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Chapter 5
ABSTRACT
Screening by colonoscopy is a proven instrument for early diagnosis of colorectal cancer, but
often experienced as an uncomfortable procedure. Today, there are two main strategies to
facilitate colonoscopy. First, deep sedation, which results in satisfied patients, but increases
sedation-associated risks and raises costs for health care providers. Second, there is the
advocacy for colonoscopies without any form of sedation. This might be an option for a
special group of patients, but does not hold true for everybody.
Following Moerman’s hypothesis: “If pain is the crucial point, why do we need sedation?”
this review shows the analgesic options towards a painless procedure, increasing success-
rates without increasing risk of sedation. There are two agents with the potential to be
a nearly ideal analgesic agent for colonoscopy: alfentanil and nitrous oxide (N
2
O). Both
substances aim at a comfortable, yet alert patient and facilitate a short turnover combined
with a superior safety profile. Besides owning anxiolytic and analgesic characteristics, both
drugs show a rapid begin and termination of action and are therefore easy to titrate to
reach the aimed level of sedation.