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ENGLISH SUMMARY
this prearrangement, the “only - analgesia” approach can facilitate a safe and satisfying
company of the patient during colonoscopies as well as during other painful procedures
without the potential complications of sedation.
Therefore, we can conclude: Even if there is a demand for sedation stated either by the
operator or the patient, not each special procedure is suitable for sedation. Sometimes, it is
more appropriate to use local anaesthesia, analgesics alone, or even general anaesthesia –
in combination with the fitting team.
This led us to our second question. If we decide to provide analgo-sedation: how can we
achieve it best? Which drug is suitable for which procedure?
The term “analgo-sedation” is not unambiguously. Analgo-sedation is a drug-induced
continuum that combines analgesia with light, moderate or even deep sedation. The level
of sedation - which also means the level of consciousness of the patient - often depends
on the chosen drug.
In chapter 6,
we started with the “only analgesic - without sedation” approach during
CT colonography.
20
CT colonography can be a painful procedure with a procedure time
of approximately 20 minutes.
21
For this reason, we selected a single bolus of 7.5 μg/kg
alfentanil. Alfentanil has its maximum effect within 1–2 minutes and a distribution half life
of 14 minutes
22
– ideal for short lasting, painful procedures.
We could show in this randomised double-blind placebo-controlled multi-centre trial
that a single bolus of intravenous alfentanil could provide a clinically relevant reduction of
maximum pain during CT colonography.
Desaturations as a known consequence of respiratory depression by an opioid were more
frequently observedwith alfentanil, but were not considered clinically relevant because they
were all short lasting and self-limiting.
10
These data showed that the analgesic approach
without sedation – and even without attendance of anaesthesia staff - could be a way to
improve CT colonography acceptance.
Chapter 7
compared this “analgesic approach” of alfentanil with two other analgosedation
strategies for colonoscopies: Mild sedation combined with analgesia (midazolam and
fentanyl) and deep sedation with analgesia (propofol and alfentanil).
23
Primary outcomes of this trial were safety aspects for patients and satisfaction level for
patients and endoscopists.
All groups showed a high level of satisfaction. However, patients with propofol sedation
were more satisfied with their sedation experience, although one has to keep in mind that