Jump to comment:
- Page navigation anchor for RE: Derp Sedation UnnecessaryRE: Derp Sedation Unnecessary
As an individual who has had colonoscopies and will continue to have them every 5 years, I'm deeply concerned with any gastroenterologist who performs the procedure who feels sedation is unnecessary and minimizes the great discomfort to the patient. I'm also concerned at the lack of awareness that ceasing to offer sedation will preclude many patients from having the procedure which would increase mortality from late stage discovery of colo-rectal cancers which would negate any dollar savings from denial of sedation.
I'd also suggest the authors offer themselves as teaching "tools" to new doctors performing this procedure, without anaesthesia, to aid in their training by giving audible feedback when poor technique is used.Competing Interests: None declared. - Page navigation anchor for Anesthesiologists bring value to the care of patients undergoing colonoscopyAnesthesiologists bring value to the care of patients undergoing colonoscopy
I read with great interest the commentary piece by Pace and Borgaonkar entitled "Deep sedation for colonoscopy is unnecessary and wasteful" in the February 12, 2018 online issue of the Journal (1) and I offer the following observations and comments.
The authors begin by noting that "in many countries, a large proportion of colonoscopies are performed with little or no sedation", citing a 2011 national audit in the United Kingdom (UK) where 10.7% of colonoscopies were performed without sedation, and in only 0.4% was propofol or general anesthesia administered (Gavin DR). The authors neglected to note that the UK study also reported as a "key auditable outcome" an assessment of patient comfort. This outcome was recorded using the Gloucester comfort score, which is a nurse-assessed measure of comfort with a defined 5-point scale. The reported incidence of a "comfort score" 4 or greater (indicating moderate to severe discomfort) was 9.8%, which is virtually equivalent to the proportion of colonoscopies performed with no sedation. The authors noted that it is unacceptable for such a large proportion of patients to experience significant distress during their colonoscopy.
Pace and Borgaonkar also note the reported increase in use of propofol for colonoscopy in Ontario between 2005 and 2012, and correctly identify the major reasons for this as patient preference, endoscopist preference, and improved efficiency gained from fast...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Propofol sedation improves efficiency and optimizes patient satisfaction during colonoscopyPropofol sedation improves efficiency and optimizes patient satisfaction during colonoscopy
The well-meaning, if not provocative, commentary from Drs. Pace and Borgaonkar (1) proposing that deep sedation for colonoscopy is wasteful and unnecessary, serves to highlight a complex perioperative issue. In doing so, however, they fail to highlight the need for balance in understanding the issues involved. Their selective referencing and interpretation of the varied literature on the subject results in a distorted picture of clinical reality. Their commentary also lacks substantive evidence for many of their claims. Furthermore, many of their speculative statements appear to be quite contradictory. For example, the authors state that “there is no convincing evidence that the level of sedation affects the cecal intubation rate or the adenoma detection rate”, but then they go on to suggest that deep sedation with propofol may adversely affect colonoscopy “quality”. Interestingly, they reference no study that supports any purported adverse effect of propofol on quality.
As for safety, they quote a meta-analysis that showed no difference in cardiopulmonary adverse effects when comparing propofol (i.e., deep sedation) with traditional agents (i.e., mild to moderate sedation).(2) Logic would have it, then, that if using propofol for deep sedation does not adversely affect the adenoma detection rate, and shows no overall difference in cardiopulmonary adverse events, then one needs to look at other parameters to determine whether there is value in deep sedation. For exa...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: propofol sedation for colonoscopyRE: propofol sedation for colonoscopy
Perhaps the authors would like to go first, in having their colonoscopy done without any sedation and analgesia? Followed by the Health Minister and various hospital executives and policy makers. Then let's have an honest discussion about the conclusions of this article.
Competing Interests: None declared.