Blog
About

  • Record: found
  • Abstract: found
  • Article: found
Is Open Access

Portable inhaled methoxyflurane is feasible and safe for colonoscopy in subjects with morbid obesity and/or obstructive sleep apnea

Read this article at

ScienceOpenPublisherPMC
Bookmark
      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

      Abstract

      Background and study aims: Colonoscopy with inhaled methoxyflurane (Penthrox) is well tolerated in unselected subjects and is not associated with respiratory depression. The aim of this prospective study was to compare the feasibility, safety, and post-procedural outcomes of portable methoxyflurane used as an analgesic agent during colonoscopy with those of anesthesia-assisted deep sedation (AADS) in subjects with morbid obesity and/or obstructive sleep apnea (OSA). Patients and methods: The outcomes of 140 patients with morbid obesity/OSA who underwent colonoscopy with either Penthrox inhalation (n = 85; 46 men, 39 women; mean age 57.2 ± 1.1 years) or AADS (n = 55; 27 men, 28 women; mean age, 54.9 ± 1.1 years) were prospectively assessed. Results: All Penthrox-assisted colonoscopies were successful, without any requirement for additional intravenous sedation. Compared with AADS, Penthrox was associated with a shorter total procedural time (24 ± 1 vs. 52 ± 1 minutes, P < 0.001), a lower incidence of hypotension (3 /85 vs. 23 /55, P < 0.001), and a lower incidence of respiratory desaturation (0 /85 vs. 14 /55, P < 0.001). The patients in the Penthrox group recovered more rapidly and were discharged much earlier than those in the AADS group (27 ± 2 vs. 97 ± 5 minutes, P < 0.0001). Of those who underwent colonoscopy with Penthrox, 90 % were willing to receive Penthrox again for colonoscopy. More importantly, of the patients who underwent colonoscopy with Penthrox and had had AADS for previous colonoscopy, 82 % (28 /34) preferred to receive Penthrox for future colonoscopies. Penthrox-assisted colonoscopy cost significantly less than colonoscopy with AADS ($ 332 vs. $ 725, P < 0.001), with a cost saving of approximately $ 400 for each additional complication avoided. Conclusions: Compared with AADS, Penthrox is highly feasible and safe in patients with morbid obesity/OSA undergoing colonoscopy and is associated with fewer cardiorespiratory complications. Because of the advantages of this approach in regard to procedural time, recovery time, and cost benefit in comparison with AADS, further evaluation in a randomized trial is warranted.

      Related collections

      Most cited references 19

      • Record: found
      • Abstract: found
      • Article: not found

      Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists.

      Propofol is under evaluation as a sedative for endoscopic procedures. Eighty outpatients (ASA Class I or II) undergoing colonoscopy were randomized to receive either propofol or midazolam plus meperidine, administered by a nurse and supervised by an endoscopist. Endpoints were patient satisfaction, procedure and recovery times, neuropsychological function, and complications. The mean dose of propofol administered was 218 mg; mean doses of midazolam and meperidine were, respectively, 4.7 mg and 89.7 mg. Mean time to sedation was faster in the propofol patients (2.1 min vs. 7.0 min; p < 0.0001), and depth of sedation was greater (p < 0.0001). On average, after the procedure, the propofol patients could stand at the bedside sooner (14.2 vs. 30.2 min), reached full recovery faster (14.4 vs. 33.0 min), and were discharged sooner (40.5 vs. 71.1 min) (all p < 0.0001). Patients who received propofol also expressed greater overall mean satisfaction on a 10-point visual analog scale (9.3 vs. 8.6; p < 0.05). At discharge, the propofol group had better scores on tests reflective of learning, memory, working memory span, and mental speed. Four patients in the midazolam/meperidine group developed minor complications (1 hypotension and bradycardia, 2 hypotension alone, and 1 tachycardia) and 1 patient in the propofol group had oxygen desaturation develop during an episode of epistaxis. For outpatient colonoscopy, propofol administered by nurses and supervised by endoscopists has several advantages over midazolam plus meperidine and deserves additional investigation.
        Bookmark
        • Record: found
        • Abstract: not found
        • Article: not found

        Psychometric properties of the STAI: a reply to Ramanaiah, Franzen, and Schill.

          Bookmark
          • Record: found
          • Abstract: not found
          • Article: not found

          Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening.

            Bookmark

            Author and article information

            Affiliations
            [1 ]Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
            [2 ]Colo-Rectal Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
            [3 ]Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
            [4 ]Department of Gastroenterology, Flinders Medical Centre, Bedford Park, South Australia, Australia
            Author notes
            Corresponding author Nam Q. Nguyen, MD Department of Gastroenterology and HepatologyRoyal Adelaide HospitalNorth TerraceAdelaideSouth Australia, 5000Australia+61-8-8222-5885 quoc.nguyen@ 123456health.sa.gov.au
            Journal
            Endosc Int Open
            Endosc Int Open
            10.1055/s-0034-1377934
            Endoscopy International Open
            © Georg Thieme Verlag KG (Stuttgart · New York )
            2364-3722
            2196-9736
            October 2015
            24 June 2015
            : 3
            : 5
            : E487-E493
            4612230
            10.1055/s-0034-1392366
            © Thieme Medical Publishers
            Categories
            Article

            Comments

            Comment on this article