On-demand sedation with propofol for colonoscopy—A prospective pilot study of the influence on short-term memory, psychomotor function and postural stability*

Mogens Rørbæk Madsen

Surgical Research Unit, Department of Surgery, Herning Regional Hospital, Herning, Denmark.

DOI: 10.4236/ojcd.2013.33023                

Abstract

Background: After sedated colonoscopy, patients are discharged on the basis of their subjective judgment that they have recovered, corroborated by the nursing staff. The aim of this study was to assess objectively whether patients were in fact fully recovered at the time of discharge, and to demonstrate whether the methods of testing applied could detect any influence of sedation on short-term memory, psychomotor function and postural stability. Methods: Twenty-two patients were investigated. At the beginning of the procedure, a defined bolus of propofol/alfentanil was given intravenously. During the procedure, an additional bolus was injected one or more times as requested by the patient. After colonoscopy, the patients stayed in the recovery room until the patients judged that they had recovered completely, which was also the judgement of the nursing staff at that time. Before colonoscopy and again before discharge, tests were performed of short-term memory, psychomotor function and postural stability (balance). Results: A positive correlation was found between the duration of colonoscopy and the amount of sedative given (p < 0.03). No differences in short-term memory or postural control were found when measurements obtained before and after colonoscopy were compared. Reaction time was prolonged significantly after colonoscopy (p < 0.01), which was mainly due to prolongation of perception time (p < 0.003). No correlation was found between the observed reduction in psychomotor function and the amount of sedative given. Conclusions: The introduction of ultrashort-acting sedative and hypnotic agents has facilitated out-patient colonoscopy. However, although they feel that they have recovered fully, some patients are still affected by the sedative at the time of discharge, as demonstrated by tests of short-term memory, reaction time and postural stability.

Keywords

Colonoscopy; Sedation; Propofol; Reaction Time; Postural Stability

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	L. I. Iverson and D. S. Tulsky, “Detecting Malingering on the WAIS-III Unususal Digit Span Performance Patterns in the Normal Population and in Clinical Groups,” Archives of Clinical Neuropsychology, Vol. 18, No. 1, 2003, pp. 1-9.
[2]	P. Era, J. Jokela and E. Heikkinen, “Reaction and Movement Times in Men of Different Ages: A Population Study,” Perceptual and Motor Skills, Vol. 63, No. 1, 1986, pp. 111-130. doi:10.2466/pms.1986.63.1.111
[3]	P. Era and E. Heikkinen, “Postural Sway during Standing and Unexpected Disturbance of Balance in Random Samples of Men of Different Ages,” Journal of Gerontology, Vol. 40, No. 3, 1985, pp. 287-295. doi:10.1093/geronj/40.3.287
[4]	P. Era, M. Schroll, H. Ytting, I. Gause-Nilsson et al., “Postural Balance and Its Sensory-Motor Correlates in 75-Years-Old Men and Women: A Cross-National Comparative Study,” Journal of Gerontology, Vol. 51, No. 2, 1996, pp. 53-63.
[5]	D. Külling, A. C. Fantin, P. Biro et al., “Safer Colonoscopy with Patient-Controlled Analgesia and Sedation with Propofol and Alfentanil,” Gastrointestinal Endoscopy, Vol. 54, No. 1, 2001, pp. 1-7. doi:10.1067/mge.2001.116174
[6]	T. Theodorou, P. Hales, P. Gillespie et al., “Total Intraveneous versus Inhalation Anaesthesia for Colonoscopy: A Prospective Study of Clinical Recovery and Psychomotor Function,” Anaesth Intensive Care, Vol. 1, No. 2, 2001, pp. 124-136.
[7]	L. B. Cohen, A. N. Dubovsky, J. Aisenberg et al., “Propofol for Endoscopic Sedation: A Protocol for Safe and Effective Administration by the Gastroenterologist,” Gastrointestinal Endoscopy, Vol. 58, No. 5, 2003, pp. 725-732. doi:10.1016/S0016-5107(03)02010-8
[8]	E. Bright, C. Roseveare, D. Dalgleish et al., “Patient-Controlled Sedation for Colonoscopy: A Randomized Trial Comparing Patient-Controlled Administration of Propofol and Alfentanil with Physician-Administered Midazolam and Pethidine,” Endoscopy, Vol. 35, No. 8, 2003, pp. 683-687. doi:10.1055/s-2003-41519
[9]	R. Rudner, P. Jalowiecki, P. Kawecki et al., “Conscious Analgesia/Sedation with Remifentanil and Propofol versus Total Intravenous Anesthesia with Fentanyl, Midazolam, and Propofol for Outpatient Colonoscopy,” Gastro-intestinal Endoscopy, Vol. 57, No. 6, 2003, pp. 657-663. doi:10.1067/mge.2003.207
[10]	M. E. VanNatta and D. K. Rex, “Propofol Alone Titrated to Deep Sedation versus Propofol in Combination with Opoids and/or Benzodiazepines and Titrated to Moderate Sedation for Colonoscopy,” The American Journal of Gastroenterology, Vol. 101, No. 10, 2006, pp. 2209-2217. doi:10.1111/j.1572-0241.2006.00760.x
[11]	D. K. Rex, V. P. Deenadayalu, E. Eid et al., “Endoscopist-Directed Administration of Profofol: A Worldwide Safely Experience,” Gastroenterology, Vol. 137, No. 4, 2009, pp. 1229-1237. doi:10.1053/j.gastro.2009.06.042
[12]	H. Singh, W. Poluha, M. Cheung et al., “Propofol for Sedation during Colonoscopy,” Cochrane Database of Systematic Reviews, Vol. 8, No. 4, 2008, Article ID: CD006268.
[13]	L. T. Heuss, J. Drewe, P. Schnieper et al., “Patient-Controlled versus Nurse-Administered Sedation with Propofol during Colonoscopy. A Prospective Randomized Trial,” The American Journal of Gastroenterology, Vol. 99, No. 3, 2004, pp. 511-518. doi:10.1111/j.1572-0241.2004.04088.x
[14]	U. Padmanabhan, K. Leslie, A. S. Y. Eer et al., “Early Cognitive Impairment after Sedation for Colonoscopy: The Effect of Adding Midazolam and/or Fentanyl to Propofol,” Anesthesia & Analgesia, Vol. 109, No. 5, 2009, pp. 1448-1455.