Monday, 26 March 2012

Anaesthesia and colonoscopy

In UK NHS, colonoscopy is usually carried out under conscious sedation using a combination of a benzodiazepine sedative and an opiate painkiller. The endoscopist administers this combination of drugs. Whilst colonoscopy using these drugs is well tolerated by most patients, some still find their experience of colonoscopy to be very unpleasant.

In the private sector, both here in the UK and in the USA, propofol sedation has become increasingly popular with patients and endoscopists. Patients wake from the sedation with no recollection of the procedure.

Propofol sedation is only occasionally used in the NHS. Its use is usually confined to patients where previous attempts to carry out colonoscopy under benzodiazepine sedation have failed or certain patients requiring complex endoscopic procedures.

Unfortunately, only a trained anaesthetist can give propofol. This clearly has cost implications and as a result claims for anaesthetic services in the USA have continued to increase steadily over recent years. A report in the Journal of the American Medical Association estimates that anaesthetic services for low risk endoscopies now costs the US health economy $1.1 billion every year.

The development of computerised propofol delivery systems is therefore very attractive and already well underway. If the safety and efficacy of such systems is established, their use could become widespread. This would remove the necessity for a trained anaesthetist to be present, reduce the cost of propofol sedation for colonoscopy and improve the patient experience of what can be for some, an uncomfortable procedure.

JAMA 2012; 307: 1178-84.

Simon Radley March 2012

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