Deep Sedation Preferred in Colonoscopy
Researchers have found that patients with inflammatory bowel disease (IBD) who undergo colonoscopy had significantly higher scores on a satisfaction questionnaire when they received Nurse Administered Propofol Sedation (NAPS) than when moderate sedation was administered.
In a randomized clinical trial, 56 (43%) patients with ulcerative colitis, 48 (37%) with Crohn disease, and 26 (20%) who were suspected of having IBD were randomized to deep sedation with NAPS (n=63) or moderate sedation with midazolam and fentanyl (n=67). The majority of patients (88%) had experienced colonoscopy previously and all patients’ expectations regarding the procedure were similar.
The primary endpoint of patient satisfaction was assessed with a Satisfaction Questionnaire of 13 items, each assessed with a 5-point Likert scale. Higher scores showed greater satisfaction with a maximum score of 65 points.
Patients who received NAPS showed significantly higher satisfaction (mean score 60.1, SD 3.4) than patients who received moderate sedation (51.2, 8.4; p<0.001). Those who were sedated with NAPS reported less pain, greater amnesia, and overall better experience with deep sedation than with moderate sedation they had received in previous procedures. They also indicated significant preference for the same kind of sedation in future colonoscopies, and were more likely to accept more frequent procedures than patients who received moderate sedation.
Among patients who received moderate sedation with midazolam and fentanyl, procedures were more often disrupted due to pain and assistance from an additional colonoscopist was required than in the NAPS group.
“IBD patients favor deep propofol sedation over moderate midazolam and fentanyl sedation,” the researchers stated. “Availability of NAPS may facilitate patient adherence to endoscopy-based monitoring program.”
--Rebecca Mashaw
Steenholdt C, Jensen JT, Brynskov J, et al. Patient satisfaction of propofol versus midazolam and fentanyl sedation during colonoscopy in inflammatory bowel disease. Clin Gastroenterol Hepatol. Published online October 22, 2020
