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The safety, feasibility, and acceptability of
patient-controlled sedation for colonoscopy: prospective study
DWH Lee, ACW Chan, SKH Wong,
ACN Li, TS Sze, SCS Chung
Department of Surgery, The Chinese University of Hong Kong, Prince
of Wales Hospital, Shatin, Hong Kong
OBJECTIVE. To assess the safety, feasibility, and
acceptability of patient-controlled sedation for elective day-case
colonoscopy, and the factors predicting patients' unwillingness
to use patient-controlled sedation for colonoscopy.
DESIGN. Prospective, non-randomised study.
SETTING. University-affiliated endoscopy centre,
Hong Kong.
PARTICIPANTS. Five hundred patients who underwent
elective day-case colonoscopy were prospectively recruited from
January 2001 to June 2002.
INTERVENTION. Sedation for colonoscopy was a mixture
of propofol and alfentanil, which was delivered by means of a patient-controlled
syringe pump. Each bolus delivered 4.8 mg propofol and 12 �g alfentanil.
No loading dose was used and the lockout time was set at zero.
MAIN OUTCOME MEASURES. Cardiopulmonary complications,
dose of patient-controlled sedation used, recovery time, satisfaction
score, delayed side-effects, and the willingness to use the same
sedation protocol for future colonoscopy. A multiple stepwise logistic
regression model was used to assess which factors might predict
unwillingness to use patient-controlled sedation for colonoscopy.
RESULTS. The mean (standard deviation) age of patients
was 53.0 (13.9) years. The mean dose of propofol consumed was 0.93
(0.69) mg/kg. Forty-three (8.6%) patients developed hypotension
during the procedure. The mean satisfaction score was 7.2 (2.6).
Sixteen (3.2%) patients developed delayed side-effects. The median
(interquartile range) recovery time was 0 (0-5) minutes. Approximately
78% of patients were willing to use patient-controlled sedation
for future colonoscopy if needed. Younger age (<50 years), female
sex, a higher mean dose of sedatives used, a lower satisfaction
score, and the presence of delayed side-effects were independent
factors that were associated with patients" unwillingness to use
patient-controlled sedation for colonoscopy.
CONCLUSION. The use of patient-controlled sedation
for elective colonoscopy is safe, feasible, and acceptable to most
patients.
Hong Kong Med J 2004;10:84-8
Key words: Alfentanil; Colonoscopy; Conscious sedation;
Propofol
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