Higher Sedation Requirements Among Inflammatory Bowel Disease Patients Undergoing Colonoscopy for Disease Activity Assessment or Dysplasia Surveillance

Abstract

Abstract Background and Aims Patients with inflammatory bowel disease (IBD) require colonoscopy for diagnosis, disease activity assessment, and dysplasia surveillance. Few studies have evaluated anesthesia needs of IBD patients during procedures. This study aimed to examine sedation requirements of IBD patients undergoing colonoscopy. Methods A retrospective cohort study of IBD and non-IBD patients presenting for colonoscopy between August 2015 and December 2016 was undertaken. Data collected included patient and procedure focused variables. Sedation was categorized as intravenous conscious sedation (IVCS) or monitored anesthesia care (MAC). Results: A total of 522 consecutive colonoscopies (212 IBD, 310 non-IBD) between August 2015 and December 2016 met criteria for inclusion. In total, 323 cases utilized IVCS (56 IBD, 267 non-IBD) and 196 used MAC (155 IBD, 41 non-IBD). Compared with non-IBD patients (13.2%), more IBD patients (73.1%) required MAC (P < 0.01). For IVCS cases, IBD patients required more midazolam (5.73 mg versus non-IBD 4.31 mg; P <0.01) and opioid (IBD 157.59 µg fentanyl equivalents versus non-IBD 119.41 µg; P < 0.01). Diphenhydramine was more frequently added to IVCS for IBD cases (IBD 25.0% versus non-IBD 1.9%; P < 0.01). For MAC cases, propofol dosage was not significantly different between groups (IBD 355.64 mg versus non-IBD 317.104 mg; P = 0.29). IBD colonoscopies took longer (IBD 22.7 versus non-IBD 17.2 min; P < 0.01) and more patients had recent narcotic use (IBD 21.2% versus non-IBD 9.0%; P < 0.01). Conclusions IBD patients required more IVCS, including greater diphenhydramine use with longer procedure times compared with non-IBD patients. These findings suggest MAC should be considered for IBD procedural sedation.