title: What factors are associated with the difficult-to-sedate endoscopy patient?
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Washington Hospital Center, 110 Irving St NW, Suite 3A-3, Washington, DC 20010, USA. bal.bikram@gmail.com
authors.forename: Bikram S
authors.initials: BS
authors.lastname: Bal
authors.forename: Michael D
authors.initials: MD
authors.lastname: Crowell
authors.forename: Divyanshoo R
authors.initials: DR
authors.lastname: Kohli
authors.forename: Jiana
authors.initials: J
authors.lastname: Menendez
authors.forename: Farzin
authors.initials: F
authors.lastname: Rashti
authors.forename: Anjali S
authors.initials: AS
authors.lastname: Kumar
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Olden
mesh_terms: D000328:Adult; D000437:Alcoholism; D001007:Anxiety; D015331:Cohort Studies; D016292:Procedural Sedation / Q000523:psychology*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012742:Sex Offenses; D011795:Surveys and Questionnaires; D014754:Violence
chemical_list: D006993:Hypnotics and Sedatives