Su1676 INFLAMMATORY BOWEL DISEASE IS ASSOCIATED WITH INCREASED SEDATION AND ANALGESIA REQUIREMENTS DURING OUTPATIENT COLONOSCOPY

Colonoscopy plays a pivotal role in assessment of disease activity and dysplasia surveillance in patients with inflammatory bowel disease (IBD). Studies formally evaluating the anesthesia needs of IBD patients are limited. This study aimed to determine if IBD patients require increased sedation compared to non-IBD patients undergoing colonoscopy. We carried out a retrospective cohort study of outpatient colonoscopies for IBD and non-IBD patients performed at a tertiary referral center from 1/2016-12/2016. Procedure indications included disease activity assessment and dysplasia surveillance for IBD patients and colorectal cancer screening for non-IBD patients. Exclusion criteria included procedures assisted by fellows and inadequate bowel preparation. Variables of interest included psychiatric comorbidity, outpatient opioid use, total sedation requirement, and procedure time. 342 total colonoscopies were reviewed (105 IBD, 237 non-IBD). IBD patients were younger (mean age 38.3 ± 13.7 years) compared to non-IBD patients (mean age 58.8 ± 9.3 years). Monitored anesthesia care (MAC) was more often deemed necessary for IBD cases (69.5% vs. non-IBD 11.8%, p<0.0001). IBD patients were more likely to be taking outpatient opioids prior to colonoscopy (21.0% vs. non-IBD 8.0%, p=0.001); however, psychiatric medication usage was similar between the groups (IBD 27.6% vs. non-IBD 22.8%, p=0.34) (Image 1). Procedure time was longer for IBD patients (23.1 ± 9.8 minutes) than for non-IBD cases (17.2 ± 8.0 minutes, p<0.0001). Intravenous diphenhydramine was administered more frequently to IBD patients (9.5% vs. non-IBD 1.3%, p=0.0006). In cases using conscious sedation, total administered opioids (IBD 162.1 mcg vs. non-IBD 114.37 mcg fentanyl equivalents, p<0.0001) and midazolam (IBD 5.7 mg vs. non-IBD 4.3 mg, p<0.0001) were higher in IBD patients. For MAC cases, total propofol administered was not significantly higher in IBD cases (378.11 mg vs. non-IBD 321.97 mg, p=0.23), nor was the likelihood of receiving additional opioids (p=0.30) or sedatives (p=1.0) (Image 2). Crohn’s disease (CD) patients had an increased likelihood of requiring additional moderate to high dose fentanyl (≥ 50 mcg) during colonoscopy with MAC (CD 22.2% vs. non-IBD 3.6%, p=0.03). IBD patients require higher doses of conscious sedation agents, including greater intravenous diphenhydramine use, with longer procedure times compared to non-IBD patients undergoing colonoscopy. These needs may be partially attributable to increased outpatient opioid use, but they also may be due to increased procedure complexity in IBD patients, especially for CD patients. Providers must plan accordingly to optimize sedation and analgesia for IBD patients during colonoscopy. Given the higher sedation requirements, MAC may be more appropriate for IBD-indicated colonoscopies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)