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Monitored Anesthesia Care with Propofol Versus Surgeon-Monitored Sedation with Benzodiazepines and Narcotics for Preoperative Endoscopy in the Morbidly Obese

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Abstract

Background

Although still controversial, upper endoscopy is frequently performed before bariatric surgery. This study investigated the hypothesis that morbidly obese patients would prefer anesthesiologist-monitored sedation (AMS) compared to surgeon-monitored sedation (SMS) during preoperative endoscopy.

Methods

All patients who underwent endoscopy before their bariatric surgery were given a post-procedure survey regarding their experience with the preoperative endoscopy. The survey inquired about issues during and after the procedure. We compared patients who had AMS with IV propofol versus SMS IV narcotics and benzodiazepines.

Results

There were 100 patients (SMS = 49 and AMS = 51). Few patients complained of pain in the abdomen or throat during the procedure (AMS vs. SMS = 2 vs. 8% and 2 vs. 10%, respectively; p = NS). More patients complained about throat pain after the procedure (AMS vs. SMS = 37 vs. 45%; p = NS). More patients in the SMS group remembered the scope being placed in the mouth versus AMS (33 vs. 10%; p < 0.02). More patients remembered gagging during the procedure in the SMS group versus the AMS group, but this did not reach statistical significance (24 vs. 10%; p = 0.06). There was a trend that more patients in the AMS group felt they recovered in less than 1 h (53%) compared to the SMS group (37%; p = 0.1).

Conclusion

Patients who undergo upper endoscopy with either AMS or SMS seem to tolerate the procedure well. The preliminary benefits seen with AMS need to be further explored. AMS should be considered for patients undergoing preoperative upper endoscopy before bariatric surgery.

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References

  1. Madan AK, Speck KE, Hiler ML. Routine preoperative upper endoscopy for laparoscopic gastric bypass: is it necessary? Am Surg. 2004;70(8):684–6.

    PubMed  Google Scholar 

  2. Macgregor AMC, Thoburn EK. Routine preoperative gastrointestinal series. Obes Surg. 1997;7:516–7.

    Article  PubMed  CAS  Google Scholar 

  3. Verset D, Houben JJ, Gay F, et al. The place of upper gastrointestinal tract endoscopy before and after vertical banded gastroplasty for morbid obesity. Dig Dis Sci. 1997;42(11):2333–7.

    Article  PubMed  CAS  Google Scholar 

  4. Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg. 2002 Oct;12(5):634–8.

    Article  PubMed  Google Scholar 

  5. Sharaf RN, Weinshel EH, Bini EJ, et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004 Nov–Dec;14(10):1367–72.

    Article  PubMed  Google Scholar 

  6. Zeni TM, Frantzides CT, Mahr C, et al. Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass. Obes Surg. 2006 Feb;16(2):142–6.

    Article  PubMed  Google Scholar 

  7. Paspatis GA, Charoniti I, Manolaraki M, et al. Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study. J Pediatr Gastroenterol Nutr. 2006 Aug;43(2):195–9.

    Article  PubMed  CAS  Google Scholar 

  8. Elitsur Y, Blankenship P, Lawrence Z. Propofol sedation for endoscopic procedures in children. Endoscopy. 2000;32:788–91.

    Article  PubMed  CAS  Google Scholar 

  9. Khoshoo V, Thoppil D, Landry L, et al. Propofol versus midazolam plus meperidine for sedation during ambulatory esophagogastroduodenoscopy. J Pediatr Gastroenterol Nutr. 2003;37:146–9.

    Article  PubMed  CAS  Google Scholar 

  10. Montes RG, Bohn RA. Deep sedation with inhaled sevoflurane for pediatric outpatient gastrointestinal endoscopy. J Pediatr Gastroenterol Nutr. 2000;31:41–6.

    Article  PubMed  CAS  Google Scholar 

  11. Patterson KW, Casey PB, Murray JP, et al. Propofol sedation for outpatient upper gastrointestinal endoscopy: comparison with midazolam. Br J Anaesth. 1991;67(1):108–11.

    Article  PubMed  CAS  Google Scholar 

  12. Carlsson U, Grattidge P. Sedation for upper gastrointestinal endoscopy: a comparative study of propofol and midazolam. Endoscopy. 1995;27(3):240–3.

    Article  PubMed  CAS  Google Scholar 

  13. Vargo JJ, G Zuccaro J, Dumot JA, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology. 2002;123(1):8–16.

    Article  PubMed  CAS  Google Scholar 

  14. Sipe BW, Rex DK, Latinovich D, et al. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc. 2002;55(7):815–25.

    Article  PubMed  Google Scholar 

  15. Kulling D, Rothenbuhler R, Inauen W. Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy. Endoscopy. 2003;35(8):679–82.

    Article  PubMed  CAS  Google Scholar 

  16. Wehrmann T, Kokabpick S, Lembcke B, et al. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointest Endosc. 1999;49(6):677–83.

    Article  PubMed  CAS  Google Scholar 

  17. Wilcox C. Efficiency issues in sedation and monitoring. Gastrointest Endosc Clin N Am. 2004;14(4):647–56.

    Article  PubMed  Google Scholar 

  18. Paspatis GA, Manolaraki M, Xirouchakis G, et al. Synergistic sedation with midazolam and propofol versus midazolam and pethidine in colonoscopies: a prospective, randomized study. Am J Gastroenterol. 2002;97(8):1963–7.

    Article  PubMed  CAS  Google Scholar 

  19. Meining A, Semmler V, Kassem AM, et al. The effect of sedation on the quality of upper gastrointestinal endoscopy: an investigator-blinded, randomized study comparing propofol with midazolam. Endoscopy. 2007;39(4):345–9.

    Article  PubMed  CAS  Google Scholar 

  20. Shaker R. A wake-up call? Unsedated versus conventional esophagogastroduodenoscopy. Gastroenterology. 1999;117:1492–5.

    Article  PubMed  CAS  Google Scholar 

  21. Saeian K, Townsend WF, Rochling FA, et al. Unsedated transnasal EGD: an alternative approach to conventional esophagogastroduodenoscopy for documenting Helicobacter pylori eradication. Gastrointest Endosc. 1999;49(3):297–301.

    Article  PubMed  CAS  Google Scholar 

  22. Sorbi D, Gostout CJ, Henry J, et al. Unsedated small-caliber esophagogastroduodenoscopy (EGD) versus conventional EGD: a comparative study. Gastroenterology. 1999;117:1301–7.

    Article  PubMed  CAS  Google Scholar 

  23. Van Dam J, Brugge WR. Medical progress: endoscopy of the upper gastrointestinal tract. N Engl J Med. 1999;341:1738–48.

    Article  PubMed  Google Scholar 

  24. Mallery S, Van Dam J. Endoscopic practice at the start of the new millennium. Gastroenterology. 2000;118:S129–47.

    Article  PubMed  CAS  Google Scholar 

  25. Shaker R. Unsedated transnasal pharyngoesophageal gastroduodenoscopy (TEGD) technique. Gastrointest Endosc. 1994;40:346–8.

    PubMed  CAS  Google Scholar 

  26. Rey JF, Duforest D, Marek TA. The feasibility of upper GI endoscopy performed through the nose using a thin videoendoscope. Gastrointest Endosc. 1996;43:302.

    Article  Google Scholar 

  27. Zaman A, Hahn M, Hapke R, et al. A randomized trial of peroral versus transnasal unsedated endoscopy using an ultrathin videoendoscope. Gastrointest Endosc. 1999;49(3):279–84.

    Article  PubMed  CAS  Google Scholar 

  28. Waye JD. Worldwide use of sedation and analgesia for upper intestinal endoscopy. Gastrointest Endosc. 1999;50:889–91.

    Article  Google Scholar 

  29. Ladas SD, Aabakken L, Rey JF, et al. Use of sedation for routine diagnostic upper gastrointestinal endoscopy: a European society of gastrointestinal endoscopy survey of National Endoscopy Society members. Digestion. 2006;74:69–77.

    Article  PubMed  CAS  Google Scholar 

  30. Craig A, Hanlon J, Dent J, et al. A comparison of transnasal and transoral endoscopy with small-diameter endoscopies in unsedated patients. Gastrointest Endosc. 1999;49:292–6.

    Article  PubMed  CAS  Google Scholar 

  31. Chak A, Rothstein RI. Sedationless upper endoscopy. Rev Gastroenterol Disord. 2006;6 Suppl 1:S3–11.

    PubMed  Google Scholar 

  32. Mulcahy HE, Riches A, Kiely M, et al. A prospective controlled trial of an ultrathin versus a conventional endoscope in unsedated upper gastrointestinal endoscopy. Endoscopy. 2001;33(4):311–6.

    Article  PubMed  CAS  Google Scholar 

  33. Birkner B, Fritz N, Schatke W, et al. A prospective randomized comparison of unsedated ultrathin versus standard esophagogastroduodenoscopy in routine outpatient gastroenterology practice: does it work better through the nose? Endoscopy. 2003;35(8):647–51.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

The authors would like to acknowledge the technical assistance of Mrs. Courtney Bishop in the preparation of this manuscript.

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Authors and Affiliations

  1. Division of Laparoendoscopic and Bariatric Surgery, Department of Surgery, University of Miami, 1475 N.W. 12th Avenue Room 4017, Miami, FL, 33136, USA

    Atul K. Madan

  2. Minimally Invasive Surgery Section, Department of Surgery, University of Tennessee Health Science Center, 956 Court Avenue, Room G210, Memphis, TN, 38163, USA

    David S. Tichansky

  3. Anesthesiology Associates, Memphis, TN, USA

    Johnathan Isom

  4. Department of Surgery, University of Tennessee Health Science Center, 956 Court Avenue, Room G210, Memphis, TN, 38163, USA

    Gayle Minard & Tiffany K. Bee

Authors
  1. Atul K. Madan
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  2. David S. Tichansky
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  3. Johnathan Isom
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  4. Gayle Minard
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  5. Tiffany K. Bee
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Corresponding author

Correspondence to Atul K. Madan.

Appendix

Appendix

Thank you in advance for your participation. This survey is part of a research study that Dr. Atul Madan is doing to concerning support groups. The study will involve answering a series of questions, which will take approximately 10 minutes. There are no benefits or risk to you; participation is voluntary. Failure to participate will NOT adversely affect your education. To assure confidentiality, no identifying data is being collected. Only the general results of the survey will be examined and reported.

  1. 1.

    Where did you have your endoscopy?

    ___________________

  2. 2.

    Please rate your overall experience with your endoscopy.

    1 2 3 4 5 6 7 8 9 10

  3. 3.

    Do you remember getting the scope placed into your mouth?

    Yes No

  4. 4.

    Did you gag with the scope in your mouth (not the medication spray)?

    Yes No

  5. 5.

    Did you experience pain in the back of your throat during the procedure?

    Yes No

  6. 6.

    Did you experience pressure in your abdomen during the procedure?

    Yes No

  7. 7.

    Did you experience pain in your abdomen during the procedure?

    Yes No

  8. 8.

    Did you experience pain in the back of your throat after the procedure?

    Yes No

  9. 9.

    Did you experience pressure in your abdomen after the procedure?

    Yes No

  10. 10.

    Did you experience pain in your abdomen after the procedure?

    Yes No

  11. 11.

    Do you remember leaving the endoscopy suite (the actual room where procedure was done)?

    Yes No

  12. 12.

    Do you remember leaving the endoscopy area (leaving the hospital)?

    Yes No

  13. 13.

    How soon after the procedure did you feel 100% recovered?

    <1 hour 1 – 2 hours 2 – 4 hours 4 hours – overnight

  14. 14.

    Did you have any nausea after endoscopy?

    Yes No

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Madan, A.K., Tichansky, D.S., Isom, J. et al. Monitored Anesthesia Care with Propofol Versus Surgeon-Monitored Sedation with Benzodiazepines and Narcotics for Preoperative Endoscopy in the Morbidly Obese. OBES SURG 18, 545–548 (2008). https://doi.org/10.1007/s11695-007-9338-1

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  • DOI: https://doi.org/10.1007/s11695-007-9338-1

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