J Korean Med Sci.  2004 Aug;19(4):536-540. 10.3346/jkms.2004.19.4.536.

Identification of Factors that Influence Conscious Sedation in Gastrointestinal Endoscopy

Affiliations
  • 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hjson@smc.samsung.co.kr
  • 2Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Biostatistics unit of Samsung Biomedical Research Institute, Seoul, Korea.

Abstract

Although several studies examined factors that influence conscious sedation, investigation was limited into the gender and age. The aim of this prospective study is to identify the clinical variables of successful conscious sedation during gastrointestinal endoscopy. A total of 300 subjects who underwent gastrointestinal endoscopy were enrolled in a prospective fashion. They completed a questionnaire to assess height, weight, drinking, smoking, education level, recent medication, past medical history, previous experience of conscious sedation, preprocedural anxiety, and apprehension about the procedure. Efficacy of sedation and amnesia were evaluated by the subject and the endoscopist. Amnesic and sedative effects were proportionally related with age (p<0.0001). Preprocedural anxiety level was higher in women (p=0.0062), younger subjects (p=0.035), slender subjects (p=0.041), and in those without previous experience of conscious sedation (p=0.0034). This anxiety level was also related to increased pain (p=0.0026) and alertness (p=0.0003) during the procedure. Lower dose of midazolam is needed for sedation in older subjects. Subjects with a high level of preprocedural anxiety such as women, younger subjects, slender subjects, and those without previous experience of conscious sedation should be sedated with great caution because generally, they complain of much more severe pain and alertness during the procedure.

Keyword

Amnesia; Conscious Sedation; Endoscopy; Gastrointestinal; Midazolam

MeSH Terms

Age Factors
Anesthetics, Intravenous/therapeutic use
Body Weight
*Conscious Sedation
*Endoscopy, Gastrointestinal
Female
Humans
Male
Midazolam/therapeutic use
Pain/drug therapy
Prospective Studies
Questionnaires
Treatment Outcome

Reference

1. McCloy R. Asleep on the job: Sedation and monitoring during endoscopy. Scand J Gastroenterol Suppl. 1992. 192:S97–S101.
Article
2. Faigel DO, Baron TH, Goldstein JL, Hirota WK, Jacobson BC, Johanson JF, Leighton JA, Mallery JS, Peterson KA, Waring JP, Fanelli RD, Wheeler-Harbaugh J. Standards Practice Committee. American Society for Gastrointestinal Endoscopy. Guidelines for the use of deep sedation and anesthesia for gastrointestinal endoscopy. Gastrointest Endosc. 2002. 56:613–617.
3. Uygur-Bayramicli O, Dabak R, Kuzucuoglu T, Kavakli B. Sedation with intranasal midazolam in adults undergoing upper gastrointestinal endoscopy. J Clin Gastroenterol. 2002. 35:133–137.
4. Chokhavatia S, Nguyen L, Williams R, Kao J, Heavner JE. Sedation and analgesia for gastrointestinal endoscopy. Am J Gastroenterol. 1993. 88:393–396.
5. Ishiguro T, Ishiguro C, Ishiguro G, Nagawa H. Midazolam sedation for upper gastrointestinal endoscopy: Comparison between the states of patients in partial and complete amnesia. Hepatogastroenterology. 2002. 49:438–440.
6. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications. Anesthesiology. 1978. 49:239–243.
Article
7. Hong JY, Kang IS, Koong MK, Yoon HJ, Jee YS, Park JW, Park MH. Preoperative anxiety and propofol requirement in conscious sedation for ovum retrieval. J Korean Med Sci. 2003. 18:863–868.
Article
8. Mahajan RJ, Johnson JC, Marshall JB. Predictors of patient cooperation during gastrointestinal endoscopy. J Clin Gastroenterol. 1997. 24:220–223.
Article
9. Greenblatt DJ, Abernethy DR, Locniskar A, Harmatz JS, Limjuco RA, Shader RI. Effect of age, gender, and obesity on midazolam kinetics. Anesthesiology. 1984. 61:27–35.
Article
10. Smith MT, Heazlewood V, Eadie MJ, Brophy TO, Tyrer JH. Pharmacokinetics of midazolam in the aged. Eur J Clin Pharmacol. 1984. 26:381–388.
Article
11. Christe C, Janssens JP, Armenian B, Herrmann F, Vogt N. Midazolam sedation for upper gastrointestinal endoscopy in older persons: a randomized, double-blind, placebo-controlled study. J Am Geriatr Soc. 2000. 48:1398–1403.
Article
12. Levy N, Landmann L, Stermer E, Erdreich M, Beny A, Meisels R. Does a detailed explanation prior to gastroscopy reduce the patient's anxiety? Endoscopy. 1989. 21:263–265.
Article
13. Pereira SP, Hussaini SH, Wilkinson ML. Conscious sedation for gastroscopy. Gastroenterology. 1995. 109:1405–1406.
Article
14. Shapira M, Tamir A. Presence of family member during upper endoscopy. What do patients and escorts think? J Clin Gastroenterol. 1996. 22:272–274.
15. Woloshynowych M, Oakley DA, Saunders BP, Williams CB. Psychological aspects of gastrointestinal endoscopy: a review. Endoscopy. 1996. 28:763–767.
Article
16. Drossman DA, Brandt LJ, Sears C, Li Z, Nat J, Bozymski EM. A preliminary study of patients' concerns related to GI endoscopy. Am J Gastroenterol. 1996. 91:287–291.
17. Campo R, Brullet E, Montserrat A, Calvet X, Donoso L, Bordas JM. Identification of factors that influence tolerance of upper gastrointestinal endoscopy. Eur J Gastroenterol Hepatol. 1999. 11:201–204.
Article
18. Bonta PI, Kok MF, Bergman JJ, Van den Brink GR, Lemkes JS, Tytgat GN, Fockens P. Conscious sedation for EUS of the esophagus and stomach: a double-blind, randomized, controlled trial comparing midazolam with placebo. Gastrointest Endosc. 2003. 57:842–847.
Article
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