Abstract
Purpose: To evaluate whether procedure- and patient-related factors are affected by a drug utilization change implemented at an endoscopy unit for patients undergoing EGD. Methods: A single care tertiary referral center, prospective, comparative trial was completed between November 2008 and November 2010. Consecutive, unselected adults (n = 1926) underwent routine outpatient EGDs completed by one of five experienced endoscopists. Data collection included total procedure time, induction to intubation time, intubation to extubation, extubation to discharge time, patients' perceived discomfort and medication dose received. Patients received midazolam in combination with either meperidine or fentanyl. Data were analyzed using generalized estimating equations to adjust for non-independence within endoscopist clusters. Data are presented as mean (95% Confidence Intervals). Results: Patient-centered outcomes were similar in the fentanyl and meperidine groups: procedure tolerance good-excellent: 95% (94%-97%) vs. 96% (95%-97%), respectively; no sedation-related complications or need for reversal agent use. Table 1 shows the procedure-related outcomes. Fentanyl was associated with significantly reduced total procedure time by 10.2 min (8.1-12.3) resulting from shorter induction to intubation time by 6.1 min (5.3-7.0 min) and shorter extubation to discharge time by 3.3 min (1.7-5.0). Based on dosage equivalency conversion, less fentanyl was used compared with meperidine. Midazolam dosing was marginally higher in the fentanyl group compared with the meperidine group, but this was not thought to be clinically meaningful.Table 1: . No Caption available.Conclusion: Compared to meperidine, fentanyl was associated with significantly shorter induction-to-intubation and extubation-to-discharge times without affecting the actual procedure time (intubation-to-extubation) or, patient's tolerance and safety. By improving this turn around time, the volume and efficiency of an endoscopy unit can be improved by 20%.
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