title: Randomized clinical trial of Entonox versus midazolam-fentanyl sedation for colonoscopy.
abstract: BACKGROUND
  Intravenous sedation for colonoscopy is associated with cardiorespiratory complications and delayed recovery. The aim of this randomized clinical trial was to compare the efficacy of Entonox (50 per cent nitrous oxide and 50 per cent oxygen) and intravenous sedation using midazolam-fentanyl for colonoscopy.
  
  
  METHODS
  Some 131 patients undergoing elective colonoscopy were included. Patients completed a Hospital Anxiety and Depression questionnaire, letter cancellation tests and pain scores on a 100-mm visual analogue scale before, immediately after the procedure and at discharge. They also completed a satisfaction survey at discharge and 24 h after the procedure.
  
  
  RESULTS
  Sixty-five patients were randomized to receive Entonox and 66 to midazolam-fentanyl. Completion rates were similar (94 versus 92 per cent respectively; P = 0.513). Patients receiving Entonox had a shorter time to discharge. They reported significantly less pain (mean score 16.7 versus 40.1; P < 0.001), and showed better recovery of psychomotor function immediately after the procedure and at discharge. Patient satisfaction was higher among patients who received Entonox (median score 96 versus 89; P = 0.001).
  
  
  CONCLUSIONS
  Entonox provides better pain relief and faster recovery than midazolam-fentanyl and so is more effective for colonoscopy.
authors.affiliation: Academic Surgical Unit, University of Hull and Castle Hill Hospital, Cottingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Maslekar
authors.forename: A
authors.initials: A
authors.lastname: Gardiner
authors.forename: M
authors.initials: M
authors.lastname: Hughes
authors.forename: B
authors.initials: B
authors.lastname: Culbert
authors.forename: G S
authors.initials: GS
authors.lastname: Duthie
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D019162:Anesthetics, Combined; D001291:Attitude of Health Personnel; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005283:Fentanyl; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D009609:Nitrous Oxide; D010100:Oxygen; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D011597:Psychomotor Performance / Q000187:drug effects; D020127:Recovery of Function
chemical_list: D019162:Anesthetics, Combined; C001147:Entonox; D009609:Nitrous Oxide; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl