Conclusion: In selected patients NAPS with continuous perfusion technique is a safe procedure. S1093. Reduced Hypoventilation Time with Propofol Sedation.
Abstracts
S1090 Safety and Biological Tolerability of a New 2-Litre Gut Cleansing Solution Containing PEGCE in Patient Risk Groups Undergoing Colonoscopy Christian Ell, Hans-Juergen Gruss
S1092 Non-Anesthesiologist Propofol Sedation with Continuous Infusion Technique for ERCP and EUS Is Safe: A Single Center Experience of 600 Procedures Ludwig T. Heuss, Lukas Degen, Michael Sulz, Christoph Beglinger
Aim: To demonstrate that a new oral 2L gut cleansing solution PEGCE plus ascorbate (2L PEGCE) is as safe and well tolerated as the standard 4L PEGCE bowel preparation in risk group patients undergoing colonoscopy. Methods: A randomised, single-blind, multicentre study with two parallel treatment groups (2L PEGCE/Sol.A versus 4L standard PEGCE/Sol.B) included inpatients (aged: 18-85 years) undergoing routine colonoscopy. Both gut lavage solutions were taken as half the dose the evening before followed by the other half on the morning of the colonoscopy. Several subgroups were included: elderly, patients with inflammatory bowel disease (IBD), patients with concomitant cardiovascular (CV) disease and patients with impaired kidney function (creatinine clearance !80 mL/min). The laboratory results were summarised for changes from baseline or clinical significance. Endpoints of the analysis were the rate of adverse events, biological safety, patient acceptance and tolerance in relation to the observed gut cleansing quality. Results: 359 inpatients (180 with Sol.A and 179 with Sol.B) were included in the study. 87 patients (36 with Sol.A/51 with Sol.B) had an age between 65 and 75 years and 53 patients (26 with Sol.A/27 with Sol.B) an age above 75 years. 26 patients (17 with Sol.A/9 with Sol.B) had IBD, 75 patients (41 with Sol.A/34 with Sol.B) had a concomitant CV disease and 147 patients (68 Sol.A/79 Sol.B) an impaired kidney function. None of the risk factors, including age, concomitant CV disease and/or impaired renal function influenced the rate of effective gut cleansing. The observed frequency of adverse events was not different from the gereral population or the established safety profile of standard PEGCE. No clinically relevant differences were observed for the laboratory results. In terms of patient satisfaction, acceptability and taste, patients consistently preferred Sol.A over Sol.B., independent of the presence of risk factors. Similarly, the rating for ‘‘no problem’’ to drink the entire gut cleansing solution was in favour of the 2L Sol.A without any effects of age, CV conditions or impaired kidney function. Conclusion: The analysis has confirmed that the new 2L PEGCE solution is as safe as the well established 4litre PEGCE solution, including patient subgroups with risk factors, undergoing routine colonoscopies. All patient groups can be prepared with the improved 2L PEGCE solution to enhance the patient acceptance for the colonoscopy procedure.
Non-anesthesiologist administered propofol (NAPS) is increasingly used for sedation during endoscopic procedures. While repeated bolus application has been recommended to be the best way of application for EGD and colonoscopies, little is known about propofol sedation in longer lasting procedures like ERCP and endosonographies (EUS). Hypoxic complications seem to be more frequent in these longer-lasting endoscopic procedures, but a sufficient sedation of the patients is still mandatory. The aim of this study was to show the safety of NAPS by using an intravenous perfusion technique. Patients with a clinically high risk of respiratory failure (co-morbidity, ASA IV, airway obstruction) were excluded. After an individual loading dose the infusion rate was titrated between 100 and 200 mg/h, with an injection pump (Fresenius, Bad Homburg, Germany). If necessary, single boluses of 10 mg were additionally administered intravenously. Results: From 9/00 to 9/03 260 ERCP and 340 EUS were included into the study. Overall there were no cases of death or need of intratracheal intubation. One case of apnea demanding an emergency intervention with auxiliary ventilation occurred in each group (0.4% and 0.3%). An additional analgesia with pethidine was used in 232 (89%) of ERCP and 235 (69%) of EUS procedures. The mean dose of P was 322 mg for ERCP (Range 50 – 1771) and 243 mg for EUS (range 10-1060). Procedural data are shown in the table. (Data given as numbers or mean as indicated). Conclusion: In selected patients NAPS with continuous perfusion technique is a safe procedure.
S1091 Colonoscopy Times and Endoscopist Experience Level: Implications for Guidelines on Optimal Withdrawal Time Gavin Harewood, Beverly Ott Introduction: In 2002, a U.S. Multi-Society Task Force on Colorectal Cancer recommended that the withdrawal phase for colonoscopy should average at least 6 to 10 minutes. However, few studies have addressed the impact of endoscopistspecific parameters on colonoscopy duration. This study aimed to characterize the relationship between endoscopist-specific parameters (experience level, annual procedure volume) and both insertion and withdrawal times for colonoscopy. Methods: Procedural data from all routine colonoscopies performed by staff gastroenterologists at our outpatient endoscopy unit between January and December, 2003 were reviewed. Results: Procedural data of 36 staff endoscopists who performed 1,670 colonoscopies were analyzed. Median withdrawal time for 11 endoscopists (31%) was %6 minutes (figure), while of those endoscopists with at least 10 years experience, 56% demonstrated a median withdrawal time %6 minutes. Higher experience level was predictive of shorter withdrawal time, OR Z 0.13 (95% C.I., 0.02 – 0.62), p Z 0.01, and shorter insertion time, OR Z 0.08 (95% C.I., 0.01 – 0.36), p Z 0.001. Annual procedure volume was not associated with either insertion nor withdrawal time. Conclusions: Increasing endoscopist experience level correlates with both speed of insertion and speed of withdrawal at colonoscopy. Rather than prompt lengthening of withdrawal times, these findings should encourage a more rigorous appraisal of the optimum colonoscopy withdrawal time. Future studies should seek to characterize the impact of withdrawal times on neoplasia detection rates to provide evidence-based guidelines on colonoscopy timing.
AB114 GASTROINTESTINAL ENDOSCOPY Volume 61, No. 5 : 2005
S1093 Reduced Hypoventilation Time with Propofol Sedation Compared to Midazolam During Colonoscopy: A Prospective Randomized Trial Ludwig T. Heuss, Patricia Schnieper, Thomas Hirt, Christoph Beglinger Propofol’s fast onset of action, rapid distribution and quick recovery time has piqued interest as an endoscopic sedative. Some opponents of its use argue with a lack of a reversal agent and emphasize a higher potential for hypoventilation compared to standard sedation with midazolam and opioids. The aim of this study was to characterize hypoventilation profiles during colonoscopies performed under analgesia and sedation with alfentanil plus either midazolam or propofol. Hypoventilation was measured by changes in the transcutaneous carbon dioxide tension (PcCO2) in 83 patients: 42 patients randomly received either sedation with midazolam or with propofol (N Z 41) All received 4 mg/kg/BW alfentanil for analgesia and 3 L supplemental oxygen. Results: No hypoxemia (SpO2 ! 85%) or apnea cases were noted. Nevertheless, the PcCO2, indicating hypoventilation, increased after application of the sedative, an effect that would be not detectable by pulse oximetry alone. The mean maximal PcCO2 rise was similar for midazolam (8.6 G 3.7 mm Hg) and propofol (7.4 G 3.2 mm Hg). Five minutes after the end of the procedure, the mean difference to the initial PcCO2 value was significantly lower after propofol (0.9 G 3.0 mm Hg) compared to midazolam (4.3 G 3.7 mm Hg) (p ! 0.0001). Conclusions: Hypoventilation, missed with pulse oximetry alone, occurs frequently during colonoscopy sedation. The period of post-procedural hypoventilation is significantly shorter after propofol sedation compared to midazolam.
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