title: Sedation practice and comfort during colonoscopy: lessons learnt from a national screening programme.
abstract: OBJECTIVE
  Medication may be used to manage discomfort during colonoscopy but practice varies. The relationship between medication use and comfort during colonoscopy was examined in the English Bowel Cancer Screening Programme.
  
  
  METHODS
  Data related to patient comfort and medication use from all 113,316 examinations performed within the English Bowel Cancer Screening Programme between 1 January 2010 and 31 December 2012 were analysed. Comfort was rated on the five-point Modified Gloucester Comfort Scale: 1, no discomfort; 5, severe discomfort. Scores of 4 and 5 were considered to indicate significant discomfort. Correlations between the proportion of examinations associated with significant discomfort and the amounts of medication used by colonoscopists were assessed using Spearman's ρ. Logistic regression modelling examined the independent predictors of significant discomfort.
  
  
  RESULTS
  Patients had a mean age of 65.7 years, and 58% were male. Examinations were performed by 290 endoscopists. In 91% of examinations, there was no significant discomfort reported during examination; however, there was considerable variation between individual colonoscopists (range 76.1-99.2%).Intravenous sedation and opiate analgesia were used during most examinations, but there was wide variation between colonoscopists, with a median (range) usage of 95.1% (4.1-100%) and 97.3% (5.6-100%), respectively. There was no association between the amount of sedation and analgesia used and significant discomfort (ρ<0.2). On multivariate analysis, significant discomfort was found to be more common among female individuals [odds ratio (OR)=2.0], on incomplete examinations (OR=6.7), and among patients with diverticulosis (OR=1.4).
  
  
  CONCLUSIONS
  There was wide variation in medication practice among English screening colonoscopists, but this was unrelated to the occurrence of significant discomfort.
authors: aDepartment of Gastroenterology, Sheffield Teaching Hospitals bDepartment of Oncology, University of Sheffield, Medical School cSouth Yorkshire and Bassetlaw Bowel Cancer Screening Centre, Sheffield Teaching Hospitals, Sheffield dSouth of Tyne Bowel Cancer Screening Centre, South Tyneside General Hospital, South Shields eDurham University School of Medicine, Pharmacy and Health, Durham, UK.
authors: Alex J
authors: AJ
authors: Ball
authors: Colin J
authors: CJ
authors: Rees
authors: Bernard M
authors: BM
authors: Corfe
authors: Stuart A
authors: SA
authors: Riley
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D061605:Administration, Intravenous; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D019162:Anesthetics, Combined / Q000008:administration & dosage; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004241:Diverticulum, Colon / Q000150:complications; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000379:methods; D004739:England; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage; D010818:Practice Patterns, Physicians'; D012737:Sex Factors
chemical_list: D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D006993:Hypnotics and Sedatives; C001147:Entonox; D008614:Meperidine; D009609:Nitrous Oxide; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl