Sa1143 Monitored Anesthesia Care Versus Conscious Sedation for Common Endoscopic Procedures. A Prospective Patient Satisfaction and Procedure Outcome Study

Abstract

Background Sedation for endoscopic procedures induced with opioid and benzodiazepine combination is called conscious sedation (CS) and defined by The American Society of Anesthesiology (ASA) to be moderate sedation.Sedation for endoscopic procedures induced with propofol as the main anesthetic is called Monitored Anesthesia Care (MAC) and defined by the ASA to be deep sedation. This is generally administered by an anesthesiologist.In this prospective study we collected data directly from patients undergoing endoscopic procedures.We compared patient satisfaction and overall procedural outcome in two different modes of sedation. Methods:473 patients were enrolled in this prospective study at two community hospitals. Inclusion criteria were adult patients undergoing EGD or colonoscopy and able to complete the survey form. Patients with ASA score above 3 and undergoing other GI procedures were excluded. Hospital A exclusively used MAC and hospital B exclusively used CS. Group A at Hospital A enrolled 259 patients who received deep sedation with propofol as the main anesthetic, which was administered and monitored by an anesthesiologist. Group B at Hospital B enrolled 214 patients who received conscious sedation (CS) using a combination of midazolam and fentanyl administered by the endoscopist. Patient satisfaction surveys were completed once patients were out of sedation and prior to discharge. Results : Pain at drug administration site in group A was 22% as compared to 7% in group B. However, abdominal discomfort and pain was 20.46% in group A which was higher in group B at 32.71%. Interestingly, there was no difference in gagging/choking sensation during EGD in both groups with incidence of 22%. In Group A, 98.06% patient reported adequate pain control in contrast to 89.71% in comparison group B. It was noted that post procedure recovery time from the conscious sedation group was 13.80 minutes as compared to 23.15 minutes in MAC group. Overall patient satisfaction rate was 96.91% in group A and 97.66% in group B. Regarding revisit, 94.59% and 97.66% patients in group A and B respectively, would consider coming back for the next visit. In terms of periprocedural complications, only one patient showed transient respiratory depression in the CS group and was reversed with IV naloxone and flumazenil. Conclusion:This study compares patient satisfaction and periprocedural complications for the use of CS and MAC for common endoscopic procedures. We did not find any statistical differences between the two groups except for less recovery time in the CS group. In the MAC group there is less incidence of abdominal pain or discomfort while CS group has shown less pain at site of drug administration. Overall patient satisfaction and revisit consideration were the same in both groups.