Routine vs On-Demand Sedation for Colonoscopy

A study comparing the safety and tolerance of routine sedation with that of on-demand sedation for colonoscopy has found that routine administration of analgesic and sedative drugs before the procedure provides better tolerance than on-demand sedation. Conducted by researchers at Valduce Hospital (Como, Italy), the study was published in Gastrointestinal Endoscopy (2001, 54:169-174).

The prospective, randomized study involved 249 patients, divided into two groups. Group A received midazolam plus meperidine intravenously just before the insertion of the colonoscope. Group B received the same medication but only upon request during the procedure. Tolerance was assessed 24 hours after the procedure in a phone interview with a nurse unaware of the medication regimen of the two groups.

Of the patients in Group B, 83 (66%) requested sedation during colonoscopy. Among the men in this group more than 60 years old, only 23% requested sedation. The percentage of patients who reported moderate or severe pain (34% vs. 12.1%) and of patients who said they would be unwilling to undergo the procedure again (22% vs 9.7%) was significantly higher in Group B than in Group A. The researchers found that the incidence of side effects was similar in both groups. From the results, they concluded that in terms of tolerance, routine administration of sedation was superior to on-demand sedation and was not associated with any increase in side effects.




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