Higher Propofol Dosing Rates Needed for Colonoscopy in Inflammatory Bowel Disease Patients Compared to Non-Inflammatory Bowel Disease Patients

Abstract

Introduction: Patients with inflammatory bowel disease (IBD) undergo frequent endoscopic procedures. Higher pain tolerance, chronic pain medication use, and presence of active inflammation may suggest higher dosing needs to sedate IBD patients. Differences in anesthesia requirements in IBD patients compared to non-IBD patients during endoscopy have not been well studied. Thus, we conducted a retrospective study comparing anesthesia requirements in IBD vs. non-IBD patients undergoing elective outpatient colonoscopy. Methods: Patients 18 years or older undergoing elective outpatient colonoscopies using total intravenous anesthesia (TIVA) from one anesthesiologist for both IBD and non-IBD were included in the study. Patients were excluded if they were pregnant, received concurrent upper endoscopy, received additional sedation medications, or sedated by another anesthesiologist. Age, weight, ASA score, relevant comorbidities and medications were recorded. The primary outcome was the difference in the groups of amount of propofol used per kilogram per minute of procedure time (mg/kg/min). Procedure time was defined as the moment the scope was inserted to the moment it was withdrawn from the patient. The estimated sample size for the primary outcome was 196 total patients based on a mean difference of 0.02mg/kg/min propofol use. Results: A total of 200 consecutive colonoscopies that met inclusion criteria were analyzed, 100 in the IBD group, and 100 in the non-IBD group. Baseline characteristics were similar except for age 43.8 ± 3.4 years in IBD group v 58.9 ± 2.6 years in non-IBD group (Table 1). No differences between the groups in regards to psychological comorbidities, narcotics, and benzodiazepine use were noted. Baseline characteristics of the IBD group are shown in Table 2. Propofol use was significantly greater in the IBD group 0.365 ± 0.030 mg/kg/min when compared to the non-IBD group 0.261 ± 0.021 mg/kg/min (p < 0.005). (Table 3) Conclusion: Propofol use in mg/kg/min of procedure time was significantly higher in outpatient, elective colonoscopies for IBD patients when compared to non-IBD patients. Reasons for this discrepancy may have included younger age, and possibly higher inflammatory burden. This study's results are useful for both anesthesia providers and gastroenterologists in that IBD patients may require higher doses of propofol for sedation than non IBD patients.648_A Figure 1. Baseline Characteristics between IBD and non-IBD groups648_B Figure 2. Characteristics of IBD Group648_C Figure 3. Comparison of Propofol Use Between IBD and non-IBD groups