Abstract

JIMENEZ-TREJOS, Gerardo; CON-CHIN, Gil Reynaldo  and  CON-CHIN, Vicky. Triple sinergia: un método eficaz de sedoanalgesia para colonoscopías. Acta méd. costarric [online]. 2002, vol.44, n.3, pp.121-125. ISSN 0001-6002.

Justification: With the development of the new technology in the radiological as well as in the endoscopic diagnosis field, a new type of patient has emerged and has become a challenge for the anesthesiologist. Endoscopic procedures are invasive, fast, and a little painful. This has made advances in sedation techniques very necessary. Objectives: The general objective of this study was to demonstrate that hypnotic sedation with the so called triple synergy (midazolam/fentanyl/propofol) is an effective, safe and efficient method for carrying out colosnoscopies. The specific objectives were: a) to determine the number of propofol boluses necessary to perform the procedure and b) to evaluate the complications associated with to the hypnotic sedation technique. Materials and methods: A consecutive cohort of 1500 patients, older than18 years of age that underwent colonoscopy at the Centro Endoscópico Internacional, San José, Costa Rica, was prospectively studied between 1998 and 2000. Hypnotic sedation with the technique of the triple synergy was applied (midazolam/fentanyl/propofol). Results: 57.8% were men and 42.4% were women. Most of the patients were ASA II (n = 725) category. A total of 208 patients (13.8%) who presented desaturation, were easily handled with the cervical hyperextension and supplementary oxygen. The sedation technique was pleasant for 94% of the patients. One percent presented nausea and vomiting. Ninety eight percent has amnesia of the procedure. Only 2% felt pain. Conclusions: Hypnotic sedation with the triple synergy technique is an effective and safe method to satisfy the needs of the endoscopist and the patient’s comfort during the colonoscopies. The cost is minimal and the side effects are relatively few. All this reduces the length of the procedure and the patients’ stay. Since desaturation is a relatively frequent effect, we recommend to use prophylactic oxygen with a nasal cannula to every patient and to monitor them with pulseoximeter and electrocardiograply, especially in those of the ASA III category.

Keywords : Sedación hipnótica; triple sinergia; colonoscopía.