Sedation for colonoscopy using a single bolus is safe, effective, and efficient: A prospective, randomized, double-blind trial

OBJECTIVE: Practice guidelines call for the careful titration of sedatives and analgesics during endoscopy, with time taken between incremental doses to assess effect. This approach is time-consuming and has never been valida ted in a prospective trial. The aim of this study was to compare the safety and efficacy of titration, as outlined in practice guidelines, with a sing le, rapid bolus of sedatives before colonoscopy. METHODS: Consecutive colonoscopy outpatients were randomized to a single, r apid bolus of meperidine and midazolam of to a titration of doses every 3 m in until predefined levels of somnolence were achieved. The colonoscopist w as not present during sedation and remained blinded as to which technique w as used. Supplemental O-2 was given for SaO(2) <90% on three or more occasi ons. Total physician time was calculated from the first injection of sedati ves to the removal of the colonoscope. Patient assessments of pain and tole rance were obtained at the time of discharge using visual analog scales of 100 mm (0 = excellent and 100 = unbearable). RESULTS: A total of 101 patients were randomized (49 bolus, 52 titration). Demographic features were similar for both groups. Titration required more physician time than did bolus (32.2 min vs 20.1 min, p < 0.001) and was ass ociated with an increased need for supplemental O-2 (44% vs 14%, p = 0.002) . Mean tolerance scores were similar (titration 16.3 vs bolus 15.3, p = 0.7 2). CONCLUSIONS: Rapid bolus sedation for colonoscopy saves significant endosco pist time, is associated with less O-2 desaturation, and provides equivalen t levels of patient comfort. A revision of the guidelines for sedation and analgesia during endoscopy should be considered. (Am J Gastroenterol 2000;9 5:2242-2247. (C) 2000 by Am. Cell. of Gastroenterology).