Randomized Clinical Trial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1146-1154
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1146
Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy
Selda Kayaaltı, Ömer Kayaaltı
Selda Kayaaltı, Division of Anaesthesiology and Reanimation, Develi Public Hospital, Develi, Kayseri 38400, Turkey
Ömer Kayaaltı, Computer Technology, Kayseri University, Develi Huseyin Sahin Vocational College, Develi, Kayseri 38400, Turkey
Author contributions: Kayaaltı S designed and performed the research; Kayaaltı S and Kayaaltı Ö analysed the data, wrote the paper and reviewed the manuscript.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Erciyes University Medical Faculty.
Clinical trial registration statement: The registration identification number is 2018/94.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after the patients agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest with respect to the authorship and/or publication of this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that 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/
Corresponding author to: Selda Kayaaltı, MD, Specialist Doctor, Division of Anaesthesiology and Reanimation, Develi Public Hospital, Develi, Kayseri 38400, Turkey. drselda@hotmail.com
Telephone: +90-352-6216020 Fax: +90-352-6216223
Received: October 9, 2018
Peer-review started: October 10, 2018
First decision: November 1, 2018
Revised: November 9, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 26, 2018
Processing time: 75 Days and 20.6 Hours
ARTICLE HIGHLIGHTS
Research background

Sedation is performed in many centres during the colonoscopy procedure. However, since there are a limited number of anaesthesiologists, there are centres where colonoscopy is performed without sedation. In the literature, there are several studies in which colonoscopy sedation is performed without anaesthesia personnel. In this study, we aim to evaluate the patient satisfaction and the side effects of colonoscopy sedation performed by endoscopy nurse with patient-controlled analgesia (PCA) pump.

Research motivation

In studies where colonoscopy sedation is performed under the supervision of a nurse, propofol is often used alone or in combination with agents such as fentanyl, meperidine or midazolam. Ketamine, which protects spontaneous breathing and protective airway reflexes by providing dissociative anaesthesia, is not used in adult colonoscopy patients. In our study, we wanted to determine the advantages and disadvantages of ketamine in combination with propofol and midazolam without anaesthesia personnel during colonoscopy.

Research objectives

It is aimed to perform ketamine-midazolam-propofol sedation with minimum side effects and to obtain the best patient satisfaction under the supervision of a nurse in low-risk colonoscopy patients. Individual dose errors were minimized by using a PCA pump.

Research methods

Sixty American Statistical Association (ASA) I-II patients who underwent colonoscopy were included in the study. Patients were randomly divided into two groups [sedation under the supervision of anaesthetist (SSA) and sedation under the supervision of endoscopy nurse (SSEN)]. Both groups were initially administered 1 mg midazolam, 50 mg ketamine, and 30-50 mg propofol. The required dose of propofol in the SSA group was then determined and administered by the anaesthesiologist. In the SSEN group, the continuation of sedation was carried out by the nurse with PCA pump. Data such as patient satisfaction, incidence of side effects, total drug consumption, and procedure duration were recorded, and differences among the groups were evaluated.

Research results

There were no statistically significant differences (P > 0.05) between the two groups in terms of patient satisfaction, the rate of re-preference for the same method in case of repeat endoscopy, and the side effects. Total propofol consumption in the SSEN group was significantly higher (P < 0.05), whereas the systolic and diastolic pressure values were significantly lower (P < 0.05) at 5 min and after 8 min. Reaching the cecum and total procedure time were significantly longer (P < 0.05) in the SSEN group. There were no significant prolonged side effects in either group.

Research conclusions

In ASA I-II patients, sedation under the supervision of nurses with PCA pump in colonoscopy has similar side effects and patient satisfaction levels as sedation under SSA.

Research perspectives

There is a need for further studies with ASA III-IV patients and also with more patients.