Randomized clinical trial of Entonox® versus midazolam-fentanyl sedation for colonoscopy

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http://www3.interscience.wiley.com/journal/122255982/abstract?CRETRY=1 & SRETRY=0

For those who may not know..... Entonox is "gas and air"!

Randomized Clinical Trial

Randomized clinical trial of Entonox® versus midazolam-fentanyl sedation for colonoscopy

S. Maslekar, A. Gardiner, M. , B. Culbert, G. S. Duthie *

Academic Surgical Unit, University of Hull and Castle Hill Hospital, Cottingham, UK

email: G. S. Duthie (g.s.duthie@...)

*Correspondence to G. S. Duthie, University of Hull, Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham HU16 5JQ, UK

Presented to the Annual Scientific Meeting of the Association of Surgeons of Great Britain and Ireland, Edinburgh, UK, May 2006, and Digestive Disease Week, Los Angeles, California, USA, May 2006 (and published in abstract form as Br J Surg 2006; 93(Suppl 1): 20 and Gastrointest Endosc 2006; 63: AB97)

Conference: Annual Scientific Meeting of the Association of Surgeons of Great Britain and Ireland, Edinburgh, UK, May 2006

Conference: Digestive Disease Week, Los Angeles, California, USA, May 2006

Abstract

Background:

Intravenous sedation for colonoscopy is associated with cardiorespiratory complications and delayed recovery. The aim of this randomized clinical trial was to compare the efficacy of Entonox® (50 per cent nitrous oxide and 50 per cent oxygen) and intravenous sedation using midazolam-fentanyl for colonoscopy.

Methods:

Some 131 patients undergoing elective colonoscopy were included. Patients completed a Hospital Anxiety and Depression questionnaire, letter cancellation tests and pain scores on a 100-mm visual analogue scale before, immediately after the procedure and at discharge. They also completed a satisfaction survey at discharge and 24 h after the procedure.

Results:

Sixty-five patients were randomized to receive Entonox® and 66 to midazolam-fentanyl. Completion rates were similar (94 versus 92 per cent respectively; P = 0·513). Patients receiving Entonox® had a shorter time to discharge. They reported significantly less pain (mean score 16·7 versus 40·1; P < 0·001), and showed better recovery of psychomotor function immediately after the procedure and at discharge. Patient satisfaction was higher among patients who received Entonox® (median score 96 versus 89; P = 0·001).

Conclusion:

Entonox® provides better pain relief and faster recovery than midazolam-fentanyl and so is more effective for colonoscopy. Registration number: ISRCTN81142957 (http://www.controlled-trials.com). Copyright © 2009 British Journal of Surgery Society Ltd. Published by Wiley & Sons, Ltd.

Accepted: 23 February 2009

Digital Object Identifier (DOI)10.1002/bjs.6467 About DOI