Susanne Eberl

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ENGLISH SUMMARY

there is no universal definition of patient satisfaction. Pascoe defined patient satisfaction as

the patient’s reaction consisting of a ‘cognitive evaluation’ and ‘emotional response’ to the

care they receive.

This subjective affective component makes measurement of satisfaction

challenging because often not all relevant items are addressed, and ‘minimal clinically

important difference’– meaning the smallest meaningful change that a patient can detect

with confidence – is difficult to define.

Gastroenterologist´s (GE) satisfaction varied not significantly between the three alternatives.

Although GEs are satisfied to perform the procedure with propofol sedation or solely with

analgesia, patients themselves prefer deep sedation, probably to be not aware of what is

happening!

Deep sedationis generally achievedusingpropofol, whichhas a rapidon- andoffset of action.

However, its therapeutic range is relatively narrow and increases the risk of cardiorespiratory

side effects.

There were 47% (28/60 patients) respiratory events associated with sedation

observed during propofol application, 43% (26/60 patients) during midazolam/fentanyl,

but only 13% (8/60 patients) in the alfentanil group (p

0.001).

Patients receiving only alfentanil also felt less drowsy, could communicate more rapidly,

and met discharge criteria immediately after the end of the procedure.

Anaesthesia closed claims analyses suggest that serious injuries can occur during deep

sedation, even with properly trained providers

since deeply sedated patients can stop

with spontaneous breathing and therefore require assistance to prevent hypoxaemia.

Therefore, patient satisfaction alone is not the main argument in the discussion on how

to achieve best sedation for a respective procedure. Rex et al.

investigated satisfaction of

two different groups who both had to undergo colonoscopy: group 1 was sedated with

midazolam and meperidine for colonoscopy, group 2 got analgesics only on demand.

Although pain scores were higher in the “sedation as needed” group, 31 of the 34 patients

were ‘‘very satisfied’’ and 3 were ‘‘somewhat satisfied.’’ This suggests that satisfaction for the

patient does not depend on the drugs used and possible pain experienced, but also on the

compliance to physician recommended treatment and patient`s own personality type.

also shows that patient satisfaction should not be the decisive factor in the choice of the

appropriate form of analgo-sedation for a specific procedure.

Chapters 8

and 9

addressed another drug for moderate sedation: dexmedetomidine,

which is a short-acting selective α

A-adrenoceptor agonist with anxiolytic, hypnotic, and

analgesic properties.

32-34

One of the highest concentrations of α

A-receptors is found in the locus coeruleus of the

central nervous system, a major centre for the natural sleeping patron. Patients receiving

dexmedetomidine are easily arousable; yet appear calm and comfortable. When they

remain unstimulated, patients return to a hypnotic state.