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Portable inhaled methoxyflurane is feasible and safe for colonoscopy in subjects with morbid obesity and/or obstructive sleep apnea.

Nguyen NQ, Toscano L, Lawrence M, Phan VA, Singh R, Bampton P, Fraser RJ, Holloway RH, Schoeman MN - Endosc Int Open (2015)

Bottom Line: Colonoscopy with inhaled methoxyflurane (Penthrox) is well tolerated in unselected subjects and is not associated with respiratory depression.Compared with AADS, Penthrox was associated with a shorter total procedural time (24 ± 1 vs. 52 ± 1 minutes, P < 0.001), a lower incidence of hypotension (3 /85 vs. 23 /55, P < 0.001), and a lower incidence of respiratory desaturation (0 /85 vs. 14 /55, P < 0.001).The patients in the Penthrox group recovered more rapidly and were discharged much earlier than those in the AADS group (27 ± 2 vs. 97 ± 5 minutes, P < 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

ABSTRACT

Background and study aims: Colonoscopy with inhaled methoxyflurane (Penthrox) is well tolerated in unselected subjects and is not associated with respiratory depression. The aim of this prospective study was to compare the feasibility, safety, and post-procedural outcomes of portable methoxyflurane used as an analgesic agent during colonoscopy with those of anesthesia-assisted deep sedation (AADS) in subjects with morbid obesity and/or obstructive sleep apnea (OSA).

Patients and methods: The outcomes of 140 patients with morbid obesity/OSA who underwent colonoscopy with either Penthrox inhalation (n = 85; 46 men, 39 women; mean age 57.2 ± 1.1 years) or AADS (n = 55; 27 men, 28 women; mean age, 54.9 ± 1.1 years) were prospectively assessed.

Results: All Penthrox-assisted colonoscopies were successful, without any requirement for additional intravenous sedation. Compared with AADS, Penthrox was associated with a shorter total procedural time (24 ± 1 vs. 52 ± 1 minutes, P < 0.001), a lower incidence of hypotension (3 /85 vs. 23 /55, P < 0.001), and a lower incidence of respiratory desaturation (0 /85 vs. 14 /55, P < 0.001). The patients in the Penthrox group recovered more rapidly and were discharged much earlier than those in the AADS group (27 ± 2 vs. 97 ± 5 minutes, P < 0.0001). Of those who underwent colonoscopy with Penthrox, 90 % were willing to receive Penthrox again for colonoscopy. More importantly, of the patients who underwent colonoscopy with Penthrox and had had AADS for previous colonoscopy, 82 % (28 /34) preferred to receive Penthrox for future colonoscopies. Penthrox-assisted colonoscopy cost significantly less than colonoscopy with AADS ($ 332 vs. $ 725, P < 0.001), with a cost saving of approximately $ 400 for each additional complication avoided.

Conclusions: Compared with AADS, Penthrox is highly feasible and safe in patients with morbid obesity/OSA undergoing colonoscopy and is associated with fewer cardiorespiratory complications. Because of the advantages of this approach in regard to procedural time, recovery time, and cost benefit in comparison with AADS, further evaluation in a randomized trial is warranted.

No MeSH data available.


Related in: MedlinePlus

 Differences between the cardiorespiratory complication rates of patients who had colonoscopy with anesthesia-assisted deep sedation and those of patients who had colonoscopy with Penthrox analgesia.
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FI215-1:  Differences between the cardiorespiratory complication rates of patients who had colonoscopy with anesthesia-assisted deep sedation and those of patients who had colonoscopy with Penthrox analgesia.

Mentions: Although intravenous fluid therapy and oxygen supplementation were given to all patients who had AADS, there were more intraprocedural events of hypotension (42 % vs. 1 %), respiratory depression (26 % vs. 0 %), and tachyarrhythmia (15 % vs. 1 %) in the patients who received AADS than in those who received Penthrox inhalation (Fig. 1). Overall, intraprocedural cardiorespiratory adverse events were substantially more frequent in the AADS group than in the Penthrox group (56 % vs. 2 %, P < 0.001). At telephone follow-up 24 hours and 30 days after colonoscopy, no patient reported being readmitted or was found to have been readmitted to the hospital because of abnormal renal or liver function test results indicating nephrotoxicity or hepatotoxicity. Penthrox inhalation did not result in any increases in serum levels of creatinine, liver enzymes, or bilirubin after 1 month (Table 3).


Portable inhaled methoxyflurane is feasible and safe for colonoscopy in subjects with morbid obesity and/or obstructive sleep apnea.

Nguyen NQ, Toscano L, Lawrence M, Phan VA, Singh R, Bampton P, Fraser RJ, Holloway RH, Schoeman MN - Endosc Int Open (2015)

 Differences between the cardiorespiratory complication rates of patients who had colonoscopy with anesthesia-assisted deep sedation and those of patients who had colonoscopy with Penthrox analgesia.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612230&req=5

FI215-1:  Differences between the cardiorespiratory complication rates of patients who had colonoscopy with anesthesia-assisted deep sedation and those of patients who had colonoscopy with Penthrox analgesia.
Mentions: Although intravenous fluid therapy and oxygen supplementation were given to all patients who had AADS, there were more intraprocedural events of hypotension (42 % vs. 1 %), respiratory depression (26 % vs. 0 %), and tachyarrhythmia (15 % vs. 1 %) in the patients who received AADS than in those who received Penthrox inhalation (Fig. 1). Overall, intraprocedural cardiorespiratory adverse events were substantially more frequent in the AADS group than in the Penthrox group (56 % vs. 2 %, P < 0.001). At telephone follow-up 24 hours and 30 days after colonoscopy, no patient reported being readmitted or was found to have been readmitted to the hospital because of abnormal renal or liver function test results indicating nephrotoxicity or hepatotoxicity. Penthrox inhalation did not result in any increases in serum levels of creatinine, liver enzymes, or bilirubin after 1 month (Table 3).

Bottom Line: Colonoscopy with inhaled methoxyflurane (Penthrox) is well tolerated in unselected subjects and is not associated with respiratory depression.Compared with AADS, Penthrox was associated with a shorter total procedural time (24 ± 1 vs. 52 ± 1 minutes, P < 0.001), a lower incidence of hypotension (3 /85 vs. 23 /55, P < 0.001), and a lower incidence of respiratory desaturation (0 /85 vs. 14 /55, P < 0.001).The patients in the Penthrox group recovered more rapidly and were discharged much earlier than those in the AADS group (27 ± 2 vs. 97 ± 5 minutes, P < 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

ABSTRACT

Background and study aims: Colonoscopy with inhaled methoxyflurane (Penthrox) is well tolerated in unselected subjects and is not associated with respiratory depression. The aim of this prospective study was to compare the feasibility, safety, and post-procedural outcomes of portable methoxyflurane used as an analgesic agent during colonoscopy with those of anesthesia-assisted deep sedation (AADS) in subjects with morbid obesity and/or obstructive sleep apnea (OSA).

Patients and methods: The outcomes of 140 patients with morbid obesity/OSA who underwent colonoscopy with either Penthrox inhalation (n = 85; 46 men, 39 women; mean age 57.2 ± 1.1 years) or AADS (n = 55; 27 men, 28 women; mean age, 54.9 ± 1.1 years) were prospectively assessed.

Results: All Penthrox-assisted colonoscopies were successful, without any requirement for additional intravenous sedation. Compared with AADS, Penthrox was associated with a shorter total procedural time (24 ± 1 vs. 52 ± 1 minutes, P < 0.001), a lower incidence of hypotension (3 /85 vs. 23 /55, P < 0.001), and a lower incidence of respiratory desaturation (0 /85 vs. 14 /55, P < 0.001). The patients in the Penthrox group recovered more rapidly and were discharged much earlier than those in the AADS group (27 ± 2 vs. 97 ± 5 minutes, P < 0.0001). Of those who underwent colonoscopy with Penthrox, 90 % were willing to receive Penthrox again for colonoscopy. More importantly, of the patients who underwent colonoscopy with Penthrox and had had AADS for previous colonoscopy, 82 % (28 /34) preferred to receive Penthrox for future colonoscopies. Penthrox-assisted colonoscopy cost significantly less than colonoscopy with AADS ($ 332 vs. $ 725, P < 0.001), with a cost saving of approximately $ 400 for each additional complication avoided.

Conclusions: Compared with AADS, Penthrox is highly feasible and safe in patients with morbid obesity/OSA undergoing colonoscopy and is associated with fewer cardiorespiratory complications. Because of the advantages of this approach in regard to procedural time, recovery time, and cost benefit in comparison with AADS, further evaluation in a randomized trial is warranted.

No MeSH data available.


Related in: MedlinePlus