How to improve patient satisfaction during midazolam sedation for gastrointestinal endoscopy?

doi:10.3748/wjg.v23.i6.1098

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Feb 14, 2017; 23(6): 1098-1105
Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.1098

How to improve patient satisfaction during midazolam sedation for gastrointestinal endoscopy?

Eun Hyo Jin, Kyoung Sup Hong, Young Lee, Ji Yeon Seo, Ji Min Choi, Jaeyoung Chun, Sang Gyun Kim, Joo Sung Kim, Hyun Chae Jung

Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea

Kyoung Sup Hong, Jaeyoung Chun, Sang Gyun Kim, Joo Sung Kim, Hyun Chae Jung, Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 110-744, South Korea

Young Lee, Department of Biostatistics and Bioinformatics, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea

Author contributions: Hong KS was involved in making the conception or design of the work and revising it critically for important intellectual content; Jin EH drafted the manuscript and analyzed and interpreted the data; Lee Y was involved in statistical analysis; Seo JY, Choi JM and Chun J participated in data interpretation and collection; Kim SG, Kim JS and Jung HC revised the manuscript critically for important intellectual content; all authors read and approved the final manuscript.

Institutional review board statement: The study was reviewed and approved by the institutional review board of Seoul National University Hospital (IRB No. 1402-083-558).

Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.

Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.

Data sharing statement: There is no additional data available.

Correspondence to: Kyoung Sup Hong, MD, PhD, Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea. kshong1@snu.ac.kr

Telephone: +82-2-20720360 Fax: +82-2-7629662

Received: October 4, 2016
Peer-review started: October 11, 2016
First decision: November 9, 2016
Revised: November 24, 2016
Accepted: December 16, 2016
Article in press: December 19, 2016
Published online: February 14, 2017
Processing time: 131 Days and 3.7 Hours

Abstract

AIM

To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.

METHODS

We prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction.

RESULTS

The study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group.

CONCLUSION

Midazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.

Keywords: Conscious sedation; Patient satisfaction; Endoscopy; Midazolam; Surveys and questionnaires

Core tip: This was a prospective study of 456 patients that evaluated procedure-related factors with midazolam sedation satisfaction. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure duration. To improve patient satisfaction with sedation, active monitoring of sedation status by an endoscopist should be considered for patients whose procedures take a long time.