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At least 1,243 records · Page 69Linked to original sources
PubMed1994

Midazolam and ketamine as premedication in colonoscopies: a pharmacodynamic study.

As colonoscopy is often painful, a premedication appears to be indispensable. Commonly, benzodiazepines, i.e. midazolam, alone or in combination with analgesic drugs are used. Besides all advantages, midazolam especially is known to have the risk of oversedation and respiratory depression. Therefore it should be used at minimal dose. In a double-blind, randomized study, three premedication-schedules of midazolam (mid) plus ketamine (ket) were compared in 33 patients, aged between 8 and 60 years, with regard to safety and acceptance by patients and endoscopist. I: ket 1 mg/kg+mid 0.1 mg/kg, max. 5 mg II: ket 1 mg/kg+mid 0.05 mg/kg, max. 2.5 mg III: ket 0.75 mg/kg+mid 0.1 mg/kg, max. 5 mg Oxygen-saturation, heart rate and blood pressure were recorded as well as the evaluations of sedation, cooperation and complaint of pain. To assess the recovery-time of the patients, the reaction time and the attention were evaluated by "Wiener's determination apparatus" and "test d2", respectively, before and at 1, 2, 3 and 4 hours after premedication. Medication I resulted in heavy sedation, good cooperation and amnesia but had the strongest tendency towards hypoxemia. Under schedule III, reduced cooperation and acceptance were seen due to a strong experience of pain. The best conditions during the examination with regard to cooperation, experience of pain and acceptance were found after premedication II without relevant depression of vital parameters. It can be concluded that midazolam can be used at minimal recommended doses as premedication for colonoscopy if combined with ketamine in a sufficient analgesic dosage.

Adolescent↗
PubMed1994

Exploratory laparoscopy for perforation following colonoscopy.

Colonoscopy is being increasingly used for the diagnosis and therapy of colonic diseases. Bleeding and perforation are two major complications. The management of patients with perforation is undergoing evolution. There is evidence to support conservative management in selected patients with perforation without clinical signs of peritonitis. There is, however, a subset of patients with perforation where a considerable doubt exists about the choice between surgical and conservative management. We report one such patient, a 50-year-old woman with free air under the diaphragm and peritoneal signs following a therapeutic colonoscopy in whom an exploratory laparoscopy was performed. Exploratory laparoscopy is proposed for such patients when there is a question in choosing between surgical and conservative management.

Colonoscopy↗
PubMed1994

[A prospective study on cardiovascular and respiratory complications during colonoscopy].

We monitored 48 patients, considering ECG, Oxygen Saturation and arterial pressure. Our aim was to evaluate the incidence of cardiovascular and respiratory complications of colonoscopy. In 40% of the cases, these parameters showed significant modifications and in 9 cases (19%), patients showed cardiovascular events to such an extent as to constitute a potential life-threatening situation. These cardiovascular events were in relation statistically significant with pre-existing cardiovascular pathology, COLD and hypoxia. Hypoxia, in turn, depended almost exclusively on i.v. sedation, and returned to normal values when the patient received oxygen. In most cases, events were not correlated to any specific symptom. This study demonstrated a rate of cardiovascular complications higher than previous retrospective analyses would lead one to believe. We recognize the value of accurate history-taking and have adopted its use in selecting high risk patients before colonoscopy, especially if sedation is contemplated.

Aged↗
PubMed1994

Mid-ileal perforation secondary to colonoscopy.

Perforation of the bowel is a known complication of colonoscopy. Ileal perforation is a very rare complication of this procedure. We present a previously unreported case of double ileal perforation following colonoscopy secondary to dense, fixed pelvic adhesions.

Aged↗
PubMed1994

Colonoscopy and therapeutic intervention in infants and children.

Colonoscopy is an established procedure for the investigation of large bowel and terminal ileal disease in infants and children. Specific indications vary with the child's age. Preparation and sedation of the pediatric patient and colonoscopy techniques must be tailored to the age and physical stature of the patient.

Child↗
PubMed1994

Fecal occult blood screening for colorectal cancer. Is mortality reduced by chance selection for screening colonoscopy?

Annual fecal occult blood test (FOBT) screening using rehydrated Hemoccult slides has been reported in the Minnesota Colon Cancer Control Study to reduce colorectal cancer mortality by about 33%. However, some of the benefit of FOBT screening may come from "chance" selection of persons for colonoscopic examination because of the high positivity rate of FOBT (about 10%) that may occur for reasons other than a bleeding cancer or polyp. To determine how much this mechanism could account for the benefit of FOBT screening, we used a simple mathematical model to simulate the course of a cohort of screened persons, incorporating published data including those from the Minnesota study. The results suggest that one third to one half of the mortality reduction observed from FOBT screening in the Minnesota study may be attributable to chance selection for colonoscopy. We conclude that annual FOBT screening with rehydration is a haphazard method for selecting persons for colonoscopy.

Colonoscopy↗
PubMed1994

Hypnotic relaxation: a new sedative tool for colonoscopy?

Sedation is often justified in patients requiring colonoscopy. We investigated the potential usefulness of hypnotic relaxation in 13 women and 11 men (median age, 43 years; range, 22-67) for whom other forms of anesthesia were not available. Hypnotic relaxation resulted in moderate or deep sedation in 12 patients (nine women; p < 0.05). In the patients in whom hypnosis was successful, pain was less intense than in patients in whom hypnosis was unsuccessful (p < 0.001). In addition, all colonoscopies were completed in the successful group, versus 50% in the unsuccessful group (p < 0.05). The patients in the successful group all agreed to another examination under the same conditions, whereas only 2% in the unsuccessful group agreed (p < 0.001). Our study suggests that, in a subgroup of hypnotizable patients, hypnotic relaxation may be a safe alternative to drug sedation and merits further study.

Adult↗
PubMed1993

Intraoperative colonoscopy.

The authors performed intraoperative colonoscopy in 31 patients. This examination is done if preoperative colonoscopy was not performed or incomplete, and intraoperative difficulty occurs. In addition, it is indicated to localize non-palpable lesions, to perform polypectomy (if unsuccessful preoperatively but manageable intraoperatively), to define the site of endoscopic polypectomy, in certain instances to determine the resection plane, and after resection of constrictive tumours to look over the proximal intestinal section, to detect the synchronous lesions. It is emphasized that by their method the opening of the lumen becomes avoidable thus resulting in a decreased postoperative morbidity and mortality.

Colonoscopy↗
PubMed1993

A comparison of the effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation.

One hundred thirteen patients were randomized to receive either oral sodium phosphate (Fleet Phospho-Soda), lemon-flavored castor oil (Purge), or standard polyethylene glycol-based lavage solution (GoLYTELY) before elective colonoscopy. The study purpose was to confirm the efficacy of oral sodium phosphate and extend observations to include castor oil. Overall, patients reported that sodium phosphate and castor oil were easier to complete (p < 0.05). Scores for cleansing the entire colon as determined by endoscopists who were blinded to the cathartic agent were highest in patients receiving sodium phosphate (p < 0.02). Scores of left-colon cleansing for flexible sigmoidoscopy were equally high for the three methods. Scores for taste and symptom side effects were similar for each preparation. There were no recognized signs or symptoms of hypocalcemia in the sodium phosphate group. Because of the low cost of oral sodium phosphate combined with the lowest repeat endoscopy rate for inadequate cleansing, patient savings were projected to be $5000 per 100 patients at this center. Oral sodium phosphate is a cost-effective colonoscopy preparation that is better tolerated and more effective than the polyethylene glycol-electrolyte lavage solution or castor oil.

Administration, Oral↗
PubMed1993

[Ambulatory colonoscopy under systemic general anesthesia. Our experience apropos of 500 cases].

The authors report a retrospective study of 500 colonoscopies performed on outpatients under general anaesthesia. Anaesthesia protocol associated diluted propofol in continuous titrated infusion and alfentanil. The doses used were relatively low and no serious adverse effects were observed. Therefore this method appears to be appropriate for most outpatients undergoing a colonoscopy provided that usual security rules are respected.

Adult↗
PubMedDate not supplied

[Colonoscopy: diagnostic and treatment methods].

The author presents the historical and technical development of the colonoscopy showing the advantages provided by the employment of the method, specially with the use of new equipment. He discusses different pre-colonoscopy bowel cleansing methods, and particularly the use of mannitol 10%.

Colon↗
PubMed1996

Complications of colonoscopy and flexible sigmoidoscopy.

Complications can occur during both diagnostic and therapeutic endoscopy. Most statistics concerning complications are based on reports generated when colonoscopy was in its infancy. This article examines the diagnosis and treatment of complications that arise during the course of both colonoscopy and polypectomy. Surgery may not be required in all cases. The criteria for operative or nonoperative treatment are presented.

Bacteremia↗
PubMedDate not supplied

[Early detection of adenomas in asymptomatic subjects: flexible sigmoidoscopy or colonoscopy].

OBJECTIVE: The aim of this study was to determine the frequency of adenomas as well as sensitivity, specificity, positive and negative predictive values of FS for polyp screening in two groups of asymptomatic individuals using colonoscopy (CP) as the gold standard. BACKGROUND: Flexible sigmoidoscopy (FS) is the screening procedure of choice for polyps and colorectal carcinoma (CRC) in asymptomatic individuals. However, the validity of this approach has been questioned, specially in subjects with a family history of CRC. METHODS: A total of 92 asymptomatic individuals were included in two groups: group A: with a family history (1st or 2nd degree relatives) of polyps or CRC (fifty-eight), and group B: without a family history and > 50 years (thirty-four). FS was simulated with the videocolonoscope until 60 cm, and was continued into the cecum. The number, type and localization of polyps were noted for each, FS and CP. The values mentioned previously were calculated according to established formulas. Comparisons were performed using Chi square test. RESULTS: Adenomas were found in twenty individuals in group A (34.4%) and 7 in group B (20.5%), p = NS. Sensitivity for FS in group A was 42% vs 71% in group B, with a negative predictive value of 44.5 and 93%, respectively. CONCLUSION: Colonoscopy is probably the screening procedure of choice in individuals with a family history of polyps or CRC. The utility of FS for screening purposes in asymptomatic individuals without a family history seems adequate, although more studies are required in different populations in our country.

Adenoma↗
PubMed1996

Colonoscopy by a family physician: a 9-year experience of 1048 procedures.

BACKGROUND: In the last 15 years, family physicians and general internists have adopted flexible fiberoptic endoscopy as a procedure to screen patients at risk of premature death from colorectal cancer. There has been controversy regarding the ability of non-fellowship-trained primary care physicians to extend this experience to full colonoscopy. METHODS: The results of 1048 consecutive colonoscopy examinations performed by a family physician over a 9-year period were tabulated. Outcomes measured included the reach-the-cecum rate (RCR), use of medication, complication rate, and diagnostic yield. In a convenience sample of 110 cases, the effectiveness of the non-narcotic analgesic ketorolac was assessed by the RCR. Outcomes of cases in which ketorolac was used were compared with cases in which traditional sedation and analgesia were used. RESULT: A high diagnostic yield without significant complications was noted. The RCR for nonmedicated patients was 36%. Among all medicated cases, the RCR was 93%. In patients who were given the non-narcotic analgesic ketorolac, the RCR was 96%, compared with 95% in patients not given ketorolac. CONCLUSIONS: A family physician in rural practice was able to attain and sustain a state-of-the-art, reach-the-cecum rate over a 9-year period. This service resulted in a high diagnostic yield, high degree of safety, and satisfactory results for the community. Ketorolac is an effective alternative for patients who may be hypersensitive to narcotic analgesia/sedation.

Adolescent↗
PubMed1996

[Preparation for colonoscopy: a reliable and easily implemented regimen].

Three different colonoscopy preparation methods were tested in 150 out-patients who received colonoscopies, 50 in each group, a randomized prospective simple blind study. The original Golytely-recepture with three litres of liquid was tested against Clean Prep which has to be dissolved in four litres of liquid. Both receptures had the same isotonic salt solutions. The third group was a method with a laxans (X-Prep) including eating restriction lasting three days. The judgment criteria were the cleanliness of the bowel, the formation of foam and the subjective sensitivity of the patient during the preparation phase. The preparation with the three bags containing three litres of Golytely solution according to the original recepture proved to be the least troublesome for the patients and was the most efficient method when it came to cleanliness and the formation of foam. The costs of this preparation methods were lower than those of the other methods.

Administration, Oral↗
PubMed1996

[The role of colonoscopy in early diagnosis of intraluminal recurrences in patients already treated for colorectal cancer].

It is a common opinion that the more often and the more rigorously the colon is examined, the more lesions will be discovered and diagnosed. However it has not been shown which methods of colonic examination and which regimen of surveillance should be used. Chart review was conducted on 481 patients who underwent curative resection for colorectal cancer between 1980 and 1990. Colonoscopy was performed preoperatively, after 12-15 months from surgical treatment, and then at an interval of 12-24 months, or when symptoms appeared. About ten percent of patients developed intraluminal recurrences, and more than 25% adenomatous polyps. More than one half of the metachronous lesions arise within the first 24 months. The median time to diagnosis was 25 months for intraluminal recurrences and 22 months for adenomatous polyps. Patients with left sited tumor at an advanced stage run a higher risk of developing recurrent intraluminal disease, and patients who presented associated polyps at the time of the operation for the index cancer have a higher risk of developing new polyps. About 50% of recurrences were detected when patients were asymptomatic. Colonoscopy must be performed within the first 12-15 months after operation, while an interval of 24 months between each examination seems sufficient to guarantee an early detection of metachronous lesion. Asymptomatic patients are more frequently reoperated for cure and thus have a better survival rate.

Adult↗
PubMed1996

[Hemoperitoneum caused by lesions to the appendix epiploica. An unusual complication of colonoscopy].

A rare case of hemoperitoneum in a young man who performed a diagnostic colonoscopy is reported. The rupture of an epiploic appendix among rectum and colon sigma caused massive bleeding into the peritoneum cavity followed by haemorrhagic shock. Diagnostic and therapeutic colonoscopy has a low rate of morbility; perforation and bleeding are the most common events; hemoperitoneum following colonscopy is usually due to spleen rupture. Among other complications, ileal and cecal volvolus, incarceration of hernias and subcutaneous emphysema are reported.

Adult↗