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MIDAZOLAM/FENTANYL, PROPOFOL/ALFENTANIL OR ALFENTANIL ONLY FOR COLONOSCOPY
7
After colonoscopy and before discharge, patients and gastroenterologists filled in validated
questionnaires modified and translated from the Patient Satisfaction with Sedation
Instrument (PSSI)
11
and Clinician Satisfaction with Sedation Instrument (CSSI),
11
respectively,
whichprovide feasible and valid assessment of procedural sedation satisfaction inoutpatient
colonoscopy with 4 subscores for patient`s and 3 subscores for endoscopist`s satisfaction.
11
Subscores for the PSSI contain questions on sedation delivery, procedural recall, sedation
side effects, and global satisfaction.
Subscores for the CSSI refer to corresponding issues among gastroenterologists: sedation
administration, recovery, as well as post-procedural and global satisfaction. Both groups
could classify their (dis)satisfaction during the procedure ranging from 1 = very satisfied,
2 = satisfied, 3 = somewhat satisfied, 4 = neither satisfied nor dissatisfied, 5 = somewhat
dissatisfied, 6 = dissatisfied to 7 = very dissatisfied.
Monitoring
After assessment of baseline data, an intravenous line was inserted, and patients were
prepared for the procedure. During colonoscopy, patients were monitored with three-lead
electrocardiogram (ECG), non-invasive blood pressure (NIBP), pulse oximetry (SpO
2
), and
end-tidal capnography (etCO
2
), documented at 5-min intervals. Heart rate (HR) was derived
both from the ECG and pulse oximetry. Two l/min of oxygen was given via a nasal cannula
from the start of sedation.
Team activities were observed by a trained medical student without clinical experience
regarding sedation, using a four-channel remote video system, which did not only provide
a wide angle overview of the sedation room, but also recorded time-synchronised ECG,
plethysmographic, and capnographic traces as well as derived HR, SpO
2
, NIBP, and
etCO
2
. The observer recorded the total time of colonoscopy, drugs (type, dosage, and
time of administration), and time from the end of the procedure until OAA/S > 4, any
cardiorespiratory events, and all actions taken to prevent or treat these problems (e.g. chin
lift/jaw thrust, stimulation of the patient, or temporary mask ventilation).
As significant events were considered: decline in SpO
2
< 90%, respiratory rate < 6/min,
increase of etCO
2
> 50 mmHg; change in HR to +20% of baseline or occurrence of any
arrhythmia’s; and systolic NIBP +20 % of the first NIBP measurement.
Recovery
After colonoscopy, patients had to stay at least 1 h in the recovery room. Monitoring
included SpO
2
, ECG, and NIBP. The modified Aldrete score
12
was recorded on arrival in the
recovery area, after 30 min and 1 h. It describes patient`s motor activity, respiratory function,
SpO
2
, NIBD, and consciousness, and is designed to assess patient recovery. The total score