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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 visual analogue scale (VAS) pain scores before, during, and after colonoscopy of patients who had anesthesia-assisted deep sedation (AADS) and those of patients who had Penthrox analgesia for colonoscopy.
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FI215-3:  Differences between the visual analogue scale (VAS) pain scores before, during, and after colonoscopy of patients who had anesthesia-assisted deep sedation (AADS) and those of patients who had Penthrox analgesia for colonoscopy.

Mentions: Although there was no difference between the satisfaction scores of the two groups (AADS vs. Penthrox: 94 ± 6 vs. 98 ± 5; P = 0.76), 28 of 34 Penthrox patients (82 %) who had undergone a previous colonoscopy with AADS preferred Penthrox over AADS. The patients who had completed colonoscopy with Penthrox alone reported that the inhaler was easy to use, provided adequate analgesia, and allowed them to have good recall of the procedural findings, and 90 % were willing to receive Penthrox again for colonoscopy. Although the patients who received Penthrox had a higher pain score during colonoscopy (3.6 ± 0.2 vs. 0.9 ± 0.1, P < 0.001; Fig. 3), the pain was perceived as tolerable and short-lasting. There were no differences between the total STAI-Y anxiety (“nervousness”) scores of the two groups before and after colonoscopy (Table 1).


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 visual analogue scale (VAS) pain scores before, during, and after colonoscopy of patients who had anesthesia-assisted deep sedation (AADS) and those of patients who had Penthrox analgesia for colonoscopy.
© Copyright Policy
Related In: Results  -  Collection

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

FI215-3:  Differences between the visual analogue scale (VAS) pain scores before, during, and after colonoscopy of patients who had anesthesia-assisted deep sedation (AADS) and those of patients who had Penthrox analgesia for colonoscopy.
Mentions: Although there was no difference between the satisfaction scores of the two groups (AADS vs. Penthrox: 94 ± 6 vs. 98 ± 5; P = 0.76), 28 of 34 Penthrox patients (82 %) who had undergone a previous colonoscopy with AADS preferred Penthrox over AADS. The patients who had completed colonoscopy with Penthrox alone reported that the inhaler was easy to use, provided adequate analgesia, and allowed them to have good recall of the procedural findings, and 90 % were willing to receive Penthrox again for colonoscopy. Although the patients who received Penthrox had a higher pain score during colonoscopy (3.6 ± 0.2 vs. 0.9 ± 0.1, P < 0.001; Fig. 3), the pain was perceived as tolerable and short-lasting. There were no differences between the total STAI-Y anxiety (“nervousness”) scores of the two groups before and after colonoscopy (Table 1).

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