Moderate Conscious Sedation Research Articles

Tu1584 The Efficacy and Safety of Moderate Sedation for Double-Balloon Enteroscopy

While moderate (conscious) sedation (MS) and monitored anesthesia care (MAC) are the primary methods of sedation for Double-Balloon Enteroscopy (DBE) in Japan and Europe, there is a progressive trend towards the use of MAC or general anesthesia (GA)for DBE procedures in the United States. This is in part due to concerns for patient safety, procedure tolerance, and risk of complications during lengthy procedures. Limited availability of anesthesiologists can thus significantly impact the efficiency in scheduling these procedures.

Does Level of Sedation Impact Detection of Advanced Neoplasia?

Two of the foremost issues in screening colonoscopy involve delivering quality and maximizing adenoma detection rates (ADR). Little is known about the impact of deep sedation on ADR. This study aims to compare the detection of advanced lesions during screening colonoscopy performed with moderate conscious sedation (MCS) versus deep sedation (DS). A retrospective cohort study was performed using the Clinical Outcomes Research Initiative database. Average risk screening colonoscopies performed January 2000 to December 2005 were examined for practice setting, patient demographics, and findings, including detection of a polyp >9 mm and suspected malignant lesions. A total of 104,868 colonoscopies were examined, 97% of which were performed with MCS. Univariate analysis demonstrated that more polyps of any size were detected with MCS (38 vs. 34%, p < 0.0001) and more advanced lesions were found with DS compared with MCS (7 vs. 6%, p = 0.01). When exclusively examining sites that performed DS > 10% for all procedures, a more significant increase in advanced lesion detection when using DS was observed (7.5 vs. 5.7%, p = 0.003). When adjusted for age, gender, race/ethnicity, site, prep quality, and ASA group, DS was 25% more likely to detect an advanced lesion. Our data suggest that use of DS may be associated with a higher rate of advanced lesion detection. However, this retrospective design has limitations that necessitate follow-up with prospective studies. These follow-up studies would be essential to support any change in the standard practices of sedation.

The ADA's New Emergency Airway Course For Sedationists

The ADA's New Emergency Airway Course For Sedationists

More Large Polyps Are Seen On Screening Colonoscopy with Deep Sedation Compared with Moderate Conscious Sedation

More Large Polyps Are Seen On Screening Colonoscopy with Deep Sedation Compared with Moderate Conscious Sedation

Is Immediate Pain Relief After a Spinal Injection Procedure Enhanced by Intravenous Sedation?

To determine the effect of intravenous sedation on postprocedural pain relief for patients undergoing a spinal injection procedure in which there is no expectation of immediate relief. A prospective audit to compare Visual Analog Scale (VAS) responses before and after interlaminar epidural corticosteroid injections without epidural anesthetic in those who did and did not receive intravenous sedation. This audit was undertaken in 2 interventional spine practices. A total of 102 patients were allotted to receive or not receive intravenous sedation depending on preference. Interlaminar epidural injections of corticosteroid without epidural anesthetic. Outcomes were measured by mean (VAS) scores after the procedure and mean VAS differences before and after the procedure. There were no significant differences between mean VAS scores or mean differences in VAS scores between those who did or did not receive intravenous sedation. A relatively high percentage of patients in both groups obtained greater than 50% immediate pain relief. Intravenous mild or moderate conscious sedation did not have an effect on postprocedural VAS pain scores in those receiving a therapeutic spinal injection procedure. Immediate pain relief was most likely the result of nonspecific effects.

The Accuracy of Predicting Obstructive Sleep Apnea During Colonoscopy Under Conscious Sedation

Purpose: Obstructive Sleep Apnea (OSA) is a common disorder with increasing prevalence with age. It is estimated that 93% of women and 82% of men with moderate to severe sleep apnea are not diagnosed with the disorder. Compared to normal individuals, patients with OSA are more sensitive to the effects of sedation and the disorder may in fact be unmasked by sedation. The aims of this study were to determine the predictive value of preset clinical signs and symptoms for OSA and to identify patients who may deserve prolonged monitoring after moderate conscious sedation for colonoscopy. Methods: Consecutive patients undergoing outpatient colonoscopy under conscious sedation with meperidine and midazolam were enrolled. Information about body mass index (BMI), neck circumference (NC), day sleepiness (DS), decrease vigilance (DV), mood changes were recorded as well as the oropharyngeal Mallampati score and the Epworth and the Stanford Sleepiness Scales. The endoscopist was blinded to the information prior to colonoscopy. Patients who developed audible snoring for > 10 s while in the left lateral decubitus position whilst maintaining an oxygen hemoglobin saturation of > 90% were suspected of having OSA. The total dose of sedatives used, the duration and difficulty of the procedure were recorded. After informed consent, ambulatory polysomnography was performed on suspected OSA patients and on age-and BMI-matched controls from the study cohort. Results: 131 patients were enrolled and 24 (3.1%) (22 M and 2 F) suspected of having OSA based on the above criterion. These patients had higher BMI and NC, and were more likely to have a medical history of snoring, DS, chocking or gasping sensation, DV, witnessed sleep apnea, personality and mood changes (all P < 0.05). They also had predominance of Grade III/IV Mallampati score and higher Standford and Epworth scale scores (all P < 0.01 compared with controls). There was no difference in the type or dose of sedation or in difficulty of colonoscopy but the total duration of the procedure was significantly higher compared to controls (21.2 ± 5.6 min vs. 18.1 ± 5.6 min; P= 0.01). 19 patients and 12 matched controls consented to ambulatory portable polysomnography. Moderate or severe OSA was identified in 15/19 patients and in 2/12 controls (78.9% vs. 16.7%; P < 0.01). Conclusion: Audible snoring in the left lateral decubitus position during conscious sedation for colonoscopy is highly predictive of the presence of OSA. Colonoscopy time is prolonged in these patients and may also be associated with longer recovery from sedation. Given the serious nature of OSA, such patients need to be carefully identified by the performing endoscopy team and referred for sleep medicine evaluation.

Sedation and Anesthesia in Pediatric Endoscopy: One Size Does Not Fit All

Sedation and Anesthesia in Pediatric Endoscopy: One Size Does Not Fit All

Bravo (wireless) ambulatory esophageal pH monitoring: How do day 1 and day 2 results compare?

To investigate if differences exist for patients' gastroesophageal reflux as measured by the Bravo ambulatory esophageal pH system between d 1 and d 2. A retrospective study of 27 consecutive adult patients who underwent Bravo esophageal pH monitoring was performed. Patients underwent EGD under IV conscious sedation prior to Bravo placement. Acid reflux variables and symptom scores for d 1 were compared to d 2. The mean doses of fentanyl and midazolam were 90.4 microg and 7.2 mg, respectively. D 1 results were significantly more elevated than d 2 with respect to total time pH < 4, upright position reflux, and mean number of long refluxes. No statistical difference was noted between the two days for supine position reflux, number of refluxes, duration of longest reflux, episodes of heartburn, and symptom score. Patients undergoing Bravo esophageal pH monitoring in association with EGD and moderate conscious sedation experience significantly more acid reflux on d 1 compared to d 2. The IV sedation may be responsible for the increased reflux on d 1. Performed this way, 48-h Bravo results may not be entirely representative of the patients' true GE reflux profile.

Moderate Conscious Sedation For In Vitro Fertilization Oocyte Retrieval Procedures In An Office Setting

Moderate Conscious Sedation For In Vitro Fertilization Oocyte Retrieval Procedures In An Office Setting

Moderate (Conscious) Sedation

Moderate (Conscious) Sedation

Deep Sedation Occurs Frequently During Elective Endoscopy with Meperidine and Midazolam

Although moderate (conscious) sedation is intended during elective gastrointestinal endoscopy, unintended levels of deep sedation occur. The aims of this study were to prospectively evaluate the incidence and risk factors of deep sedation during elective endoscopy with meperidine and midazolam intended to maintain a level of moderate sedation. Eighty American Society of Anesthesiology class 1-2, outpatients presenting for elective esophagogastroduodenoscopy (EGD), colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasonography (EUS) were offered enrollment. Intravenous meperidine and midazolam were administered according to a standardized protocol. Hemodynamic parameters and levels of sedation were assessed and recorded by a single observer at 3-min intervals. The Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale (ranging 1-5) is a subjective sedation assessment scale used to assess sedation levels. Occurrence of deep sedation, defined by MOAA/S 1-2, was recorded. Univariable and multivariable analyses were used to assess predictors of deep sedation. Deep sedation occurred in 54/80 (68%) patients for a total of 204/785 (26%) of total sedation assessments. The percentage of deep sedation episodes of all sedation-level observations by procedure was 26% for EGD, 11% for colonoscopy, 35% for ERCP, and 29% for EUS. Deep sedation occurred at least once in 60% of EGD, 45% of colonoscopy, 85% of ERCP, and 80% of EUS. Multivariable analysis showed that only ERCP and EUS were independent risk factors of deep sedation. Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam used with the intent of moderate sedation. ERCP and EUS are risk factors for the occurrence of deep sedation, independent of sedation dose or length of procedure.

ICD-9-CM and CPT Codes for 2006

<i>ICD-9-CM</i> and <i>CPT</i> Codes for 2006

Moderate Conscious Sedation for In Vitro Fertilization (IVF) Oocyte Retrieval Procedures

Moderate Conscious Sedation for In Vitro Fertilization (IVF) Oocyte Retrieval Procedures

Moderate (Conscious) Sedation Update, Challenges, and Issues

Moderate (Conscious) Sedation Update, Challenges, and Issues

Capnographic monitoring of ventilatory status during moderate (conscious) sedation

Capnographic monitoring of ventilatory status during moderate (conscious) sedation