Anesthesia professional-delivered sedation has become increasingly common when performing colonoscopy and EGD.
To provide an estimate of anesthesia professional-participation rates in colonoscopy and EGD procedures and to examine rate changes over time and geographic variations for both procedures.
Retrospective sample design.
National survey data from i3 Innovus for the period 2003 to 2007 on the use rate of anesthesia professionals in both procedures.
A sample of 3688 observations included 3-digit zip code-level information on anesthesia professional use rates.
Data were linked to the Bureau of Health Professions' Area Resource File to control for sociodemographic factors and provider supply characteristics for anesthesia professional use rates.
Multivariable regression analyses were performed to identify factors predicting the use rate of anesthesia professionals in these procedures and to forecast use rates for the years 2009 to 2015.
For colonoscopy and EGD, anesthesia professional participation is projected to grow from 23.9% and 24.4% in 2007 to 53.4% and 52.9% by 2015, respectively. Average growth rates were highest in the northeast for colonoscopy (145.8%) and EGD (146.6%). Anesthesia professional use rates were significantly greater in areas having a higher percentage of older subjects (45 years and older), higher per capita income and lower unemployment rates, and higher per capita inpatient admissions and were significantly lower in areas having more per capita outpatient visits for both procedures.
Nonexperimental retrospective sample study design. Database sample may not be nationally representative. Market area characteristics were used to control for socioeconomic and demographic factors. However, there may remain some important market factors that we were unable to control.
Anesthesia professional-delivered sedation is projected to grow substantially for both procedures.
"Liu 55 showed that the proportion of sedated endoscopic procedures 56 has more than doubled, from approximately 14% in 2003 to 30% 57 in 2009 (Liu et al., 2012). In another study, the percentage of 58 sedated endoscopy was expected to increase by 53% in 2015 59 (Inadomi et al., 2010). 60 Generally, periodic surveillance endoscopy is recommended for 61 various conditions and risk factors, varying from every 3 months to 62 every 2–3 years (Hirota et al., 2006). "
"However, it is surprising that anesthesia professional-delivered sedation for EGD and colonoscopy has become more common in the United States. From 2003 to 2007, the involvement of anesthesiologists in colonoscopy increased from 9 to 25%, and this might be up to more than 50% by 2015
. Further observation is warranted. "
[Show abstract][Hide abstract] ABSTRACT: There is increasing interest in balanced propofol sedation (BPS) titrated to moderate sedation (conscious sedation) for endoscopic procedures. However, few controlled studies on BPS targeted to deep sedation for diagnostic endoscopy were found. Alfentanil, a rapid and short-acting synthetic analog of fentanyl, appears to offer clinically significant advantages over fentanyl during outpatient anesthesia.
It is reasonable to hypothesize that low dose of alfentanil used in BPS might also result in more rapid recovery as compared with fentanyl.
A prospective, randomized and double-blinded clinical trial of alfentanil, midazolam and propofol versus fentanyl, midazolam and propofol in 272 outpatients undergoing diagnostic esophagogastroduodenal endoscopy (EGD) and colonoscopy for health examination were enrolled. Randomization was achieved by using the computer-generated random sequence. Each combination regimen was titrated to deep sedation. The recovery time, patient satisfaction, safety and the efficacy and cost benefit between groups were compared.
260 participants were analyzed, 129 in alfentanil group and 131 in fentanyl group. There is no significant difference in sex, age, body weight, BMI and ASA distribution between two groups. Also, there is no significant difference in recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between two groups. Though deep sedation was targeted, all cardiopulmonary complications were minor and transient (10.8%, 28/260). No serious adverse events including the use of flumazenil, assisted ventilation, permanent injury or death, and temporary or permanent interruption of procedure were found in both groups. However, fentanyl is New Taiwan Dollar (NT$) 103 (approximate US$ 4) cheaper than alfentanil, leading to a significant difference in total cost between two groups.
This randomized, double-blinded clinical trial showed that there is no significant difference in the recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between the two most common sedation regimens for EGD and colonoscopy in our hospital. However, fentanyl is NT$103 (US$ 4) cheaper than alfentanil in each case.
Institutional Review Board of Buddhist Tzu Chi General Hospital (IRB097-18) and Chinese Clinical Trial Registry (ChiCTR-TRC-12002575)
"This means deep sedation is likely to be more resource-intensive due to a higher need for specialized staff and monitoring . The percentage of colonoscopies performed with the participation of anesthesia professionals is expected to rise from 23.9 % in 2007 to 53.4 % by 2015, respectively . In view of this dramatic increase, health insurance companies are attempting to restrict coverage for anesthesia professional-delivered sedation . "
[Show abstract][Hide abstract] ABSTRACT: Colonoscopy is a proven method for bowel cancer screening and is often experienced as a painful procedure. Today, there are two main strategies to facilitate colonoscopy. First, deep sedation results in satisfied patients but increases sedation-associated risks and raises costs for healthcare providers. Second, there is the advocacy for colonoscopies without any form of sedation. This might be an option for a special group of patients, but does not hold true for everybody. Following Moerman's hypothesis: "If pain is the crucial point, why do we need sedation?" this review shows the analgesic options for a painless procedure, increasing success rates without increasing risk of sedation. There are two agents, with the potential to be a nearly ideal analgesic agent for colonoscopy: alfentanil and nitrous oxide (N(2)O). Administration of either substance causes the patient to be comfortable yet alert and facilitates a short turnover. Advantages of these drugs include rapid onset and offset of action, analgesic and anxiolytic effects, ease of titration to desired level, rapid recovery, and an excellent safety profile.
Techniques in Coloproctology 06/2012; 16(4):271-6. DOI:10.1007/s10151-012-0834-5 · 2.04 Impact Factor
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