Background: In many gastrological centres, colonoscopy is performed under general anaesthesia to ensure more comfort to the patient and to facilitate the performance of the procedure by the physician. There have, however, appeared reports about the lack of essential benefits resulting from the use of anaesthesia. It is the increased costs of the examination itself and the lengthened time of its duration that speak against the use of anaesthesia as a routine procedure during colonoscopy.
The aim of this study is an attempt at evaluating the necessity of using intravenous anaesthesia in the course of colonoscopy.
Material and methods: From January 2000 to December 2001 some 1950 colonoscopies were performed. The analysis referred to 1422 examinations that had been performed by the same physician (M.G.). All patients expressed written consent for the examination, having been previously informed about the colonoscopy. Ten minutes after the completion of the colonoscopic examination, the patient, assisted by a secretary and without the presence of the staff performing the colonoscopy, was asked to fill in an anonymous 7-degree questionnaire about the pain intensity and was asked to evaluate satisfaction on a 5-degree scale.
Results: From among 1422 patients the intubation of the caecum was achieved with 1390 patients (98%); the colonoscopy was not performed with 32 patients (12 - insufficient preparation, 11 - missed splenic flexure, 9 - colorectal cancer). 27.3% of patients were painless, 60.8% had abdominal discomfort, 11% experienced periodic pain with slight intensity, 0.9% continuous pain with small intensity. None of the patients pointed to either the average or great or severe pain. With 54.2% of patients, the pain was observed during the splenic flexure penetration, with 28% of patients in the course of penetrating the colon both flexures, whereas the pain felt by 18% of patients did not have any connection with the localisation of the colonoscope in the colon. The male patients more often than the female ones (113 vs. 50) evaluated the pain score. Twenty-nine (2%) patients required anaesthesia, with 9 of them pointing to a feeling of shame as the main reason for the use of anaesthesia.
Conclusions: Most of the patients do not require the use of intravenous anaesthesia during the colonoscopic procedures. It should, however, be readily accessible to those patients who need it because of pain rendering the continuation of the colonoscopic procedure not possible. That is the reason for which the physician performing the colonoscopy should act in close co-operation with the anaesthesiologist.