A time performance comparison between moderate and deep sedation for screening colonoscopies in obese patients with obstructive sleep apnea
Columbus Morales IM, Kaur R, Ashraf T, Nimri FM, Bhatti S, and Kutait A. A time performance comparison between moderate and deep sedation for screening colonoscopies in obese patients with obstructive sleep apnea. Gastrointestinal Endoscopy 2020; 91(6):AB278.
Introduction: Colonoscopy is currently one of the preferred screening modalities for colon cancer in the US being advantageous due to allowing direct visualization, ability to perform polypectomy and biopsies. Different sedation modalities are available to perform the procedure but there has been a shift to the use of deep sedation for the past decade due to its association to higher patient satisfaction; the evidence is lacking in terms of other benefits. In special patient populations, such as morbid obese and obstructive sleep apnea (OSA), there is an indication to use deep sedation, however, there is little evidence to support its practice over other modalities, such as moderate sedation. The use of deep sedation may not be the safer choice in comparison to moderate sedation while adding unnecessary expenses. The purpose of this study is to determine if moderate sedation can be as efficient as deep sedation for screening colonoscopies in obese patients with OSA. Methods: A retrospective cohort study of obese patients with OSA undergoing screening colonoscopy from 2014 to 2018 was performed. Patients with a colonoscopy performed for non-screening purposes were excluded. Examined time metrics were sedation to scope, cecum time, duration of procedure and recovery time. Other clinical data obtained included age, sex, social history, ASA classification, Mallampati score, procedural complications, and peri-procedural vital signs. Moderate sedation was supervised by the endoscopist using midazolam with fentanyl or meperidine. Deep sedation was done with anesthesia staff using propofol. Results: A total of 458 patients with OSA and obesity who underwent screening colonoscopy were identified. The mean age was 59.2 years, 46.5% were male and the mean BMI was 42.8 (Table 1). From the study population, 225 (49.1%) underwent moderate sedation (Table 2). The mean sedation to scope time was 4.5 minutes and 7 minutes in the moderate and deep sedation groups, respectively (p <0.001). The mean duration of the procedure was 18.4 vs 21.7 minutes, in the moderate sedation and deep sedation, respectively (p <0.001). The recovery time was 45.1 and 57.6 minutes in moderate sedation and deep sedation, respectively (p <0.001). The most common complication was hypotension found on 11.6% of patients on the deep sedation group (p <0.001). Conclusion: This study found that all evaluated time metrics were lower in the moderate sedation group. This can be interpreted as moderate sedation being a less time-consuming modality than deep sedation for screening colonoscopies in obese patients with OSA. This could potentially decrease health care costs and increase productivity by the number of patients that can be seen in a day while maintaining equivalent patient safety.