Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy:Canadian tertiary center experience

作     者：Alexandra Shingina George Ou Oliver Takach Sigrid Svarta Ricky Kwok Jessica Tong Kieran Donaldson Eric Lam Robert Enns 

作者机构：Department of GastroenterologyFaculty of MedicineUniversity of TorontoToronto General Hospital Department of GastroenterologyFaculty of MedicineUniversity of British Columbia Division of GastroenterologySaint Paul Hospital 

出 版 物：《World Journal of Gastrointestinal Endoscopy》 (世界胃肠内镜杂志（英文版）（电子版）)

年 卷 期：2016年第8卷第20期

页      面：770-776页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：the Department of Gastroenterology of the Saint Paul Hospital for the support with this project 

主　　题：Colonoscopy Sedation Sedation tolerance Fentanyl Midazolam Predictive model 

摘      要：AIM To develop a prediction model aimed at identifying patients that may require higher than usual sedation doses during *** A retrospective chart review on 5000 patients who underwent an outpatient colonoscopy at *** s Hospital from 2009 to 2010 was conducted in order to develop a model for identifying patients who will require increased doses of *** predictor variables including age,gender,endoscopy indication,high sedation requirements during previous endoscopies,difficulty of the procedure,bowel preparation quality,interventions,findings as well as current use of benzodiazepines,opioids and alcohol were *** outcome of study was the use ofhigh dose of sedation agents for the *** particular,the high dose of sedation was defined as fentanyl greater than 50 mcg and midazolam greater than 3 *** Analysis of 5282 patients(mean age 57 ± 12,49% female) was *** common indication for the procedure was screening colonoscopy(57%).Almost half of our patients received doses exceeding Fentanyl 50 mcg and Midazolam 3 *** regression models identified the following variables associated with high sedation:Younger age(OR=0.95 95%CI:0.94-0.95;P 0.0001);abdominal pain(OR=1.45,95%CI:1.08-1.96);P=0.01) and Inflammatory Bowel Disease(OR=1.45,95%CI:1.04-2.03;P=0.02) as indications for the procedure;difficult procedure as defined by gastroenterologist(OR=1.73,95%CI:1.48-2.03;P 0.0001);past history of abdominal surgery(OR=1.33,95%CI:1.17-1.52;P 0.0001) and previous colonoscopy(OR=1.39,95%CI:1.21-1.60;P=0.0001) and alcohol use(OR=1.26,95%CI:1.03-1.54;P=0.02).Age and gender adjusted analysis yielded inflammatory bowel disease as an indication(OR=3.17,95%CI:1.58-6.37;P=0.002);difficult procedure as defined by an endoscopist(OR=5.13 95%CI:2.97-8.85;P=0.0001) and current use of opioids,benzodiazepines or antidepressants(OR=2.88,95%CI:1.74-4.77;P=0.001) having the highest predictive value of high sedation require