orm_june-2024 - 12

READER'S CHOICE: OR AM TOP READ STORIES
Propofol sedation increases
colonoscopy costs without
improving outcomes
Routine use of propofol for colonoscopy
should be reevaluated, according to research
published March 8 in The Lancet
concluding the drug increases costs
without improving quality metrics. The
systematic review and meta-analysis of
nine randomized controlled trials contradicts
the common view that deep sedation
is required to provide a comfortable
colonoscopy procedure for patients,
who in this study reported high levels of
satisfaction regardless of sedation type.
The study evaluated 46,634 colonoscopies
performed at 21 hospitals using
either propofol (16,408, or 35.2% of
cases) or conscious sedation (30,266,
or 65.8% of cases). The use of propofol
was associated with a lower adenoma
detection rate (ADR), but not sessile
serrated polyp detection rate (ssPDR),
polyp detection rate (PDR), cecal intubation
rate (CIR), or perforation rate. On
multi-variable analysis, propofol sedation
was not associated with any differences
in ADR, PDR, or CIR. The additional
cost associated with propofol
sedation was $12,730,496 for every
100,000 cases.
-https://www.thelancet.com/
journals/eclinm/article/PIIS25895370(24)00082-8/fulltext
Propofol
anesthesia for
colonoscopy could help find
polyps, prevent cancer
By putting the patient into deeper sedation
during colonoscopy, propofol could
help doctors find difficult-to-spot " serrated "
polyps, according to a study published
April 17 in Anesthesiology.
As an alternative to moderate, " conscious "
sedation, propofol facilitates a
more thorough exam that is more likely
to identify serrated polyps, which tend
to be flatter and blend easily into the
contours of the colon tissue, researchers
write. Although other research focuses
on propofol efficiency and provider
and patient satisfacton ratings,
they say this study is the first to assess
detection of serrated polyps.
12
OR Manager | June 2024
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The study included over 54,000
colonoscopies drawn from the New
Hampshire Colonoscopy Registry and
completed between 2015 and 2020
on patients older than 50 years.Overall
polyp detection rates were higher with
propofol (34%) than moderate sedation
(24.5%). Analysis on a " restricted "
sample of about 19,000 colonoscopies
performed at facilities that did not predominantly
use one form of sedation
over the other showed similar results
(30.3% polyp detection rate with propofol,
25.7% with moderate sedation).
After adjusting for confounding factors
in the restricted sample, propofol was
still associated with a 13% higher likelihood
of detecting serrated polyps.
Researchers speculate that more
comfortable patients as well as relaxation
of smooth muscle in the colon
could be behind the improvement. They
emphasize that further studies are required,
and that these results should be
interpreted cautiously due to the limitations
of analyzing clinical registry data.
-https://pubs.asahq.org/anesthesiology/article/140/6/1088/139847/
Association-between-Colonoscopy-Sedation-Type-and
Weight
loss drugs may increase
surgical complication risk
Popular weight-loss drugs could lead to
complications in surgical procedures,
according to a study published March 6
in JAMA Surgery.
The study focused on drugs known
as glucagon-like peptide-1 receptor agonists
(GLP-1 RAs) such as Ozempic.
The researchers determined that taking
GLP-1 RAs carried a 30% increased
likelihood of residual gastric content
compared to the control group. This
poses a significant risk factor for pulmonary
aspiration under anesthesia. However,
they emphasize that more data is
needed to determine whether patients
on these drugs are safe to undergo
surgery following existing fasting recommendations.
-https://jamanetwork.com/journals/
jamasurgery/article-abstract/2815663
Federal
regulations require
written consent for pelvic exams
Federal guidelines require obtaining written
informed consent before conducting
pelvic and other sensitive medical
examinations, according to an April 2
Associated Press report.
The new guidance from the US Department
of Health and Human Services
(HHS) focuses specifically on medical
students, nurse practitioners, and physician
assistants performing breast,
pelvic, prostate and rectal exams for
" educational and training purposes. "
According to AP, " Federal regulations
previously mentioned obtaining consent
for 'important tasks' related to surgeries,
and did not provide the level of
detail about medical students. "
Doctors and medical students sometimes
perform these exams for training
on patients under anesthesia, but
determining how often this happens
or whether patients understand forms
signed before surgery can be difficult,
AP reports. An HHS letter sent to teaching
hospitals and medical schools argues
for " clear guidelines " to ensure
providers and trainees " obtain and
document informed consent. " Consequences
for exams without consent include
ineligibility for Medicare and Medicaid
programs as well as fines and investigations
for violating patient privacy
laws.
-https://apnews.com/article/pelvicexams-consent-federal-governmenthhs-52331c180249daa1aa12c470
f8d70061
www.ormanager.com
https://jamanetwork.com/journals/jamasurgery/article-abstract/2815663 https://www.ormanager.com/subscribe-or-am https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00082-8/fulltext https://pubs.asahq.org/anesthesiology/article/140/6/1088/139847/Association-between-Colonoscopy-Sedation-Type-and https://apnews.com/article/pelvic-exams-consent-federal-government-hhs-52331c180249daa1aa12c470f8d70061 http://www.ormanager.com

orm_june-2024

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