Louis Y Korman1, Nadim G Haddad2, David C Metz3, Lawrence J Brandt4, Stanley B Benjamin2, Susan K Lazerow5, Hannah L Miller5, Mihriye Mete6, Milind Patel7, Vladimir Egorov7. 1. Chevy Chase Clinical Research, Chevy Chase, Maryland, USA. 2. Division of Gastroenterology, Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC, USA. 3. Division of Gastroenterology, Hospital University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. 4. Division of Gastroenterology, Montefiore Medical Center, Albert Einstein School of Medicine, Bronx, New York, USA. 5. Gastroenterology Division, Department of Veterans Affairs Medical Center, Washington, DC, USA. 6. Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Washington, DC, USA. 7. Artann Laboratories, Trenton, New Jersey, USA.
Abstract
BACKGROUND: Sedation is frequently used during colonoscopy to control patient discomfort and pain. Propofol is associated with a deeper level of sedation than is a combination of a narcotic and sedative hypnotic and, therefore, may be associated with an increase in force applied to the colonoscope to advance and withdraw the instrument. OBJECTIVE: To compare force application to the colonoscope insertion tube during propofol anesthesia and moderate sedation. DESIGN: An observational cohort study of 13 expert and 12 trainee endoscopists performing colonoscopy in 114 patients. Forces were measured by using the colonoscopy force monitor, which is a wireless, handheld device that attaches to the insertion tube of the colonoscope. SETTING: Community ambulatory surgery center and academic gastroenterology training programs. PATIENTS: Patients undergoing routine screening or diagnostic colonoscopy with complete segment force recordings. MAIN OUTCOME MEASUREMENTS: Axial and radial forces and examination time. RESULTS: Axial and radial forces increase and examination time decreases significantly when propofol is used as the method of anesthesia. LIMITATIONS: Small study, observational design, nonrandomized distribution of sedation type and experience level, different instrument type and effect of prototype device on insertion tube manipulation. CONCLUSIONS: Propofol sedation is associated with a decrease in examination time and an increase in axial and radial forces used to advance the colonoscope.
BACKGROUND: Sedation is frequently used during colonoscopy to control patient discomfort and pain. Propofol is associated with a deeper level of sedation than is a combination of a narcotic and sedative hypnotic and, therefore, may be associated with an increase in force applied to the colonoscope to advance and withdraw the instrument. OBJECTIVE: To compare force application to the colonoscope insertion tube during propofol anesthesia and moderate sedation. DESIGN: An observational cohort study of 13 expert and 12 trainee endoscopists performing colonoscopy in 114 patients. Forces were measured by using the colonoscopy force monitor, which is a wireless, handheld device that attaches to the insertion tube of the colonoscope. SETTING: Community ambulatory surgery center and academic gastroenterology training programs. PATIENTS: Patients undergoing routine screening or diagnostic colonoscopy with complete segment force recordings. MAIN OUTCOME MEASUREMENTS: Axial and radial forces and examination time. RESULTS: Axial and radial forces increase and examination time decreases significantly when propofol is used as the method of anesthesia. LIMITATIONS: Small study, observational design, nonrandomized distribution of sedation type and experience level, different instrument type and effect of prototype device on insertion tube manipulation. CONCLUSIONS:Propofol sedation is associated with a decrease in examination time and an increase in axial and radial forces used to advance the colonoscope.