Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2017; 23(16): 2964-2971
Published online Apr 28, 2017. doi: 10.3748/wjg.v23.i16.2964
One year experience with computer-assisted propofol sedation for colonoscopy
Otto S Lin, Danielle La Selva, Richard A Kozarek, Deborah Tombs, Wade Weigel, Ryan Beecher, Johannes Koch, Susan McCormick, Michael Chiorean, Fred Drennan, Michael Gluck, Nanda Venu, Michael Larsen, Andrew Ross
Otto S Lin, Danielle La Selva, Richard A Kozarek, Deborah Tombs, Johannes Koch, Susan McCormick, Michael Chiorean, Fred Drennan, Michael Gluck, Nanda Venu, Michael Larsen, Andrew Ross, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
Wade Weigel, Ryan Beecher, Department of Anesthesia, Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: All authors contributed to study conception and design; Lin OS and La Selva D contributed to acquisition of data, statistical analysis, analysis and interpretation of data; Lin OS drafted the manuscript; La Selva D, Kozarek RA, Tombs D, Weigel W, Beecher R, Koch J, McCormick S, Chiorean M, Drennan F, Gluck M, Venu N, Larsen M and Ross A critically revised the manuscript for important intellectual content; Kozarek RA and Ross A also contributed to study supervision; and all authors approved the final article.
Institutional review board statement: The study was reviewed and approved by the Virginia Mason Benaroya Research Institute Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used de-identified aggregate clinical data.
Conflict-of-interest statement: Lin OS, Tombs D, Beecher R, Koch J and Ross A served as consultants for SEDASYS Inc., there are no other conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Otto S Lin, MD, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, United States. otto.lin@vmmc.org
Telephone: +1-206-6257373 Fax: +1-206-3411405
Received: December 25, 2016
Peer-review started: December 31, 2016
First decision: January 19, 2017
Revised: February 10, 2017
Accepted: March 30, 2017
Article in press: March 30, 2017
Published online: April 28, 2017
Processing time: 124 Days and 6.8 Hours
Abstract
AIM

To report our one-year experience with computer assisted propofol sedation (CAPS) for colonoscopy as the first United States Medical Center to adopt CAPS technology for routine clinical use.

METHODS

Between September 2014 and August 2015, 2677 patients underwent elective outpatient colonoscopy with CAPS at our center. All colonoscopies were performed by 1 of 17 gastroenterologists certified in the use of the CAPS system, with the assistance of a specially trained nurse. Procedural success rates, polyp detection rates, procedure times and recovery times were recorded and compared against corresponding historical measures from 2286 colonoscopies done with midazolam and fentanyl from September 2013 to August 2014. Adverse events in the CAPS group were recorded.

RESULTS

The mean age of the CAPS cohort was 59.9 years (48.7% male); 31.3% were ASA I, 67.3% ASA II and 1.4% ASA III. 45.1% of the colonoscopies were for screening, 31.5% for surveillance, and 23.4% for symptoms. The mean propofol dose administered was 250.7 mg (range 16-1470 mg), with a mean fentanyl dose of 34.1 mcg (0-100 mcg). The colonoscopy completion and polyp detection rates were similar to that of historical measures. Recovery times were markedly shorter (31 min vs 45.6 min, P < 0.001). In CAPS patients, there were 20 (0.7%) cases of mild desaturation (< 90%) treated with a chin lift and reduction or temporary discontinuation of the propofol infusion, 21 (0.8%) cases of asymptomatic hypotension (< 90 systolic blood pressure) treated with a reduction in the propofol rate, 4 (0.1%) cases of marked agitation or discomfort due to undersedation, and 2 cases of pronounced transient desaturation requiring brief (< 1 min) mask ventilation. There were no sedation-related serious adverse events such as emergent intubation, unanticipated hospitalization or permanent injury.

CONCLUSION

CAPS appears to be a safe, effective and efficient means of providing moderate sedation for colonoscopy in relatively healthy patients. Recovery times were much shorter than historical measures. There were few adverse events, and no serious adverse events, related to CAPS.

Keywords: Colonoscopy; Propofol; Sedation; Colon cancer screening; Anesthesia

Core tip: As the first United States Medical Center to adopt computer assisted propofol sedation (CAPS) technology for routine clinical use, we report our one-year experience with CAPS for colonoscopy. Between September 2014 and August 2015, 2677 patients underwent colonoscopy with CAPS. The colonoscopy completion and polyp detection rates were similar to that of historical controls who received midazolam and fentanyl sedation. Procedure and recovery times were shorter. In CAPS patients, there were only 2 cases of desaturation requiring mask ventilation, and no sedation-related serious adverse events. In conclusion, CAPS is a safe, effective and efficient means of providing moderate sedation for colonoscopy.