Introduction The BSG has published guidelines suggesting maximum sedation doses for patients aged over 70 years.1 Elderly patients have greater co morbidity and potential for complications from sedation at lower doses than younger patients.2 We investigated whether the maximum doses as suggested by the BSG resulted in adequate pain relief and patient perception that adequate sedation was given.
Methods A prospective study of patients aged over 70 years of age attending our unit to undergo colonoscopy. Data were collected on patient reported pain scores (visual analogue score 0–10) during colonoscopy, sedation and doses used. Patients completed a post endoscopic questionnaire to ascertain if more or less sedation would be preferred for future endoscopic procedures. ASA grade was also assessed. All colonoscopists in the study had caecal intubation rates of at least 85%.
Results 183 patients were included (96 Male and 87 Female). 74 patients received the maximum recommended sedation dose. Of those, nine would prefer less sedation, 44 the same, 11 more. Eight would refuse a further procedure and five were undecided. With those who requested more sedation, three patients had an ASA grade of 3 or more. Patients requesting more sedation had higher reported pain scores than those who were satisfied with the sedation they received (mean pain score 4.68 vs 1.51). 20 patients received less than maximal sedation, eight would choose the same sedation again, six more and three would refuse a future test. The average ASA score in those requesting more sedation was 1.98.
89 patients received more than the recommended dose of sedation, (mean Midazolam (M) 3.11 mg (range 2.5–5 mg). Mean Fentanyl (F) 94.7 μg (range 75–100 μg)). Average ASA score was 1.69. In this group 56 wanted the same sedation, 1 less, 17 more and 4 patients would refuse a future test and 11 were unsure. 14 of the 89 had more than recommended doses of both M and F. No adverse events were reported for any patients.
Conclusion Sedation doses recommended by current BSG guidelines appear inadequate for a significant proportion of elderly patients under going colonoscopy. Failing to address patient comfort for safety would appear to have a negative affect on the acceptability of the procedure.