Importance of Conscious Sedation and Monitoring for Safe and Effective Total Colonoscopy.

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  • 大腸内視鏡時の意識下鎮静法（Ｃｏｎｓｃｉｏｕｓ　ｓｅｄａｔｉｏｎ）の検討

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To achieve painless and safe total colonoscopy (TCS), 48 patients who underwent diagnostic and therapeutic procedures by TCS were generally controlled by conscious sedation and monitoring. Flunitrazepam (mean 12μg/kg) was administered intravenously for sedation before TCS and was added adequately according to the degrees of pain. Flumazenil, a specific antagonist of benzodiazepine, (mean 8μg/kg) was administered intravenously to reverse patients soon after TCS. All patients were monitored to detect early signs of distress before compromised vital function occured. This included changes in pulse rates, blood pressure, ventilatory status, cardiac electrical activity, and clinical and neurologic status. Pulse rates decreased slightly after sedation but the change was not statistically significant. Blood pressure decreased significantly (systolic blood pressure; p<0.01, diastolic blood pressure ; p< 0.05) after sedation and the decrease remained unchanged after the injection of the antagonist. The value of oxygen saturation decreased significant-ly (p<0.01) after sedation and rapidly returned to the former value after its reversal. Electrocardiographic rhythm showed no significaant change by sedation and its reversal. Pain scores of the sedation group (N=48) were significantly (p<0.01) low, compared with those of non-sedation group (N=8). In the sedation group, pain scores of previous lapar-otomy group (N=25) were significantly (p<0.05) high, compared with the scores of previous non-laparotomy group (N=23). In conclusion, the method of conscious sedation and monitoring is useful for the decrease of the pain and increase of the safety in TCS.

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