Bolus Administration of Fentanyl and Midazolam for Colonoscopy Increases Endoscopy Unit Efficiency and Safety Compared With Titrated Sedation
| Autor: | R. Thomas Finn, Amanda Boyd, Li Lin, Ziad F. Gellad |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.drug_class Midazolam Sedation Colonoscopy Fentanyl Hospitals University Young Adult 03 medical and health sciences 0302 clinical medicine Patient satisfaction Bolus (medicine) North Carolina medicine Humans Hypnotics and Sedatives Dosing Aged Retrospective Studies Hepatology medicine.diagnostic_test business.industry Gastroenterology Middle Aged Surgery Treatment Outcome Patient Satisfaction 030220 oncology & carcinogenesis Anesthesia Sedative Female 030211 gastroenterology & hepatology Deep Sedation medicine.symptom business Adjuvants Anesthesia medicine.drug |
| Zdroj: | Clinical Gastroenterology and Hepatology. 15:1419-1426.e2 |
| ISSN: | 1542-3565 |
| Popis: | Guidelines recommend slow titration of sedatives for moderate sedation. Bolus sedation, in which a larger weight-based dose of medication is given upfront, has been shown in a single trial to be beneficial. We evaluated the effects of bolus sedation on procedural safety, efficiency, and patient experience.We performed a retrospective analysis of colonoscopies performed between April 2010 and April 2011 at Duke Medical Center. Colonoscopies before October 2010 were performed with nurse-directed titration of sedative (n = 966); colonoscopies performed after October 2010 were performed with physician-directed administration of bolus sedative (n = 699). We compared sedation and recovery times, medication doses, and adverse events between groups. We also compared patient satisfaction in a subset of patients from each group. Data were compared using the chi-square test for categorical variables and Wilcoxon rank sum test for continuous and ordinal categorical variables.Patients in the bolus group had a shorter sedation time (6.0 min) than patients in the titration group (13.0 min; P.01) and a slightly longer colonoscopy time (25.0 min vs 24.0 min in the titration group; P.01). Recovery time did not differ significantly between groups (53.0 min in the bolus group vs 52.1 min in the titration group; P = .07). Patients in the bolus group received lower weight-adjusted doses of fentanyl (1.71 μg/kg vs 1.89 μg/kg in the titration group) and midazolam (0.065 mg/kg vs 0.075 mg/kg in the titration group). A smaller proportion of patients in the bolus sedative group developed hypotension (12.7% vs 17.9% in the titration group; P.01). These findings persisted even after adjustment for baseline patient age, race, sex, smoking status, alcohol use, body mass index, and American Society of Anesthesiologists' classification.In a retrospective study of patients undergoing colonoscopy, we found that compared with titrated administration of sedative, bolus dosing improves endoscopy unit efficiency and safety and decreases the amount of sedative required. This benefit does not come at the expense of the patient experience. |
| Databáze: | OpenAIRE |
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