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Chapter 7
ABSTRACT
Background:
We investigated the satisfaction of patients and endoscopists, and concurrently
safety aspects of an “alfentanil only’’ and two clinically routinely used sedation regimes in
patients undergoing colonoscopy in a teaching hospital.
Methods:
One hundred and eighty patients were prospectively randomised in three
groups: M (midazolam/fentanyl), A (alfentanil), and P (propofol/alfentanil); M and A were
administered by an endoscopy nurse, P by an anaesthesia nurse. Interventions, heart rate,
oxygen saturation, electrocardiogram, non-invasive blood pressure, and end-tidal CO
2
were monitored using video assistance. After endoscopy, patients and gastroenterologists
completed questionnaires about satisfaction.
Results:
A high level of satisfaction was found in all groups, with patients in group P being
more satisfied with their sedation experience (median 1.75, p<0.001). Gastroenterologist
satisfaction varied not significantly between the three alternatives. Patients in group A felt
less drowsy, could communicate more rapidly than patients in both other groups, and met
discharge criteria immediately after the end of the procedure. Respiratory events associated
with sedation were observed in 43 % patients in group M, 47 % in group P, but only 13 %
in group A (p<0.001).
Conclusions:
These results suggest that alfentanil could be an alternative for sedation in
colonoscopy even in the setting of a teaching hospital. It results in satisfied patients easily
taking up information and recovering rapidly. Although one might expect to observe more
respiratory depression with an “opioid only” sedation technique without involvement of
anaesthesia partners, respiratory events were less frequent than when other methods were
used.