of fluid delivered and procedural hypotension, adverse events, or procedure duration. Anesthesiologists should question the clinical and pharmaco-economic value of routine fluid administration for patients undergoing elective endoscopy.
Highlights
Routine fluid prescription is common practice amongst anesthesiologists caring for patients undergoing colonoscopy
We performed a prospective observational study assessing the routine fluid prescription practices of anesthesiologists caring for patients undergoing elective colonoscopy
One-hundred and eighty one patients (63%) received a cannula size 22 gauge or smaller; and 108 patients (37%) received a 20 gauge cannula or larger (Figure 1). All patients had their IV cannulae inserted in the procedure room before the colonoscopy procedure commenced
Summary
Routine fluid prescription is common practice amongst anesthesiologists caring for patients undergoing colonoscopy. We performed a prospective observational study assessing the fluid prescription practices of anesthesiologists caring for patients undergoing elective colonoscopy. Intravenous (IV) fluid administration for patients undergoing colonoscopy is common practice amongst anesthesiologists despite the lack of evidence for reduction of intra-procedural hypotension or post-procedural morbidity outcomes [4]. Fluid administration in this setting allows a continuous flush line for the administration of anesthesia drugs, and may facilitate faster recovery and promote patient satisfaction. We performed a prospective observational study assessing the routine fluid prescription practices of anesthesiologists caring for patients undergoing elective colonoscopy
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