Higher Sedation Requirements Among Inflammatory Bowel Disease Patients Undergoing Colonoscopy for Disease Activity Assessment or Dysplasia Surveillance. Issue 1 (3rd June 2019)

• Record Type: Journal Article
• Authors: Weber, Andrew T; Ather, Nimah; Tran, Vivy; Sauk, Jenny; Ha, Christina
• Is Part Of: Crohn's & colitis 360. Volume 1:Issue 1(2019)
• Publication Date: 2019-06-03
• Subjects: inflammatory bowel disease -- colonoscopy -- monitored anesthesia care -- intravenous conscious sedation; Crohn's disease -- Periodicals; Colitis -- Periodicals; 616.344
• DOI: 10.1093/crocol/otz006
• Languages: English
• ISSNs: 2631-827X

Abstract

Abstract: Background and Aims: Patients with inflammatory bowel disease (IBD) require colonoscopy for diagnosis, disease activity assessment, and dysplasia surveillance. Few studies have evaluated anesthesia needs of IBD patients during procedures. This study aimed to examine sedation requirements of IBD patients undergoing colonoscopy. Methods: A retrospective cohort study of IBD and non-IBD patients presenting for colonoscopy between August 2015 and December 2016 was undertaken. Data collected included patient and procedure focused variables. Sedation was categorized as intravenous conscious sedation (IVCS) or monitored anesthesia care (MAC). Results: A total of: 522 consecutive colonoscopies (212 IBD, 310 non-IBD) between August 2015 and December 2016 met criteria for inclusion. In total, 323 cases utilized IVCS (56 IBD, 267 non-IBD) and 196 used MAC (155 IBD, 41 non-IBD). Compared with non-IBD patients (13.2%), more IBD patients (73.1%) required MAC ( P < 0.01). For IVCS cases, IBD patients required more midazolam (5.73 mg versus non-IBD 4.31 mg; P <0.01) and opioid (IBD 157.59 µg fentanyl equivalents versus non-IBD 119.41 µg; P < 0.01). Diphenhydramine was more frequently added to IVCS for IBD cases (IBD 25.0% versus non-IBD 1.9%; P < 0.01). For MAC cases, propofol dosage was not significantly different between groups (IBD 355.64 mg versus non-IBD 317.104 mg; P = 0.29). IBD colonoscopies took longer (IBD 22.7 versus non-IBD 17.2 min; P < 0.01) and more patients had recent narcotic use (IBD 21.2% versus non-IBD 9.0%; P < 0.01). Conclusions: IBD patients required more IVCS, including greater diphenhydramine use with longer procedure times compared with non-IBD patients. These findings suggest MAC should be considered for IBD procedural sedation. Lay Summary: Persons with inflammatory bowel disease (IBD) (chronic inflammatory non-curable disorder of the digestive tract) usually require frequent colonoscopy (visualization of colon using a flexible tube-like instrument) to assess bowel damage and screen for colonic cancer. Colonoscopy is usually performed under sedation (administration of medications to induce calmness or sleep). There are several ways to induce sedation. Dr Ha et al from University of California, Los Angeles reviewed the medical charts of 522 adult persons, some with IBD and the rest without, who had colonoscopies using 2 different types of sedation, one is called intravenous conscious sedation (IVCS) and the other is called monitored anesthesia care (MAC), between August 2015 and December 2016. The researchers found out that person with IBD who underwent colonoscopy utilizing IVCS needed higher doses of some medications such as midazolam and more frequent use of other medications such as diphenhydramine compared with those without IBD. On the other hand, the amount of a drug, called propofol, used in MAC was the same for persons with or without IBD. Colonoscopy for persons with IBD, however, took longer time to perform. On the basis of their findings, the researchers recommended MAC for colonoscopy sedation in persons with IBD. While these findings are important, the study is limited by its design and failure of reporting complications and costs associated with each type of sedation.