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190

ENGLISH SUMMARY

and treatment, but also for managing of potential complications.

3

Therefore, not only the

form of anaesthesia or sedation matters, but also the configuration of the entire team.

Chapter 4

focused on the different anaesthesia/sedation approaches during different

treatment procedures for achalasia.

4

Achalasia is an oesophageal muscle disease with an

elevated strain of the lower oesophagus sphincter (LOS) leading to stasis of food and liquid.

Intention of all treatment therapies for achalasia is, to lower the existing pressure in the

lower oesophagus sphincter (LOS). One option is an injection with botulinum toxin. This

treatment is performed under mild sedation with midazolam by the gastroenterologist

himself without anaesthesia attendance. Option two, pneumatic dilatation, is realised under

deep sedation with propofol administered by a specialised sedation practitioner. The third

option, myotomy, can be performed surgically under general anaesthesia on the operation

room (OR), but also peroral endoscopically (POEM) on the endoscopy suite outside the OR.

On both locations an anaesthesiologist administers general anaesthesia for the respective

procedure.

Although all three therapy forms have the same aim, each individual technique requires

a tailored sedation-anaesthesia approach. Treatment of achalasia is therefore an excellent

example of how important the appropriate combination of the respective procedure and

corresponding sedation approach can be.

Chapter 5

addresses another aspect of sedationoutside theOR: is sedation always necessary,

simply because it is a special demand of the patient or the operator, or is it enough to

apply only analgesia (without sedation) during possibly painful procedures? Besides all

advantages of sedation, there are existing drawbacks like cardiopulmonary depression that

should be avoided if possible.

Colonoscopies are procedures, which do not necessarily need an immobile, unconscious,

say a sedated patient. A painful procedure requires analgesia, but not compulsory sedation.

In our review

5

we gave a summary of the different analgesics that could be used for this

purpose, including meperidine

6

, fentanyl

7

, alfentanil

8-10

, remifentanil

11,12

, and nitrous oxide

(N

2

O).

13-19

Two substances have the capability to be a perfect analgesic solution during

colonoscopies: alfentanil and nitrous oxide. Both drugs have analgesic and anxiolytic effects,

a fast begin and end of action, are easy to titrate to the desired level of analgesia, and show

a superior safety profile. This allows a comfortable and awake patient and facilitates short

turnover periods.

Additionally, for colonoscopies – but also for other painful procedures - it could be of

avail to describe the expected painful situations and the analgesic options clearly to the

patient before the procedure. Giving this information preprocedurally, the patient has the

possibility to keep control of the situation and demand analgesia on time. Combined with