Introduction Most private hospitals in the United Kingdom perform colonoscopies under intravenous sedation. We aimed to compare patients who had colonoscopies using Entonox (50:50 mixture of nitrous oxide and oxygen) or intravenous sedation in the setting of a private hospital.
Method Patients undergoing colonoscopy from January 1, 2014 to December 31, 2014 at Shirley Oaks Hospital, a JAG accredited private healthcare provider, were offered a choice of intravenous sedation or patient activated Entonox inhalation. It was confirmed that there were no contraindications to use of Entonox. All patients had Moviprep (Norgine) as bowel preparation. Pulse oximetry was used for monitoring patients during the procedure. Entonox (BOC Healthcare) was administered through a hand held mouthpiece which was activated by patient breath. They were offered intravenous sedation during the procedure if they were not able to tolerate the discomfort. Statistical analysis was performed using chi square test and t-test.
Results There were 144 patients who had Entonox (Group A) and 504 patients who had intravenous sedation (Group B). Procedures were performed by 5 experienced colonoscopists in Group A and 7 in Group B. 15 patients (10%) in Group A had to be converted to intravenous sedation. The time to colonoscopy is the time from entry into endoscopy room to the completion of procedure. In Group B, intravenous sedation included a combination of Midazolam in 494 (98%), Pethidine in 432(86%), Fentanyl in 50(10%), Propofol (1). There were no complications in Group A and 1 patient each had a bleed and cardio-respiratory compromise in Group B. No reversal agents were used. Other results are shown in Table 1.
Conclusion There was statistical significance for higher adenoma detection in the sedation group although there was no difference in the polyp detection rate. More patients having Entonox had moderate discomfort during the procedure while more patients had none/minimal discomfort in sedation group. As expected, time to colonoscopy was more in the sedation group. Larger studies are required to identify the group of patients who may benefit from Entonox in the private sector.
Disclosure of interest None Declared.
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