Patient Satisfaction of Propofol Versus Midazolam and Fentanyl Sedation During Colonoscopy in Inflammatory Bowel Disease

Casper Steenholdt; Jeppe T Jensen; Jørn Brynskov; Ann Merete Møller; Anne Christine Limschou; Lars Konge; Peter Vilmann

doi:10.1016/j.cgh.2020.10.037

Patient Satisfaction of Propofol Versus Midazolam and Fentanyl Sedation During Colonoscopy in Inflammatory Bowel Disease

Clin Gastroenterol Hepatol. 2022 Mar;20(3):559-568.e5. doi: 10.1016/j.cgh.2020.10.037. Epub 2020 Oct 22.

Authors

Casper Steenholdt¹, Jeppe T Jensen², Jørn Brynskov², Ann Merete Møller³, Anne Christine Limschou², Lars Konge⁴, Peter Vilmann²

Affiliations

¹ Department of Gastroenterology, Herlev-Gentofte University Hospital, Herlev, Denmark. Electronic address: steenholdt@dadlnet.dk.
² Department of Gastroenterology, Herlev-Gentofte University Hospital, Herlev, Denmark.
³ Department of Anaesthesiology, Herlev-Gentofte University Hospital, Herlev, Denmark.
⁴ Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Copenhagen, Copenhagen, Denmark.

PMID: 33371995
DOI: 10.1016/j.cgh.2020.10.037

Abstract

Background & aims: Colonoscopy is essential for optimal management of inflammatory bowel disease. However, many patients opt out due to unpleasantness related to this procedure. We investigated if Nurse Administered Propofol Sedation (NAPS) would improve patient satisfaction and attitude towards future colonoscopies.

Methods: Randomized clinical trial of deep sedation with NAPS (n = 63) versus moderate midazolam and fentanyl sedation (n = 67). To assess the primary end point of patient satisfaction at discharge, we developed a Satisfaction Questionnaire comprising 13 items each rated by a 5-point Likert scale and with higher scores reflecting more positive outcomes (13-65 points).

Results: Fifty-six patients (43%) with ulcerative colitis, 48 (37%) with Crohn's disease, and 26 (20%) with high suspicion of inflammatory bowel disease were included. Most (88%) had previously had a colonoscopy and pre-procedure expectations were similar between groups. Patients receiving deep sedation had significantly higher satisfaction score (mean 60.1, SD 3.4) than those receiving moderate sedation (51.2, 8.4; P < .001). This was driven especially by less pain, more amnesia, sedation more to their liking, and better experience with the current than previous sedations. Importantly, these patients significantly more often preferred the same sedation for a future colonoscopy and were also inclined to accept more frequent colonoscopies. Assistance from another colonoscopist and disruption of the procedure due to pain occurred significantly more frequent in the moderate sedation group. There were no safety signals associated with NAPS.

Conclusions: Patients with inflammatory bowel disease favor deep propofol sedation over moderate midazolam and fentanyl sedation. Availability of NAPS may facilitate patient adherence to endoscopy-based monitoring programs. Clinicaltrials.gov NCT01934088.

Keywords: Colonoscopy; IBD; Nurse-Administered Propofol Sedation; Patient-Reported Outcomes; Satisfaction.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Colonoscopy / methods
Fentanyl
Humans
Hypnotics and Sedatives
Inflammatory Bowel Diseases*
Midazolam
Patient Satisfaction
Propofol*

Substances

Hypnotics and Sedatives
Midazolam
Fentanyl
Propofol

Associated data

ClinicalTrials.gov/NCT01934088