Introduction: Upper endoscopy is commonly performed under conscious sedation in the US. This prospective study examines whether (1) the assessment of the endoscopists and GI nurses correlate to patient discomfort during diagnostic upper endoscopy; (2) the level of sedation or the level of amnesia predict patient discomfort. Methods: Consecutive patients undergoing diagnostic upper endoscopy using midazolam and fentanyl for sedation were independently assessed by experienced endoscopists [E] and well trained GI nurses [N], Assessment was conducted for: (1) level of sedation, (2) patients discomfort, (3) patient [P]'s perception of (a) the adequacy of sedation, (b) level of amnesia, (c) discomfort level at intubation and during examination. The patients were interviewed after recovering from the conscious sedation. Results: n=113 A. Correlation of discomfort assessment (Spearman's rank correlation) at intubation rs p during exam rs p [E] & [P] 0.41 <0.01 [E] & [P] 0.30 <0.01 [N] & [P] 0.30 <0.01 [N] & [P] 0.18 <0.05 B. Effect of amnesia on patient discomfort (Kruskal-Wallis) mean discomfort score no recall recall p at intubation 0.4 1.3 <0.001 during examination 0.2 0.8 <0.001 Key: discomfort score: 0=no pain, 1=mild, 2=moderate, 3=severe amnesia level: 0=no recall, 1-recall C. Predictor of patient discomfort (multivariate generalized linear model) Amnesia*(p value) Sedation*(p value) at intubation 0.001 0.47 during examination 0.008 0.13*adjusted for duration of examination Conclusions: (1) Endoscopists' assessment correlate with patient discomfort although on average they tend to overestimate. (2) Patient discomfort is significantly associated with incomplete amnesia. (3) Amnesia is a more important predictor for patient comfort than sedation.
|Original language||English (US)|
|State||Published - 1998|
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