In most countries general anaesthesia for colonoscopy is limited to intolerant patients.
Dr Thomas Crepeau and colleagues from France determined whether patient-controlled sedation could provide a lighter sedation than general anesthesia adapted to the patient's individual requirement.
The investigators gave general anesthesia to more than 90% of patients aged 18 to 80 undergoing colonoscopy.
The patients were prospectively randomized to receive either standard sedation in the control group or patient-controlled-sedation.
In the control group, patients received a continuous infusion of propofol.
|97% with patient-controlled-sedation vs 73% of controls would repeat the examination|
|Gastroentérologie Clinique et Biologique|
The patient-controlled-sedation group were connected to an infusion pump containing propofol and self-administered 20-mg boluses as often as required.
An anesthetist was present throughout the procedure.
The investigators' main outcome was patient satisfaction measured on a visual analog scale 4 hours after colonoscopy.
The investigative team included 173 eligible patients out of 402 patients who underwent elective colonoscopy.
Only 72 gave their informed consent and were prospectively randomized.
The team did not find a significant difference in the patients' mean satisfaction scores between the 2 groups.
The team found that mean doses of propofol, depth of sedation and time before discharge were significantly lower in the patient-controlled-sedation group.
The investigative team observed that 26% did not use the pump and had total colonoscopy without sedation.
There were no statistically significant differences between the 2 groups regarding total duration of colonoscopy, difficulty and therapeutic procedures.
The investigators noted that 2 weeks after the procedure, 97% of patients in the patient-controlled-sedation group were willing to repeat the examination under the same conditions.
However, only 73% of patients in the control group were willing to repeat the examination.
Dr Crepeau's team concluded, “The results demonstrate that need of sedation is widely overestimated in France.”
“A subset of our patients is willing to consider colonoscopy without general anesthesia.”
“For them, patient-controlled-sedation with propofol is an effective and very well accepted form of sedation.”