Autonomous Nervous Response During Sedation in Colonoscopy and the Relationship With Clinician Satisfaction
Open Access
- 16 June 2021
- journal article
- research article
- Published by Frontiers Media SA in Frontiers in Medicine
Abstract
Background: Nurse assisted propofol sedation (NAPS) is a common method used for colonoscopies. It is safe and widely accepted by patients. Little is known, however, about the satisfaction of clinicians performing colonoscopies with NAPS and the factors that negatively influence this perception such as observer-reported pain events. In this study, we aimed to correlate observer-reported pain events with the clinicians' satisfaction with the procedure. Additionally, we aimed to identify patient biosignals from the autonomic nervous system (B-ANS) during an endoscopy that correlate with those pain events. Methods: Consecutive patients scheduled for a colonoscopy with NAPS were prospectively recruited. During the procedure, observer-reported pain events, which included movements and paralinguistic sounds, were simultaneously recorded with different B-ANS (facial electromyogram (EMG), skin conductance level, body temperature and electrocardiogram). After the procedure, the examiners filled out the Clinician Satisfaction with Sedation Instrument (CSSI). The primary endpoint was the correlation between CSSI and observer-reported pain events. The second primary endpoint was the identification of B-ANS that make it possible to predict those events. Secondary endpoints included the correlation between CSSI and sedation depth, the frequency and dose of sedative use, polyps resected, resection time, the duration of the procedure, the time it took to reach the coecum and the experience of the nurse performing the NAPS. ClinicalTrials.gov: NCT03860779. Results: 112 patients with 98 (88.5%) available B-ANS recordings were prospectively recruited. There was a significant correlation between an increased number of observer-reported pain events during an endoscopy with NAPS and a lower CSSI (r = −0.318, p = 0.001). Additionally, the EMG-signal from facial muscles correlated best with the event time points, and the signal significantly exceeded the baseline 30 s prior to the occurrence of paralinguistic sounds. The secondary endpoints showed that the propofol dose relative to the procedure time, the cecal intubation time, the time spent on polyp removal and the individual nurse performing the NAPS significantly correlated with CSSI. Conclusion: This study shows that movements and paralinguistic sounds during an endoscopy negatively correlate with the satisfaction of the examiner measured with the CSSI. Additionally, an EMG of the facial muscles makes it possible to identify such events and potentially predict their occurrence.This publication has 38 references indexed in Scilit:
- Biofeedback und Neurofeedback: Anwendungsmöglichkeiten in Psychosomatik und PsychotherapiePPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie, 2015
- Endoscopic Sedation and Monitoring Practice in Germany: Re-evaluation From the First Nationwide Survey 3 Years After the Implementation of an Evidence and Consent Based National GuidelineZeitschrift für Gastroenterologie, 2013
- Propofol sedation for colonoscopy with a new ultrathin or a standard endoscope: a prospective randomized controlled studyEndoscopy, 2013
- Nonanesthesiologist-administered propofol sedation: from the exception to standard practice. Sedation and monitoring trends over 20 yearsEndoscopy, 2012
- Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phaseEndoscopy, 2011
- A randomized controlled trial of endoscopist vs. anaesthetist-administered sedation for colonoscopyDigestive and Liver Disease, 2011
- Development and Validation of the Patient and Clinician Sedation Satisfaction Index for Colonoscopy and Upper EndoscopyClinical Gastroenterology and Hepatology, 2009
- A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic proceduresGastrointestinal Endoscopy, 2008
- The application of the Hilbert spectrum to the analysis of electromyographic signalsInformation Sciences, 2008
- Trained Registered Nurses/Endoscopy Teams Can Administer Propofol Safely for EndoscopyGastroenterology, 2005