Nguyen Nam Q, Toscano Leanne, Lawrence Matthew, Moore James, Holloway Richard H, Bartholomeusz Dylan, Lidums Ilmars, Tam William, Roberts-Thomson Ian C, Mahesh Venkataswamy N, Debreceni Tamara L, Schoeman Mark N
Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia.
Colo-Rectal Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia.
Gastrointest Endosc. 2013 Dec;78(6):892-901. doi: 10.1016/j.gie.2013.05.023. Epub 2013 Jun 28.
Inhaled methoxyflurane (Penthrox, Medical Device International, Melbourne, Australia) has been used extensively in Australasia (Australia and New Zealand) to manage trauma-related pain. The aim is to evaluate the efficacy, safety, and outcome of Penthrox for colonoscopy.
Prospective randomized study.
Three tertiary endoscopic centers.
Two hundred fifty-one patients were randomized to receive either Penthrox (n = 125, 70 men, 51.4 ± 1.1 years old) or intravenous midazolam and fentanyl (M&F; n = 126, 72 men, 54.9 ± 1.1 years old) during colonoscopy.
Discomfort (visual analogue scale [VAS] pain score), anxiety (State-Trait Anxiety Inventory Form Y [STAI-Y] anxiety score), colonoscopy performance, adverse events, and recovery time.
Precolonoscopy VAS pain and STAI-Y scores were comparable between the 2 groups. There were no differences between groups in (1) pain VAS or STAI Y-1 anxiety scores during or immediately after colonoscopy, (2) procedural success rate (Penthrox: 121/125 vs M&F: 124/126), (3) hypotension during colonoscopy (7/125 vs 8/126), (4) tachycardia (5/125 vs 3/126), (5) cecal arrival time (8 ± 1 vs 8 ± 1 minutes), or (6) polyp detection rate (30/125 vs 43/126). Additional intravenous sedation was required in 10 patients (8%) who received Penthrox. Patients receiving Penthrox alone had no desaturation (oxygen saturation [SaO(2)] < 90%) events (0/115 vs 5/126; P = .03), awoke quicker (3 ± 0 vs 19 ± 1 minutes; P < .001) and were ready for discharge earlier (37 ± 1 vs 66 ± 2 minutes; P < .001) than those receiving intravenous M&F.
Inhaled Penthrox is not yet available in the United States and Europe.
Patient-controlled analgesia with inhaled Penthrox is feasible and as effective as conventional sedation for colonoscopy with shorter recovery time, is not associated with respiratory depression, and does not influence the procedural success and polyp detection.
吸入用甲氧氟烷（澳米普明，医疗器械国际公司，墨尔本，澳大利亚）已在澳大拉西亚（澳大利亚和新西兰）广泛用于处理创伤相关疼痛。目的是评估澳米普明用于结肠镜检查的疗效、安全性和结果。
前瞻性随机研究。
三个三级内镜中心。
251例患者在结肠镜检查期间被随机分为接受澳米普明组（n = 125，70名男性，51.4±1.1岁）或静脉注射咪达唑仑和芬太尼组（M&F；n = 126，72名男性，54.9±1.1岁）。
不适（视觉模拟量表[VAS]疼痛评分）、焦虑（状态-特质焦虑量表Y型[STAI-Y]焦虑评分）、结肠镜检查操作、不良事件和恢复时间。
两组结肠镜检查前VAS疼痛和STAI-Y评分相当。两组在以下方面无差异：（1）结肠镜检查期间或检查后立即的疼痛VAS或STAI Y-1焦虑评分；（2）操作成功率（澳米普明组：121/125 vs M&F组：124/126）；（3）结肠镜检查期间的低血压（7/125 vs 8/126）；（4）心动过速（5/125 vs 3/126）；（5）到达盲肠时间（8±1 vs 8±1分钟）；或（6）息肉检出率（30/125 vs 43/126）。接受澳米普明的10例患者（8%）需要额外静脉镇静。单独接受澳米普明的患者无血氧饱和度降低（氧饱和度[SaO₂]<90%）事件（0/115 vs 5/126；P = 0.03），苏醒更快（3±0 vs 19±1分钟；P<0.001），且比接受静脉注射M&F的患者更早准备好出院（37±1 vs 66±2分钟；P<0.001）。
吸入用澳米普明在美国和欧洲尚未上市。
患者自控吸入澳米普明镇痛用于结肠镜检查是可行的，与传统镇静效果相同，恢复时间更短，不伴有呼吸抑制，且不影响操作成功率和息肉检出率。
