University of Florence, Department of Critical Care Medicine, Section of Anesthesiology and Intensive Care, Florence, Italy.
Minerva Anestesiol. 2009 Dec;75(12):677-83.
Colorectal cancer screening colonoscopies require sedation for both anxiety and pain. Propofol is used worldwide and allows for rapid and profound sedation with quick recovery after cessation of infusion. However, there is still a debate about whether it should be administered by anesthetists, gastroenterologists, or trained nurses. The aim of the study was to assess the number and proportion of patients who might benefit from the quality and safety of sedation under propofol during colonoscopies in a cohort of colorectal cancer screening outpatients.
Patients' genders, ages, numbers of operative procedures, and prior experience with colonoscopies were recorded, and differences were tested between sedated and unsedated patients. The need for mask ventilation and the rate of anesthetically, medically, or surgically related complications were compared between sedated and unsedated patients. The number of complete colonoscopies, length of the procedures, and time to reach the ileocecal valve were compared between sedated and unsedated patients.
Of 135 colonoscopies, 101 were performed under sedation. All sedated patients underwent complete endoscopic examinations, while 8.9% of unsedated patients had their examination stopped due to excessive discomfort or pain. Colonoscopies tended to be shorter in sedated than unsedated patients. No anesthesia-related complications occurred. In 3/135 patients, a short period (<3 min) of mask ventilation was necessary. One surgical complication occurred among the sedated patients. One unsedated patient suffered a medical complication (dyspnea and ST-T elevation).
Propofol sedation can be safely applied to colorectal cancer screening outpatients. Sedation was managed by a dedicated anesthetic staff and no patient suffered anesthesia-related complications.
结直肠癌筛查结肠镜检查需要镇静以缓解焦虑和疼痛。丙泊酚在全球范围内使用，可实现快速而深度的镇静，停止输注后可快速恢复。然而，关于应由麻醉师、胃肠病学家还是经过培训的护士来管理丙泊酚镇静仍存在争议。本研究旨在评估在一组结直肠癌筛查门诊患者中，接受结肠镜检查的患者中有多少人可能从丙泊酚镇静的质量和安全性中受益。
记录患者的性别、年龄、手术次数和结肠镜检查的既往经验，并比较镇静和未镇静患者之间的差异。比较镇静和未镇静患者之间需要面罩通气的情况以及麻醉、医学或手术相关并发症的发生率。比较镇静和未镇静患者之间完整结肠镜检查的数量、手术的长度和到达回盲瓣的时间。
在 135 例结肠镜检查中，101 例在镇静下进行。所有接受镇静的患者均完成了内镜检查，而 8.9%的未镇静患者因过度不适或疼痛而停止检查。镇静患者的结肠镜检查时间往往比未镇静患者短。未发生与麻醉相关的并发症。在 135 例患者中，有 3 例需要面罩通气短暂时间（<3 分钟）。镇静患者中发生 1 例手术并发症。1 例未镇静患者发生 1 例医学并发症（呼吸困难和 ST-T 抬高）。
丙泊酚镇静可安全用于结直肠癌筛查门诊患者。镇静由专门的麻醉人员管理，无患者发生与麻醉相关的并发症。
