title: Impact of fentanyl in lieu of meperidine on endoscopy unit efficiency: a prospective comparative study in patients undergoing EGD.
abstract: BACKGROUND
  Turnaround time is an important component of endoscopy unit efficiency. Any reduction in the total time from patient arrival in the endoscopy room to departure from the recovery area may translate into better endoscopy unit efficiency.
  
  
  OBJECTIVE
  To evaluate the effects on endoscopy unit efficiency of a change in narcotic choice for moderate sedation in patients undergoing EGD at an ambulatory surgery center.
  
  
  METHODS
  Prospective, comparative, quality-improvement project.
  
  
  METHODS
  Endoscopy unit of a tertiary-care academic medical center.
  
  
  METHODS
  We enrolled consecutive patients (n = 1963) who underwent outpatient EGD by 1 of 5 endoscopists between November 2008 and November 2010.
  
  
  METHODS
  Moderate sedation with midazolam plus fentanyl versus meperidine.
  
  
  METHODS
  Sedation-dependent endoscopy unit efficiency and total procedure time (induction-to-intubation, intubation-to-extubation, and extubation-to-discharge).
  
  
  RESULTS
  Fentanyl was associated with reduced total procedure time by 10.1 minutes resulting from both shorter induction-to-intubation time and extubation-to-discharge time (P < .001). The mean (± SD) sedation-dependent endoscopy unit efficiency was 3.2 (± 1.9) procedures per hour for the meperidine group and 3.9 (± 2.7) procedures per hour for the fentanyl group (P = .012); this would translate into possibly increasing the endoscopy suite efficiency by 22%. Based on dosage equivalency conversion, equal doses of fentanyl and meperidine were used. No sedation-related complications or need for reversal agents were recorded.
  
  
  CONCLUSIONS
  No randomization was performed.
  
  
  CONCLUSIONS
  Compared with meperidine, fentanyl in combination with midazolam was associated with significantly shorter total procedure time. By improving the turnaround time, sedation-dependent endoscopy unit efficiency may be improved by 22%.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
authors.forename: Ivana
authors.initials: I
authors.lastname: Dzeletovic
authors.forename: M Edwyn
authors.initials: ME
authors.lastname: Harrison
authors.forename: Michael D
authors.initials: MD
authors.lastname: Crowell
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Ramirez
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Yows
authors.forename: Lucinda A
authors.initials: LA
authors.lastname: Harris
authors.forename: Shabana F
authors.initials: SF
authors.lastname: Pasha
authors.forename: Suryakanth R
authors.initials: SR
authors.lastname: Gurudu
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Leighton
authors.forename: Russell I
authors.initials: RI
authors.lastname: Heigh
mesh_terms: D000759:Adjuvants, Anesthesia / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008614:Meperidine / Q000627:therapeutic use*; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D008614:Meperidine; D008874:Midazolam; D005283:Fentanyl