Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 25, 2016; 8(4): 232-238
Published online Feb 25, 2016. doi: 10.4253/wjge.v8.i4.232
Efficiency and patient experience with propofol vs conventional sedation: A prospective study
Patrick Thornley, Mohammad Al Beshir, James Gregor, Andreas Antoniou, Nitin Khanna
Patrick Thornley, Michael G. DeGroote School of Medicine, MsMaster University, Hamilton, Ontario L8S 4L8, Canada
Mohammad Al Beshir, Division of Gastroenterology, King Fahad Specialist Hospital - Dammam, Dammam 31444, Saudi Arabia
James Gregor, Nitin Khanna, Division of Gastroenterology, Western University, London, Ontario N6A 3K7, Canada
Andreas Antoniou, Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario N6A 3K7, Canada
Author contributions: Thornley P, Al Beshir M, Gregor J, Antoniou A and Khanna N contributed to study conception and design; Thornley P, Al Beshir M and Khanna N contributed to data acquisition, data analysis and interpretation, and writing of the article; Gregor J, Antoniou A and Khanna N contributed to editing, reviewing and final approval of the article.
Supported by Division of Gastroenterology at Western University (in part), Canada.
Institutional review board statement: The study was reviewed and approved by the Western University Institutional Review Board.
Informed consent statement: All study participants provided informed verbal and written consent prior to study enrolment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nitin Khanna, MD, Division of Gastroenterology, Western University, 529 McGarrell Place, London, Ontario N6A 3K7, Canada. nitin.khanna@sjhc.london.on.ca
Telephone: +1-519-6466125 Fax: +1-519-6466130
Received: October 2, 2015
Peer-review started: October 2, 2015
First decision: November 5, 2015
Revised: December 7, 2015
Accepted: December 19, 2015
Article in press: December 23, 2015
Published online: February 25, 2016
Processing time: 143 Days and 9 Hours
Abstract

AIM: To determine whether anaesthesiologist-administered sedation with propofol (AAP) or endoscopist-administered conscious sedation (EAC) with fentanyl/midazolam shortens colonoscopy duration/total room time.

METHODS: This is a prospective, non-randomized, comparative study that enrolled patients greater than 18 years of age undergoing colonoscopy in a single Canadian academic outpatient endoscopy unit over a three-month consecutive period. Colonoscopies in this unit are performed both with AAP and EAC. Patient demographics, procedure-related data and adverse events were documented. Additionally, the level of procedure difficulty, and whether a staff endoscopist, trainee with assistance, or independent trainee, performed the procedure were documented. A validated modified 4-question, 5-point Likert scale telephone survey was used to assess patient satisfaction with colonoscopy. The telephone patient satisfaction survey was conducted 24-72 h following the procedure.

RESULTS: Two hundred and thirty patients were enrolled during the study period with 126 patients in the AAP group and 104 patients in the EAC group. Mean procedure time was 18.3 ± 10.1 min in the AAP group and 14.7 ± 7.1 min in the EAC group (P = 0.002). Mean total room time was 36.8 ± 13.7 with AAP and 30.1 ± 11 min with EAC (P < 0.001). Multivariate analysis revealed the use of AAP (P = 0.002), resident participation (P < 0.001), diagnostic interventions (P = 0.033), therapeutic interventions (P < 0.001), lower body mass index (P = 0.008) and American Society of Anaesthesiologist class (P = 0.016), to be predictors of longer total room time. Patient age and gender were not significant predictors. After excluding cases in which trainees were involved, there was no significant difference in procedure time between the two groups (P = 0.941), however total room time was still prolonged in the AAP group (P = 0.019). The amount of pain experienced was lower with AAP (P = 0.02), with a trend toward overall higher patient satisfaction (P = 0.074). There were 2 sedation-related adverse events, both in the AAP group involving a patient with aspiration requiring hospitalization and a patient with hypoxia managed with bronchodilators.

CONCLUSION: EAC results in reduced total room time compared to AAP. Resident participation doubles procedure time regardless of sedation type.

Keywords: Patient satisfaction; Fentanyl; Colonoscopy; Midazolam; Propofol

Core tip: There is little research examining sedation type in light of patient satisfaction and overall efficiency of colonoscopy. Our novel prospective study evaluated the total procedure room time and patient satisfaction in a high-volume endoscopy center, which performs colonoscopy using conventional sedation and propofol sedation. A statistically significant reduction in total room time with conventional sedation (midazolam/fentanyl) when compared to anaesthetist-administered propofol was demonstrated. Patients reported less procedure pain when receiving propofol sedation compared to conventional sedation. Special discussion emphasizes the need to further examine strategies to maximize endoscopy unit efficiency to respond to increasing patient demand, while maximizing patient satisfaction.