Clin Colon Rectal Surg 2001; 14(4): 325-330
DOI: 10.1055/s-2001-18511
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Sedation, Analgesia, and Monitoring

Sergio W. Larach, Joaquim Simoes Neto, Cary L. Gentry
  • College of Medicine, University of Florida, Gainsville, FL
Further Information

Publication History

Publication Date:
19 November 2001 (online)

ABSTRACT

The use of colonoscopy in recent years for colorectal cancer screening has led to an increase in the number of procedures performed. Primary care physicians, gastroenterologists, surgeons, and colorectal surgeons perform the majority of these procedures. In the United States, it is the standard of care to perform colonoscopy with some form of sedation and/or analgesia. However, there are various approaches to delivering appropriate sedation and analgesia. The use of monitoring during colonoscopy is also felt to be a vital aspect of the procedure. We reviewed the current literature regarding sedation, analgesia, and monitoring during colonoscopy. We believe that colonoscopy should be performed with adequate sedation in a monitored setting. The use of a narcotic in conjunction with a benzodiazepine or propofol seems to provide the highest level of patient satisfaction and safety.

REFERENCES

  • 1 Wolff W I. Colonoscopy: history and development.  Am J Gastroenterol . 1989;  84 1017-1025
  • 2 Ingegno A P, Dagradi A E. Historical note: the first total colonoscopy.  Am J Gastroenterol . 1985;  80 605-607
  • 3 Goustout C J. The role of endoscopy in managing acute lower gastrointestinal bleeding.  N Engl J Med . 2000;  342 125-127
  • 4 Ogutu E O, Okoth F A, Lule G N. Colonoscopic findings in Kenyan African patients.  East Afr Med J . 1998;  75 540-543
  • 5 Sebastian J J, Garcia S, Soria M T. Visceral leishmaniasis diagnosed by colonoscopy.  J Clin Gastroenterol . 1997;  25 691-692
  • 6 Krevsky B. Detection and treatment of angiodysplasia.  Gastrointest Endosc Clin North Am . 1997;  7 509-524
  • 7 Farivar M, Perotto J L. Urgent colonoscopic for the diagnosis and treatment of severe diverticular hemorrhage.  N Engl J Med . 2000;  342 1608-1611
  • 8 Inadomi J M, Sonnenberg A. The impact of colorectal cancer screening on life expectancy.  Gastrointest Endosc . 2000;  51 517-523
  • 9 Wexner S D, Forde K A, Sellers G. How well can surgeons perform colonoscopy?.  Surg Endosc . 1998;  12 1410-1414
  • 10 Read T E, Kodner I J. Colorectal cancer: risk factors and recommendations for early detection.  Am Fam Phys . 1999;  59 3083-3092
  • 11 Rex D K. Colonoscopy.  Gastrointest Endosc Clin North Am . 2000;  125-160
  • 12 Pierzchajlo R PJ, Ackermann R J, Vogel R L. Colonoscopy performed by a family physician: a case series of 751 procedures.  J Fam Pract . 1997;  44 473-480
  • 13 Rex D K, Imperiale T F, Portish V. Patients willing to try colonoscopy without sedation: associate clinical factors and results of a randomized controlled trial.  Gastrointest Endosc . 1999;  49 554-559
  • 14 Stermer E, Gaitini L, Yudashkin M, Essaian G, Tamir A. Patient-controlled analgesia for conscious sedation during colonoscopy: a randomized controlled study.  Gastrointest Endosc . 2000;  51 278-281
  • 15 Hoffman M S, Butler T W, Shaver T. Colonoscopy without sedation.  J Clin Gastroenterol . 1998;  26 279-282
  • 16 Ristikankare M, Hartikainen J, Heikkinen M. Is routinely given conscious sedation of benefit during colonoscopy?.  Gastrointest Endosc . 1999;  49 566-572
  • 17 Early D S, Saifuddin T, Johson J C. Patient attitudes toward undergoing colonoscopy without sedation.  Am J Gastroenterol . 1999;  94 1862-1865
  • 18 Zakko S F, Seifert H A, Gross J B. A comparison of midazolan and diazepam for conscious sedation during colonoscopy in a prospective double-blind study.  Gastrointest Endosc . 1999;  49 684-689
  • 19 Macken E, Gevers A M, Hendrickx A, Rutgeerts P. Midazolan versus diazepam in lipid emulsion as conscious sedation for colonoscopy with or without reversal of sedation with flumazenil.  Gastrointest Endosc . 1999;  47 57-61
  • 20 Van Houten S J, Pharm D, Crane S T. A randomized, prospective, double-blind comparison of midazolan (Versed) and emulsied diazepam (Dizac) for opioid-based, conscious sedation in endoscopic procedures.  Am Gastroenterol . 1998;  93 170-174
  • 21 DiPalma J A, Herrera J L, Weis F R, Dark-Mezick L, Brown R S. Alfentanil for conscious sedation during colonoscopy.  South Am J . 1995;  88 630-634
  • 22 Morrow J B, Zuccaro Jr G, Conwell D L. Sedation for colonoscopy using a single bolus is safe, effective, and efficient: a prospective, randomized, double-blind trial.  Am J Gastroenterol . 2000;  95 2242-2247
  • 23 Darvas K, Tarjanyi M, Molnar Z. Sedation for ambulatory endoscopy.  Acta Chirurg Hung . 1999;  38 143-146
  • 24 Koshy G, Nair S, Norkus E P. Propofol versus midazolan and meperidine for conscious sedation in GI endoscopy.  Am J Gastroenterol . 2000;  95 1476-1479
  • 25 Reimann F M, Samson U, Derard I. Synergistic sedation with low-dose midazolan and propofol for colonoscopies.  Endoscopy . 2000;  32 239-244
  • 26 Roseveare C, Seavell C, Patel P. Patient-controlled sedation with propofol and alfentanil during colonoscopy: a pilot study.  Endoscopy . 1998;  30 482-483
  • 27 . Practice guidelines for sedation and analgesia by non-anaesthesiologists: a report by the American Society of Anaesthesiologists Task Force on Sedation.  Anesthesiology . 1996;  84 459-471
  • 28 Eckardt V F, Kanzler G, Schimitt T. Complications and adverse effects of colonoscopy with selective sedation.  Gastrointest Endosc . 1999;  49 560-565
  • 29 Morgan J, Roufeil L, Kaushik S, Basset M. Influence of coping style and precolonoscopy information on pain and anxiety of colonoscopy.  Gastrointest Endosc . 1998;  48 119-127
  • 30 Froelich F, Thorens J, Schwizer W. Sedation and analgesia for colonoscopy: patient tolerance, pain, and cardiorespiratory parameters.  Gastrointest Endosc . 1997;  45 01-09
  • 31 Fassoulaki A, Mihas A. Changes in arterial blood gases associated with gastrointestinal endoscopies.  Acta Anaesth Belg . 1987;  38 127-131
  • 32 DiSario J A, Waring J P, Talbert G, Sanowski R A. Monitoring of blood pressure and heart rate during routine endoscopy: a prospective,, randomized, controlled study.  Am J Gastroenterol . 1991;  86 956-960
  • 33 Ristikankare M, Julkunen R, Mattila M. Conscious sedation and cardiorespiratory safety during colonoscopy.  Gastrointest Endosc . 2000;  52 48-54
  • 34 McKee C C, Ragland J J, Myers J O. An evaluation of multiple clinical variables for hypoxia during colonoscopy.  Surg Gynecol Obstet . 1991;  173 37-40
  • 35 Sauders B P, Fukumoto M, Halligan S. Patient-administered nitrous oxide/oxygen inhalation provides effective sedation and analgesia for colonoscopy.  Gastrointest Endosc . 1994;  4 418-421
  • 36 Holm C, Christensen M, Schulze S, Rosenberg J. Effect of oxygen on tachycardia and arterial oxygen saturation during colonoscopy.  Eur J Surg . 1999;  165 755-758
  • 37 Gross J B, Long W B. Nasal oxygen alleviates hypoxemia in colonoscopy patients sedated with midazolan and meperidine.  Gastrointest Endosc . 1989;  36 26-29
  • 38 . Sedation and monitoring of patients undergoing gastrointestinal endoscopic procedures.  Gastrointest Endosc . 1995;  42 626-629
  • 39 Minoli G, Meucci G, Prada A. Quality assurance and colonoscopy.  Endoscopy. 1999;  31 522-527
  • 40 . Guidelines for Training in Patient Monitoring and Sedation and Analgesia.  American Society for Gastrointestinal Endoscopy. 1998;  48 6
  • 41 Galandiuk S, Ahmad P. Impact of sedation and resident teaching on complications of colonoscopy.  Dig Surg . 1998;  15 60-63
  • 42 Ward B, Shan S, Kirwan P, Mayberry J F. Issues of consent in colonoscopy: if patient says `stop' should we continue?.  J R Soc Med . 1999;  92 132-133
  • 43 Marshall J B, Patel M, Mahajan R J. Benefit of intravenous antispasmotic (hyoscyamine sulfate) as premedication for colonoscopy.  Gastrointest Endosc . 1999;  49 720-726
  • 44 Forbes G M, Collins B J. Nitrous oxide for colonoscopy: a randomized controlled study.  Gastrointest Endosc . 2000;  51 271-277
  • 45 Trojan J, Saunders B P, Wloshynowych M. Immediate recovery of psychomotor function after patient-administered nitrous oxide/oxygen inhalation for colonoscopy.  Endoscopy . 1997;  29 17-22
  • 46 Heiman D R, Tolliver B T, Weis F R. Patient-controlled anesthesia for colonoscopy using propofol: results of a pilot study.  South Med J . 1998;  91 560-564
  • 47 Hayward S R, Sugawa C, Wilson R F. Changes in oxygenation and pulse rate during endoscopy.  Am Surg . 1989;  55 198-202
  • 48 Yano H, Lishi H, Tatsuta M. Oxygen desaturation during sedation for colonoscopy in elderly patients.  Hepato-Gastroenterology . 1998;  45 2138-2141
  • 49 Bell G D. Premedication, preparation, and surveillance.  Endoscopy . 2000;  32 92-100
  • 50 Yuno K, Iishi H, Tatsuta M. IV Midazalon as a sedative for colonscopy: a randomized double blind clinical trial.  Aliment Pharmacol Ther . 1996;  10 981-984
  • 51 Notini-Gudmarsson A, Dolk A, Jakobsson J, Johansson C. Nitrous oxide: a valuable alternative for pain relief and sedation during routine colonoscopy.  Endoscopy . 1996;  28 283-287
  • 52 Barkin J S, Krieger B, Blinder M. Oxygen desaturation and changes in breathing pattern in patients undergoing colonoscopy and gastroscopy.  Gastrointest Endosc . 1989;  35 526-530
  • 53 Waxman I, Mathews J, Gallagher J. Limited benefit of atropine as premedication for colonoscopy.  Gastrointest Endosc . 1991;  37 329-331
  • 54 Gepts E, Claeys M A, Camu F, Smekens L. Infusion of propofol (`Diprivan') as sedative technique for colonoscopies.  Postgrad Med J . 1985;  61 120-126
  • 55 Barnes P RH, Willians C B, Davies R L. The use of intravenous meptazinol for analgesia in colonoscopy.  Postgrad Med J . 1985;  61 221-224
  • 56 Yilmaz E N, Vahl A C, van Rij G. Endoluminal pulse oximetry of the sigmoid colon and the monitoring of the colonic circulation.  Cardiovasc Surg . 1999;  7 704-709
  • 57 Thompson A M, Park K GM, Kerr F, Munro A. Safety of fibreoptic endoscopy: analysis of cardiorespiratory events.  Br J Surg . 1992;  79 1046-1049
  • 58 Bisson B. Methane gas explosion during colonoscopy.  Gastroenterol Nurs . 1997;  20 136-137
  • 59 . Monitoring Equipment for Endoscopy.  American Society for Gastrointestinal Endoscopy. November 1994;