1. 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

2. 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.

3. 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

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

5. 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

6. 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

7. ASA CLASSIFICATION

9. 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

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

11. 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.

12. 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

13. 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

14. 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

15. 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

16. Thank you for your attention