Autonomous nervous response during sedation in colonoscopy and the relationship with clinician satisfaction

peer-reviewed
Erstveröffentlichung
2021-06-16Authors
Hann, Alexander
Gruss, Sascha
Goetze, Sebastian
Mehlhase, Niklas
Frisch, Stephan
Wissenschaftlicher Artikel
Published in
Frontiers in Medicine ; 8 (2021). - Art.-Nr. 643158. - eISSN 2296-858X
Link to original publication
https://dx.doi.org/10.3389/fmed.2021.643158Institutions
UKU. Klinik für Innere Medizin IUKU. Klinik für Psychosomatische Medizin und Psychotherapie
External cooperations
Universität WürzburgDocument version
published version (publisher's PDF)Abstract
Background: Nurse assisted propofol sedation (NAPS) is a common method used for colonoscopies. It is safe and widely accepted by patients. Little is known, however, about the satisfaction of clinicians performing colonoscopies with NAPS and the factors that negatively influence this perception such as observer-reported pain events. In this study, we aimed to correlate observer-reported pain events with the clinicians' satisfaction with the procedure. Additionally, we aimed to identify patient biosignals from the autonomic nervous system (B-ANS) during an endoscopy that correlate with those pain events.
Methods: Consecutive patients scheduled for a colonoscopy with NAPS were prospectively recruited. During the procedure, observer-reported pain events, which included movements and paralinguistic sounds, were simultaneously recorded with different B-ANS (facial electromyogram (EMG), skin conductance level, body temperature and electrocardiogram). After the procedure, the examiners filled out the Clinician Satisfaction with Sedation Instrument (CSSI). The primary endpoint was the correlation between CSSI and observer-reported pain events. The second primary endpoint was the identification of B-ANS that make it possible to predict those events. Secondary endpoints included the correlation between CSSI and sedation depth, the frequency and dose of sedative use, polyps resected, resection time, the duration of the procedure, the time it took to reach the coecum and the experience of the nurse performing the NAPS. ClinicalTrials.gov: NCT03860779.
Results: 112 patients with 98 (88.5%) available B-ANS recordings were prospectively recruited. There was a significant correlation between an increased number of observer-reported pain events during an endoscopy with NAPS and a lower CSSI (r = −0.318, p = 0.001). Additionally, the EMG-signal from facial muscles correlated best with the event time points, and the signal significantly exceeded the baseline 30 s prior to the occurrence of paralinguistic sounds. The secondary endpoints showed that the propofol dose relative to the procedure time, the cecal intubation time, the time spent on polyp removal and the individual nurse performing the NAPS significantly correlated with CSSI.
Conclusion: This study shows that movements and paralinguistic sounds during an endoscopy negatively correlate with the satisfaction of the examiner measured with the CSSI. Additionally, an EMG of the facial muscles makes it possible to identify such events and potentially predict their occurrence.
Publication funding
Open-Access-Förderung durch die Medizinische Fakultät der Universität Ulm
Is supplemented by
https://www.frontiersin.org/articles/10.3389/fmed.2021.643158/full#supplementary-materialSubject headings
[GND]: Coloskopie | Sedierung | Vegetatives Nervensystem | Biosignal[MeSH]: Colonoscopy | Deep sedation | Conscious sedation | Autonomic nervous system | Propofol
[DDC subject group]: DDC 610 / Medicine & health
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Please use this identifier to cite or link to this item: http://dx.doi.org/10.18725/OPARU-38064
Hann, Alexander et al. (2021): Autonomous nervous response during sedation in colonoscopy and the relationship with clinician satisfaction. Open Access Repositorium der Universität Ulm und Technischen Hochschule Ulm. http://dx.doi.org/10.18725/OPARU-38064
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