Randomized Clinical Trial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1146-1154
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1146
Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy
Selda Kayaaltı, Ömer Kayaaltı
Selda Kayaaltı, Division of Anaesthesiology and Reanimation, Develi Public Hospital, Develi, Kayseri 38400, Turkey
Ömer Kayaaltı, Computer Technology, Kayseri University, Develi Huseyin Sahin Vocational College, Develi, Kayseri 38400, Turkey
Author contributions: Kayaaltı S designed and performed the research; Kayaaltı S and Kayaaltı Ö analysed the data, wrote the paper and reviewed the manuscript.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Erciyes University Medical Faculty.
Clinical trial registration statement: The registration identification number is 2018/94.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after the patients agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest with respect to the authorship and/or publication of this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that 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/
Corresponding author to: Selda Kayaaltı, MD, Specialist Doctor, Division of Anaesthesiology and Reanimation, Develi Public Hospital, Develi, Kayseri 38400, Turkey. drselda@hotmail.com
Telephone: +90-352-6216020 Fax: +90-352-6216223
Received: October 9, 2018
Peer-review started: October 10, 2018
First decision: November 1, 2018
Revised: November 9, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 26, 2018
Processing time: 75 Days and 20.6 Hours
Abstract
AIM

To compare the results of midazolam-ketamine-propofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.

METHODS

American Statistical Association (ASA) I-II 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist (SSA) and sedation under the supervision of an endoscopy nurse (SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSA group and the nurse with a patient-controlled analgesia (PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale (VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.

RESULTS

Total propofol consumption in the SSEN group was significantly higher (P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences (P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.

CONCLUSION

Colonoscopy sedation in ASA I-II patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.

Keywords: Midazolam-ketamine-propofol combination; Patient-controlled analgesia pump; Nurse-administered sedation; Colonoscopy

Core tip: Sedation is frequently performed during interventional procedures such as colonoscopy. In cases where there are not enough anaesthetists, there are a variety of sedation protocols that can be applied by educated non-anaesthesia personnel. In our study, we showed that midazolam-ketamine-propofol combination can be applied under the supervision of an endoscopy nurse.