Ileo-Colonoscopy, Cardio -Respiratory Diseases And Adequate Sedation 1N.V. Chrysanthos, 2N. Mpardatsou 1E. Anagnostopoulou, 2P. Alexandraki 1Gastrointestinal Department 2Department of Anesthesiology "St. George" General Hospital of Chania

Background Background Current guidelines state that all must undergo preventive colonoscopy at age of 50. It’s not known whether medical history affects patient’s tolerance and requires deeper sedation. Anesthesiologists posses efficient drugs for sedation but the "golden dose" that offers painless colonoscopy without adverse reactions varies among patients.

Best screening probe for prevention of CRC Ileo-Colonoscopy Gold standard for diagnosis and therapeutic procedures regarding small and gross intestine’s pathology Best screening probe for prevention of CRC Better ADR accuracy than CT colonoscopy polyp extraction

Cardio-Respiratory Diseases & Sedation High risk patients: Acute infarct with life threatening bleeding Unstable angina Severe asthma Active smokers 3 packets/day Sleep apnea

Cardiovascular function SEDATION Minimal Conscious Deep Anesthesia Functions Verbal command normal respond purposefully respond purposefully following repeated or painful stimulation No response Cognitive function Usually normal Probably impaired impaired Coordination Ventilation Unnafected Sp ventilation might be required Cardiovascular function unnafected usually unnafected May be impaired Sedation

Drugs Pethidine Fentanyl Diazepam Midazolam Propofol Ketamine Entry action 3-6 1-2 2-3 <1 30 sec Max effect 5-7 3-5 3-4 Duration 60-180 30-60 360 15-80 4-8 1st dose 25-50 50-100 5-10 10-40 Max dosage 100 200 20 6 400 Pregnancy C D B Antagonist Naloxone Flumazenil - Side effects Apnea, orth hypotension , vomit Apnea, vomit Apnea Apnea, Atention Barbiturics neurotoxicit y Thorax rigidity flebitis Aggresion Cardiac Resp instability Drugs

ASA CLASSIFICATION

ASSESMENT ASA ≥3 ASA Class Mallampati cl. ≥3 Age BMI>35 Age>70 Chronic use of narcotics Analgesics Pharyngolaryngeal tumors Long lasting procedure ASA Class Age BMI Mallampati classification Risk factors for sleep apnea

Aim Optimum levels of sedation in patients with cardiovascular and respiratory diseases (CRD) who undergo an ileo- colonoscopy

Methods Prospective study in the last 2 years Study group: 193 patients who underwent an ileo- colonoscopy 149 patients with heart disease 44 patients with respiratory disease Data were compared with a control group of 180 patients with dyslipidemia (Dyslip), chronic thyroiditis (CTh) and diabetes mellitus (DM), using SPSS 21.0.

DF or DPF P DF or DPF+PRO DF or DPF+KET CHD Nr=10 (%) 7 (70) 0.8 2 (20) 0.9 1 (10) 1.0 ByPass Nr=4 (%) 4 0.5 - AH Nr=111(%) 50 (44) <0.001 32 (28.8) 0.2 19 (17.2) 0.4 Valve Disease Nr=11(%) 7 (63.6) 3 (27.3) 1.1 1 (9.1) 1.2 Arrythmias Nr=13(%) 7 (53.9) 4 (30.7) 2 (15.4) CPD Nr= 21(%) 10 9 2 0.89 Asthma Nr= 17 (%) 5 0.7 3 0.86 Sleep Apnea Nr=6(%) 1 0.61 DLP Nr= 53 (%) 30 16 7 0.21 THYROID DIS Nr= 88 (%) 44 0.6 28 0.15 DM Nr=39 (%) 21 13 0.31

Results Patients with coronary or valvular disease, arrhythmias & ByPass requires mild levels of sedation with opioids & analgesics Almost half of our patients with hypertension received sedation with propofol or ketamine Patients with asthma or CPD receives more frequent deeper sedation with propofol or ketamine

Results Patients with sleep apnea rarely receives deep sedation and ketamine has the primary role Nearly half of (Dlip)/(CTh) or (DMII) patients receives deep sedation without side effects

Conclusions Patients with cardio-respiratory diseases are able to receive if it is needed deep sedation during colonoscopy Patients with sleep apnea seems to tolerate better ketamine than propofol and it is preferred during endoscopy

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