title: The impact of chronic opioid use on colonoscopy outcomes.
abstract: BACKGROUND
  Endoscopic procedures are frequently performed on patients chronically on opioids, raising concerns about the safety and efficacy of conventional sedation.
  
  
  OBJECTIVE
  We hypothesized that chronic opioid use is associated with longer procedure times, higher dosages of sedation medications, and an increase in adverse effects.
  
  
  METHODS
  This is a retrospective review from June 2012 to June 2013. Patients on chronic opioids (opioids use ≥ 12 weeks) were compared to randomly selected patients matched for age, race, and sex. Multivariate regression analysis was performed to identify factors that were independently predictive of longer procedure times.
  
  
  RESULTS
  Patients on chronic opioids required higher doses of fentanyl (122.0 ± 45.3 vs. 105.8 ± 47.2 µg; P < 0.0001) and midazolam (5.3 ± 5.3 vs. 4.4 ± 2 mg; P = 0.0037) and were more likely to receive diphenhydramine (42.8 vs. 22.6 %; P < 0.001). The induction period (11.3 ± 8.8 vs. 7.5 ± 4.0 min), duration of procedure (39.1 ± 17.5 vs. 33.4 ± 14.1 min), and recovery times (38.7 ± 15.3 vs. 33.8 ± 12.1 min) were significantly longer for patients on chronic opioids. In the multivariate regression analysis, opioid use was an independent predictor of longer procedure duration (P < 0.05). Hypotensive episodes did not differ between groups (2.8 vs. 2.7 %; P = 0.8). However, patients on chronic opioids experienced more pain (13.4 vs. 5.9 %; P 0.001) and hypertensive episodes (8.1 vs. 2.8 %; P 0.002).
  
  
  CONCLUSIONS
  Patients on chronic opioids represent a high-risk population with longer procedural times and more discomfort, despite higher dosages of sedative agents. Prospective studies are required to define the risks and benefits of more costly alternative sedation strategies for patients on chronic opioids.
authors.affiliation: Section of Digestive Diseases, Department of Internal Medicine, University of Oklahoma Health Sciences Center, 920 Stanton Young Blvd. WP 1345, Oklahoma City, OK, 73104, USA, salman-nusrat@ouhsc.edu.
authors.forename: Salman
authors.initials: S
authors.lastname: Nusrat
authors.forename: Sultan
authors.initials: S
authors.lastname: Mahmood
authors.forename: Hussein
authors.initials: H
authors.lastname: Bitar
authors.forename: William M
authors.initials: WM
authors.lastname: Tierney
authors.forename: Klaus
authors.initials: K
authors.lastname: Bielefeldt
authors.forename: Mohammad F
authors.initials: MF
authors.lastname: Madhoun
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D003113:Colonoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl
references.citation: Gastrointest Endosc. 2000 Jul;52(1):39-44
references.pmid: 10882960