Can Visual Distraction Decrease the Dose of Patient-Controlled Sedation Required During Colonoscopy? A Prospective Randomized Controlled Trial

Background and Study Aims: We previously demonstrated that audio distraction using relaxation music could lead to a decrease in the dose of sedative medication required and improve patient satisfaction during colonoscopy. This prospective randomized controlled trial was designed to test the hypotheses that visual distraction may also decrease the requirement for sedatives and that audio and visual distraction may have additive beneficial effects when used in combination.
Patients and Methods: 165 consecutive patients who underwent elective colonoscopy were randomly allocated into three groups to receive different modes of sedation: group 1 received visual distraction and patient-controlled sedation (PCS); group 2 received audiovisual distraction and PCS; group 3 received PCS alone. A mixture of propofol and alfentanil, delivered by a Graseby 3300 PCA pump, was used for PCS in these groups. Each bolus of PCS delivered 4.8 mg propofol and 12 µg alfentanil. Measured outcomes included the dose of PCS used, complications, recovery time, pain score, satisfaction score, and willingness to use the same mode of sedation if the procedure were to be repeated.

Results: Eight patients were excluded after randomization. The mean±SD dose of propofol used in group 2 (0.81 mg/kg ± 0.49) was significantly less than the dose used in group 1 (1.17 mg/kg ± 0.81) and that used in group 3 (1.18 mg/kg ± 0.60) (P < 0.01, one-way analysis of variance). The mean ± SD pain score was also lower in group 2 (5.1 ± 2.5), compared with the pain scores in group 1 (6.2 ± 2.2) and group 3 (7.0 ± 2.4) (P < 0.01, one-way analysis of variance). The mean ± SD satisfaction score was higher in groups 1 (8.2 ± 2.4)) and 2 (8.4 ± 2.4), compared with the score in group 3 (6.1 ± 2.9) (P < 0.01, one-way analysis of variance). A majority of patients in groups 1 (73 %) and 2 (85 %) said that they would be willing to use the same mode of sedation again, compared with only 53 % in group 3 (P < 0.01, chi-squared test).
Conclusions: Visual distraction alone did not decrease the dose of sedative medication required for colonoscopy. When audio distraction was added, both the dose of sedative medication required and the pain score decreased significantly. Both visual and audiovisual distraction might improve patients’ acceptance of colonoscopy.

References

• 1 Keeffe E B, O’Connor K W. 1989 ASGE survey of endoscopic sedation and monitoring practices.  Gastrointest Endosc. 1990;  36 S13-S18
• 2 Froehlich F, Gonvers J J, Fried M. Conscious sedation, clinically relevant complications and monitoring of endoscopy: results of a nationwide survey in Switzerland.  Endoscopy. 1994;  26 231-234
• 3 Holm C, Christensen M, Rasmussen V. et al . Hypoxaemia and myocardial ischaemia during colonoscopy.  Scand J Gastroenterol. 1998;  33 769-772
• 4 Arrowsmith J B, Gerstman B B, Fleischer D E, Benjamin S B. Results from the American Society for Gastrointestinal Endoscopy/US Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy.  Gastrointest Endosc. 1991;  37 421-427
• 5 Nelson D B, Barkun A N, Block K P. et al . Propofol use during gastrointestinal endoscopy.  Gastrointest Endosc. 2001;  53 876-879
• 6 Bell G D. Premedication, preparation, and surveillance.  Endoscopy. 2002;  34 2-12
• 7 Rex D K, Imperiale T F, Portish V. Patients willing to try colonoscopy without sedation: associated clinical factors and results of a randomized controlled trial.  Gastrointest Endosc. 1999;  49 554-559
• 8 Ristikankare M, Hartikainen J, Heikkinen M. et al . Is routinely given conscious sedation of benefit during colonoscopy?.  Gastrointest Endosc. 1999;  49 566-572
• 9 Zuccaro G Jr. Sedation and sedationless endoscopy.  Gastrointest Endosc Clin N Am. 2000;  10 1-20
• 10 Lee D W, Chan K W, Poon C M. et al . Relaxation music decreases the dose of patient-controlled sedation during colonoscopy: a prospective randomized controlled trial.  Gastrointest Endosc. 2002;  55 33-36
• 11 Seyrek S K, Corah N L, Pace L F. Comparison of three distraction techniques in reducing stress in dental patients.  J Am Dent Assoc. 1984;  108 327-329
• 12 Johnson M H, Petrie S M. The effects of distraction on exercise and cold pressor tolerance for chronic low back pain sufferers.  Pain. 1997;  69 43-48
• 13 Hoffman H G, Patterson D R, Carrougher G J. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study.  Clin J Pain. 2000;  16 244-250
• 14 Bensten B, Svensson P, Wenzel A. Evaluation of effect of 3D video glasses on perceived pain and unpleasantness induced by restorative dental treatment.  Eur J Pain. 2001;  5 373-378
• 15 Hoffman H G, Patterson D R, Carrougher G J, Sharar S R. Effectiveness of virtual reality-based pain control with multiple treatments.  Clin J Pain. 2001;  17 229-235
• 16 Sander Wint S, Eshelman D, Steele J, Guzzetta C E. Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer.  Oncol Nurs Forum. 2002;  29 E8-E15
• 17 Lembo T, Fitzgerald L, Matin K. et al . Audio and visual stimulation reduces patient discomfort during screening flexible sigmoidoscopy.  Am J Gastroenterol. 1998;  93 1113-1116
• 18 Bampton B, Draper B. Effect of relaxation music on patient tolerance of gastrointestinal endoscopic procedures.  J Clin Gastroenterol. 1997;  25 343-345
• 19 Palakanis K C, DeNobile J W, Sweeney W B, Blankenship C L. Effect of music therapy on state anxiety in patients undergoing flexible sigmoidoscopy.  Dis Colon Rectum. 1994;  37 478-481
• 20 Chlan L, Evans D, Greenleaf M, Walker J. Effects of a single music therapy intervention on anxiety, discomfort, satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy.  Gastroenterol Nurs. 2000;  23 148-156
• 21 Roseveare C, Seavell C, Patel P. et al . Patient-controlled sedation and analgesia, using propofol and alfentanil, during colonoscopy: a prospective randomized controlled trial.  Endoscopy. 1998;  30 768-773
• 22 Knight W E, Rickard N S. Relaxing music prevents stress-induced increases in subjective anxiety, systolic blood pressure, and heart rate in healthy males and females.  J Music Ther. 2001;  38 254-272