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Digestive Diseases and Sciences

, Volume 57, Issue 10, pp 2527–2534 | Cite as

What Factors Are Associated with the Difficult-to-Sedate Endoscopy Patient?

  • Bikram S. BalEmail author
  • Michael D. Crowell
  • Divyanshoo R. Kohli
  • Jiana Menendez
  • Farzin Rashti
  • Anjali S. Kumar
  • Kevin W. Olden
Original Article

Abstract

Background

Difficult sedation during endoscopy results in inadequate examinations and aborted procedures. We hypothesized that gender, alcohol abuse, physical/sexual abuse, and anxiety are predictors of difficult-to-sedate endoscopy patients.

Methods

This is a prospective cohort study. At the time of enrollment, subjects completed the following three validated questionnaires: state-trait anxiety inventory, self-report version of alcohol use disorder inventory, and Drossman questionnaire for physical/sexual abuse. Conscious sedation was administered for the endoscopic procedures at the discretion of the endoscopist and was graded in accordance with the Richmond agitation sedation scale (RASS). Subjects’ perceptions of sedation were documented on a four-point Likert scale 24 h after their procedure.

Results

One-hundred and forty-three (79 %) of the 180 subjects enrolled completed the study. On the basis of the RASS score, 56 (39 %) subjects were found to be difficult to sedate of which only five were dissatisfied with their sedation experience. State (n = 39; p = 0.003) and trait (n = 41; p = 0.008) anxiety and chronic psychotropic use (p = 0.040) were associated with difficult sedation. No association was found between difficult sedation and gender (p = 0.77), alcohol abuse (p = 0.11), sexual abuse (p = 0.15), physical abuse (p = 0.72), chronic opioid use (p = 0.16), or benzodiazepines (BDZ) use (p = 0.10).

Conclusion

Pre-procedural state or trait anxiety is associated with difficult sedation during endoscopy. In this study neither alcohol abuse nor chronic opiate/BDZ use was associated with difficult sedation.

Keywords

Endoscopy Difficult to sedate Abuse Anxiety 

Notes

Conflict of interest

No conflict of interest.

References

  1. 1.
    Abraham NS, Fallone CA, Mayrand S, Huang J, Wieczorek P, Barkun AN. Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a Canadian randomized controlled cost-outcome study. Am J Gastroenterol. 2004;99:1692–1699.PubMedCrossRefGoogle Scholar
  2. 2.
    Zubarik R, Ganguly E, Benway D, Ferrentino N, Moses P, Vecchio J. Procedure-related abdominal discomfort in patients undergoing colorectal cancer screening: a comparison of colonoscopy and flexible sigmoidoscopy. Am J Gastroenterol. 2002;97:3056–3061.PubMedCrossRefGoogle Scholar
  3. 3.
    Cook PJ, Flanagan R, James IM. Diazepam tolerance: effect of age, regular sedation, and alcohol. Br Med J (Clin Res Ed). 1984;289:351–353.CrossRefGoogle Scholar
  4. 4.
    Pena LR, Mardini HE, Nickl NJ. Development of an instrument to assess and predict satisfaction and poor tolerance among patients undergoing endoscopic procedures. Dig Dis Sci. 2005;50:1860–1871.PubMedCrossRefGoogle Scholar
  5. 5.
    Schutz SM, Lee JG, Schmitt CM, Almon M, Baillie J. Clues to patient dissatisfaction with conscious sedation for colonoscopy. Am J Gastroenterol. 1994;89:1476–1479.PubMedGoogle Scholar
  6. 6.
    Mahajan RJ, Johnson JC, Marshall JB. Predictors of patient cooperation during gastrointestinal endoscopy. J Clin Gastroenterol. 1997;24:220–223.PubMedCrossRefGoogle Scholar
  7. 7.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370.PubMedCrossRefGoogle Scholar
  8. 8.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption II. Addiction. 1993;88:791–804.PubMedCrossRefGoogle Scholar
  9. 9.
    Allen JP, Litten RZ, Fertig JB, Babor T. A review of research on the alcohol use disorders identification test (AUDIT). Alcohol Clin Exp Res. 199;21:613–619.CrossRefGoogle Scholar
  10. 10.
    Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care. 2nd ed. Geneva: World Health Organization; 2001.Google Scholar
  11. 11.
    Spielberger CD. The State Trait anxiety inventory: A Comprehensive Bibliography. CA: Consulting Psychologists Press; 1983.Google Scholar
  12. 12.
    Briere J, Runtz M. Multivariate correlates of childhood psychological and physical maltreatment among university women. Child Abuse Negl. 1988;12:331–341.PubMedCrossRefGoogle Scholar
  13. 13.
    Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol. 1993;61:984–991.PubMedCrossRefGoogle Scholar
  14. 14.
    Badgley R, Allard H, McCormick N, et al. Occurrence in the population. In: Kortet R, Vainikka A, eds. Anonymous Sexual Offences against Children, vol. 1. Ottawa: Canadian Government Publishing Centre; 1984:175–193.Google Scholar
  15. 15.
    Leserman J, Drossman DA, Li Z, Toomey TC, Nachman G. The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders. Behav Med. 1995;21:141–150.PubMedCrossRefGoogle Scholar
  16. 16.
    Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166:1338–1344.PubMedCrossRefGoogle Scholar
  17. 17.
    Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond agitation-sedation scale (RASS). JAMA. 2003;289:2983–2991.PubMedCrossRefGoogle Scholar
  18. 18.
    Rhoney DH, Murry KR. National survey of the use of sedating drugs, neuromuscular blocking agents, and reversal agents in the intensive care unit. J Intensive Care Med. 2003;18:139–145.PubMedCrossRefGoogle Scholar
  19. 19.
    Samuelson KA, Larsson S, Lundberg D, Fridlund B. Intensive care sedation of mechanically ventilated patients: a national Swedish survey. Intensive Crit Care Nurs. 2003;19:350–362.PubMedCrossRefGoogle Scholar
  20. 20.
    Nisbet AT, Mooney-Cotter F. Comparison of selected sedation scales for reporting opioid-induced sedation assessment. Pain Manag Nurs. 2009;10:154–164.PubMedCrossRefGoogle Scholar
  21. 21.
    Almgren M, Lundmark M, Samuelson K. The Richmond agitation-sedation scale: translation and reliability testing in a Swedish intensive care unit. Acta Anaesthesiol Scand. 2010;54:729–735.PubMedCrossRefGoogle Scholar
  22. 22.
    Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed. New York: Wiley; 1981:38–46.Google Scholar
  23. 23.
    Froehlich F, Thorens J, Schwizer W, et al. Sedation and analgesia for colonoscopy: patient tolerance, pain, and cardiorespiratory parameters. Gastrointest Endosc. 1997;45:1–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy, Lichtenstein DR, Jagannath S, Baron TH, et al. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2008;68:815–826.PubMedCrossRefGoogle Scholar
  25. 25.
    Davy E. The endoscopy patient with a history of sexual abuse: strategies for compassionate care. Gastroenterol Nurs. 2006;29:221–225.PubMedCrossRefGoogle Scholar
  26. 26.
    Borum ML. Childhood sexual trauma as a potential factor for noncompliance with endoscopic procedures. Gen Hosp Psychiatry. 1998;20:381–382.PubMedCrossRefGoogle Scholar
  27. 27.
    Cohen LB, Delegge MH, Aisenberg J, et al. AGA Institute review of endoscopic sedation. Gastroenterology. 2007;133:675–701.PubMedCrossRefGoogle Scholar
  28. 28.
    Drossman D, et al. Ann Intern Med. 1995; 123:782–794.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Bikram S. Bal
    • 1
    Email author
  • Michael D. Crowell
    • 3
  • Divyanshoo R. Kohli
    • 1
  • Jiana Menendez
    • 4
  • Farzin Rashti
    • 1
  • Anjali S. Kumar
    • 5
  • Kevin W. Olden
    • 2
    • 6
  1. 1.Division of Gastroenterology, Department of Internal MedicineWashington Hospital CenterWashingtonUSA
  2. 2.Department of MedicineSt Joseph’s Hospital and Medical CenterPhoenixUSA
  3. 3.Division of Gastroenterology and HepatologyMayo ClinicScottsdaleUSA
  4. 4.Mount Sinai Medical SchoolNew YorkUSA
  5. 5.Department of SurgeryWashington Hospital CenterWashingtonUSA
  6. 6.Department of Medicine and PsychiatryCreighton University School of MedicineOmahaUSA

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