Froehlich F, Harris J K, Wietlisbach V, Burnand B, Vader J-P, Gonvers J-J
Division of Gastroenterology, Medical Outpatient Department, PMU/CHUV, University of Lausanne, Lausanne, Switzerland.
Endoscopy. 2006 May;38(5):461-9. doi: 10.1055/s-2006-925368.
Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally.
This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient.
6004 patients were included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood pressure monitoring in 34 %, and electrocardiography in 24 %. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0 % to 100 % between centers. Oxygen desaturation (</= 85 %) occurred in 5 % of patients, of whom 80 % were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27 % of colonoscopies, and during 85 % of colonoscopies using deep sedation.
Internationally, sedation and monitoring practice during colonoscopy varied widely. Moderate sedation was the most common sedation method used and electronic monitoring was used in three-quarters of patients. Deep sedation tended to be more resource-intensive, implying a greater use of staff and monitoring.
结肠镜检查期间的镇静和监测方法在不同中心以及不同时期有所差异。了解当前的操作方法对于确保医疗质量以及为未来研究指明方向至关重要。本研究旨在调查国际范围内各内镜中心的镇静和监测方法。
本观察性研究纳入了来自11个国家21个中心的连续结肠镜检查患者。内镜医师使用标准问卷，报告每位患者的镇静和监测方法。
本研究共纳入6004例患者，其中53%在结肠镜检查期间接受了清醒/中度镇静，30%接受了深度镇静，17%未接受镇静。最常用的镇静药物是咪达唑仑（47%）和阿片类药物（33%）。77%的患者在结肠镜检查期间进行了脉搏血氧饱和度监测，34%进行了血压监测，24%进行了心电图监测。脉搏血氧饱和度监测最常用于中度镇静患者，而血压监测和心电图监测主要用于深度镇静患者。各中心的镇静和监测使用率在0%至100%之间。5%的患者出现了氧饱和度下降（≤85%），其中80%为中度镇静患者。平均而言，每次操作有三名工作人员参与。27%的结肠镜检查有麻醉医生在场，在使用深度镇静的结肠镜检查中，这一比例为85%。
在国际上，结肠镜检查期间的镇静和监测方法差异很大。中度镇静是最常用的镇静方法，四分之三的患者使用了电子监测。深度镇静往往需要更多资源，这意味着需要更多工作人员和监测。
