Background and Goal of Study: Discomfort during colonoscopy is associated with failure of intervention and with dissatisfaction of the patient and operator. The goal was to test efficacy of supplementary hypnosis on sedation use, satisfaction and adverse effects.
Materials and Methods: Patients between 18 and 80 years and ASA PS 1 and 3 were included. Patients with emergency procedure, psychiatric disease, drug and/or alcohol abuse, use of CNS drugs were excluded. Patients were randomly assigned to one of three treatments: conscious sedation with hypnosis (H), conscious sedation with structured attentive behavior (A), conscious sedation alone (C). Definition of H: the physician instructed the patients to fix a point, breathe deeply and concentrate on body sensation and then close their eyes. Self-generated imagery was used to help patients focus on a safe and pleasant experience. Definition of A: the physician used verbal messages, performed fast responses to patient's requests, encouragements, attentive listening and proposed awareness of self-control. Definition of C: patient-controlled-sedation with propofol (loading dose: 20 mg; bolus: 10 mg; lock out: 18 seconds). Comparative statistics were performed using Kruskall-Wallis ANOVA and Chi-square test. Data are presented as median and interquartile range [IQR].
Results and Discussion: Sixty-four patients were included; 23 in H, 21 in A, 20 in C. No differences were observed in the demographic data (ASA, sex, age and BMI). Median need for propofol (mg/kg/min) in H was 0.05 [0.03; 0.08], in A 0.06 [0.04; 0.07], in C 0.05 [0.02; 0.08] (p=0.8671). Four percent in H had obstructive upper airways during colonoscopy, 19% in A and 25% in C (p=0.1542). Median number of apnea and IQR were 0 in all groups (p=0.1702). Ninety-six percent in H were satisfied, 95 in A, 100 in C (p=0.9926). Median satisfaction score of gastroenterologist (max =100) in H was 100 [90; 100], in A 100 [80; 100], in C 100 [88; 100] (p=0.6977). Median exam time (min) in H was 33 [30; 41], in A 33 [30; 43], in C 35 [28; 45] (p=0.8896). Recovery room's median stay (min) in H was 27 [22; 35] in A 25 [21; 42], in C 27 [19; 42] (p=0.9788). Hundred percent of patients in H go back to their usual activity at day one, 81%in A, 75% in C (p=0.3492).
Conclusion(s): Supplementary hypnosis did not decrease sedation use; with the addition of hypnosis a trend of fewer respiratory adverse effects was observed.