Chronic Opioid Users Are More Difficult to Sedate than Alcoholics and Controls. Issue 12 (December 2015)

• Record Type: Journal Article
• Authors: Patel, Rupal; Clayton, Steven; Quintero, Eduardo; Gill, Jeffrey
• Is Part Of: Southern medical journal. Volume 108:Issue 12(2015)
• Publication Date: 2015-12
• Subjects: colonoscopy -- conscious sedation -- substance abuse; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000000384
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Objectives: Diagnostic and therapeutic colonoscopy is performed using conscious sedation. Excessive alcohol users, chronic benzodiazepine and opioid users, and polysubstance users are commonly cited as difficult to sedate. Few studies have compared and analyzed medication dosages to achieve sedation in these groups. Methods: The endoscopic database was searched for patients who underwent colonoscopy. A retrospective chart review was performed to determine whether each patient was an abuser/chronic user of opioids, benzodiazepines, marijuana, alcohol, or a combination of the above. The mean dose of fentanyl and versed administered in each group was compared. Results: A total of 239 patients were enrolled. Compared with the alcohol and control groups, the opioid group used a statistically higher mean medication dosage to achieve sedation. The mean dose of fentanyl in the opioid group was 124 μg, the mean dose in the alcohol group was 101 μg, and the mean dose in the control group was 101 μg. The mean dose of midazolam in the opioid group was 4.1 mg, the mean dose in the alcohol group was 3.3 mg, and the mean dose in the control group was 3.3 mg. Conclusions: Identifying patients who are difficult to sedate before colonoscopy is important because adequate sedation is associated with better adenoma detection, a better procedural completion rate, and patient satisfaction. In patients using daily opioids, it is important to anticipate the need for higher doses of medication to achieve adequate sedation. Abstract : This was a retrospective cohort study comparing the medication dosages to achieve conscious sedation during colonoscopy among patient groups deemed difficult to sedate. The authors found that in patients using daily opioids, in comparison to other substance using groups and controls, it is important to anticipate the need for higher doses of medication to achieve adequate sedation.