Published online Feb 25, 2016. doi: 10.4253/wjge.v8.i4.232
Peer-review started: October 2, 2015
First decision: November 5, 2015
Revised: December 7, 2015
Accepted: December 19, 2015
Article in press: December 23, 2015
Published online: February 25, 2016
AIM: To determine whether anaesthesiologist-administered sedation with propofol (AAP) or endoscopist-administered conscious sedation (EAC) with fentanyl/midazolam shortens colonoscopy duration/total room time.
METHODS: This is a prospective, non-randomized, comparative study that enrolled patients greater than 18 years of age undergoing colonoscopy in a single Canadian academic outpatient endoscopy unit over a three-month consecutive period. Colonoscopies in this unit are performed both with AAP and EAC. Patient demographics, procedure-related data and adverse events were documented. Additionally, the level of procedure difficulty, and whether a staff endoscopist, trainee with assistance, or independent trainee, performed the procedure were documented. A validated modified 4-question, 5-point Likert scale telephone survey was used to assess patient satisfaction with colonoscopy. The telephone patient satisfaction survey was conducted 24-72 h following the procedure.
RESULTS: Two hundred and thirty patients were enrolled during the study period with 126 patients in the AAP group and 104 patients in the EAC group. Mean procedure time was 18.3 ± 10.1 min in the AAP group and 14.7 ± 7.1 min in the EAC group (P = 0.002). Mean total room time was 36.8 ± 13.7 with AAP and 30.1 ± 11 min with EAC (P < 0.001). Multivariate analysis revealed the use of AAP (P = 0.002), resident participation (P < 0.001), diagnostic interventions (P = 0.033), therapeutic interventions (P < 0.001), lower body mass index (P = 0.008) and American Society of Anaesthesiologist class (P = 0.016), to be predictors of longer total room time. Patient age and gender were not significant predictors. After excluding cases in which trainees were involved, there was no significant difference in procedure time between the two groups (P = 0.941), however total room time was still prolonged in the AAP group (P = 0.019). The amount of pain experienced was lower with AAP (P = 0.02), with a trend toward overall higher patient satisfaction (P = 0.074). There were 2 sedation-related adverse events, both in the AAP group involving a patient with aspiration requiring hospitalization and a patient with hypoxia managed with bronchodilators.
CONCLUSION: EAC results in reduced total room time compared to AAP. Resident participation doubles procedure time regardless of sedation type.
Core tip: There is little research examining sedation type in light of patient satisfaction and overall efficiency of colonoscopy. Our novel prospective study evaluated the total procedure room time and patient satisfaction in a high-volume endoscopy center, which performs colonoscopy using conventional sedation and propofol sedation. A statistically significant reduction in total room time with conventional sedation (midazolam/fentanyl) when compared to anaesthetist-administered propofol was demonstrated. Patients reported less procedure pain when receiving propofol sedation compared to conventional sedation. Special discussion emphasizes the need to further examine strategies to maximize endoscopy unit efficiency to respond to increasing patient demand, while maximizing patient satisfaction.