Tuesday, June 18, 2013
Alternative anesthestics during colonoscopy
I`ve been researching alternatives to conscious sedation during colonoscopy due due adverse events/reactions to IV sedation and found that, particularly in Austalia, use of sevoflurane (nitrous oxide) is the standard. And, studies seem to show that it is cleared from the body faster than Versed or other drugs used here. Why is it not used in the U.S.? It is a cost or professional issue?
Sevoflurane and nitrous oxide are anesthetic gases used in the United States, Australia, and everywhere else in between. It is certainly acceptable practice to administer sevoflurane and/or nitrous oxide for a colonoscopy. I am not sure which specific adverse events or reactions from IV sedation you are referring to but there is no scientific evidence I am aware of that it has a better side effect profile than intravenous drugs like propofol and midazolam.
One drawback of sevoflurane is that it has a fairly pungent aroma and causes excitation and involuntary movement when used to induce general anesthesia. Therefore an IV agent is needed in addition to the gas. Another problem is the pollution of the procedure suite that can result from the use of gases. And finally, use of sevoflurane often requires the insertion of an airway device, something which can usually be avoided during moderate IV sedation.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University