Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy:Canadian tertiary center experience

• 作者: Alexandra Shingina Eric Lam George Ou Jessica Tong Kieran Donaldson Oliver Takach Ricky Kwok Robert Enns Sigrid Svarta
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: COLONOSCOPY SEDATION SEDATION TOLERANCE FENTANYL MIDAZOLAM Predictive model
• 年，卷（期）: 2016,（20）
• 页码范围: 770-776
• 页数: 7页
• 分类号: R

摘要

AIM To develop a prediction model aimed at identifying patients that may require higher than usual sedation doses during colonoscopy.METHODS A retrospective chart review on 5000 patients who underwent an outpatient colonoscopy at St. Paul’s Hospital from 2009 to 2010 was conducted in order to develop a model for identifying patients who will require increased doses of sedatives. Potential predictor variables including age, gender, endoscopy indication, high sedation requirements during previous endoscopies, difficulty of the procedure, bowel preparation quality, interventions, findings as well as current use of benzodiazepines, opioids and alcohol were analyzed. The outcome of study was the use ofhigh dose of sedation agents for the procedure. In particular, the high dose of sedation was defined as fentanyl greater than 50 mcg and midazolam greater than 3 mg. RESULTS Analysis of 5282 patients (mean age 57 ± 12, 49%female) was performed. Most common indication for the procedure was screening colonoscopy (57%). Almost half of our patients received doses exceeding Fentanyl 50 mcg and Midazolam 3 mg. Logistic regression models identified the following variables associated with high sedation: Younger age (OR = 0.95 95%CI: 0.94-0.95;P < 0.0001); abdominal pain (OR = 1.45, 95%CI:1.08-1.96); P = 0.01) and Inflammatory Bowel Disease(OR = 1.45, 95%CI: 1.04-2.03; P = 0.02) as indications for the procedure; difficult procedure as defined by gastroenterologist (OR = 1.73, 95%CI: 1.48-2.03; P< 0.0001); past history of abdominal surgery (OR= 1.33, 95%CI: 1.17-1.52; P <0.0001) and previouscolonoscopy (OR = 1.39, 95%CI: 1.21-1.60; P =0.0001) and alcohol use (OR = 1.26, 95%CI: 1.03-1.54;P = 0.02). Age and gender adjusted analysis yielded inflammatory bowel disease as an indication (OR = 3.17,95%CI: 1.58-6.37; P = 0.002); difficult procedure as efined by an endoscopist (OR = 5.13 95%CI: 2.97-8.85;P = 0.0001) and current use of opioids, benzodiazepines r antidepressants (OR = 2.88, 95%CI: 1.74-4.77; P= 0.001) having the highest p