The effect of pre-endoscopy anxiety level on tolerance of the procedure and the amount of sedative drug dose

Yıl 2011, , 47 - 51, 01.08.2011

Hakan Ümit Ünal Murat Korkmaz Gamze Özüçürümez Seniz Sarıtaş Haldun Selçuk Hülya Gönen Uğur Yılmaz

https://doi.org/10.17940/endoskopi.74859

Öz

Background and Aims: Upper gastrointestinal endoscopy produces moderate levels of anxiety. High levels of anxiety may affect tolerability of the procedure and may increase both endoscopy- and sedation-related complications. We aimed to investigate the effect of anxiety level on tolerance of the endoscopy procedure and the amount of sedative drug doses. We also investigated the possible patient characteristics that affect the level of pre-procedural anxiety and tolerance of the endoscopy procedure. Materials and Methods: All endoscopies were performed under sedoanalgesia. Patients who referred to our endoscopy unit for upper upper gastrointestinal endoscopy and were older than 18 years were enrolled into the study. Patients' anxiety level was assessed by Beck anxiety scale before the endoscopy. Results: Two hundred and thirty-three patients (153 females) who fulfilled the inclusion criteria were enrolled in the study. The median age was 45 years. Thirteen patients had a high degree of anxiety before the endoscopy and tolerance was poor in 60 patients. No statistically significant difference was determined between the tolerance groups with regard to mean anxiety scores. Conclusions: We found that pre-endoscopy anxiety level does not affect patient tolerance of the procedure. The poor tolerance group was younger than the other tolerance groups and females had higher pre-procedural anxiety than males.

Anahtar Kelimeler

Endoscopy, anxiety, tolerance, sedation

Endoskopi öncesi anksiyete derecesinin hasta toleransı ve sedatif dozu üzerine etkisi

Öz

Giriş ve Amaç: Üst gastrointestinal system endoskopisi hastalarda orta düzeyde anksiyete gelişimine neden olamaktadır. Ankiyete düzeyinin yüksek olması hastanın işleme toleransını etkileyebilmekte ve bunun sonucu olarak endoskopi işlemi ve sedasyona bağlı komplikasyon riskini arttırabilmektedir. Bizim amacımız, anksiyete derecesinin hasta toleransı ve uygulanan sedatif dozuna etkisini araştırmaktı. Aynı zamanda, endoskopi işlemi öncesi anksiyete derecesi ve işlem toleransını etkileyen hastaya ait faktörleri de değerlendirdik. Gereç ve Yöntem: Üst gastrointestinal sistem endoskopisi yapılmak üzere refere edilen 18 yaş üstü hastalar çalışmaya alındı. Endoskopi işlemi anksiyete derecesi Beck anksiyete ölçeği ile değerlendirildi. Bulgular: Toplam 233 hasta çalışmaya alındı. Hastaların 153'ü kadın olup ortalama yaş 45 idi. Otuz hastada endoskopi öncesi yüksek anksiyete düzeyleri saptanırken, 60 hastanın işlem toleransı kötü idi. Tolerans gruplarının anksiyete skorları arasındaki fark istatistiksel olarak anlamlı değil idi. Sonuç: Bizim bulgularımıza göre endoskopi öncesi anksiyete derecesi işleme tolerans düzeyini etkilememektedir. ‹şlemi kötü tolere eden grup yaş ortalaması diğer gruplara göre daha düşük olup, işlem öncesi anksiyete düzeyi kadınlarda erkeklere göre daha yüksektir.

Anahtar Kelimeler

Endoskopi, anksiyete, tolerans, sedasyon

Kaynakça

• Brandt LJ. Patients' attitudes and apprehensions about endoscopy: how to calm troubled waters. Am J Gastroenterol 2001; 96: 280-4.
• Campo R, Brullet E, Montserrat A, et al. Identification of factors that inf- luence tolerance of upper gastrointestinal endoscopy. Eur J Gastroente- rol Hepatol 1999; 11: 201-4.
• Dominitz JA, Provenzale D. Patient preferences and quality of life asso- ciated with colorectal cancer screening. Am J Gastroenterol 1997; 92: 2171-8.
• Gattuso SM, Litt MD, Fitzgerald TE. Coping with gastrointestinal endos- copy: self-efficacy enhancement and coping style. J Consult Clin Psychol 1992; 60: 133-9.
• Freeman ML. Sedation and monitoring for gastrointestinal endoscopy. Gastrointest Endosc Clin N Am 1994; 4: 475-99.
• Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991; 37: 421-7.
• Holm C, Rosenberg J. Pulse oximetry and supplemental oxygen during gastrointestinal endoscopy: a critical review. Endoscopy 1996; 28: 703- 11.
• Quine MA, Bell GD, McCloy RF, Charlton JE, Devlin HB, Hopkins A. Prospective audit of upper gastrointestinal endoscopy in two regions of England: safety, staffing, and sedation methods. Gut 1995; 36: 462-7.
• Practice guidelines for sedation and analgesia by non-anesthesiologists. An updated report by the American Society of Anesthesiologists Task Force on sedation and analgesia by non-anesthesiologists. Anesthesio- logy 2002; 96: 1004–17.
• Spielberger CD. The effects of manifest anxiety on the academic achieve- ment of college students. Ment Hyg 1962; 46: 420-6.
• Vargo JJ, Zuccaro G Jr, Dumot JA, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endos- copy: a prospective, randomized trial. Gastroenterology 2002; 123: 8- 16.
• Brody DS. Physician recognition of behavioral, psychological, and social aspects of medical care. Arch Intern Med 1980; 140: 1286-9.
• Maguire GP, Julier DL, Hawton KE, Bancroft JH. Psychiatric morbidity and referral on two general medical wards. Br Med J 1974; 1: 268-70.
• Bell GD. Review article: premedication and intravenous sedation for up- per gastrointestinal endoscopy. Aliment Pharmacol Ther 1990; 4: 103- 22.
• Lauven PM. Pharmacology of drugs for conscious sedation. Scand J Gas- troenterol Suppl 1990; 179: 1-6.
• Lee SY, Son HJ, Lee JM, et al. Identification of factors that influence cons- cious sedation in gastrointestinal endoscopy. J Korean Med Sci 2004; 19: 536-40.
• Levy N, Landmann L, Stermer E, Erdreich M, Beny A, Meisels R. Does a detailed explanation prior to gastroscopy reduce the patient's anxiety? Endoscopy 1989; 21: 263-5.
• Pereira SP, Hussaini SH, Wilkinson ML. Conscious sedation for gastros- copy. Gastroenterology 1995; 109: 1405-6.
• Mahajan RJ, Johnson JC, Marshall JB. Predictors of patient cooperation during gastrointestinal endoscopy. J Clin Gastroenterol 1997; 24: 220- 3.
• Shapira M, Tamir A. Presence of family member during upper endos- copy. What do patients and escorts think? J Clin Gastroenterol 1996; 22: 272-4.
• Woloshynowych M, Oakley DA, Saunders BP, Williams CB. Psychologi- cal aspects of gastrointestinal endoscopy: a review. Endoscopy 1996; 28: 763-7.
• Drossman DA, Brandt LJ, Sears C, Li Z, Nat J, Bozymski EM. A prelimi- nary study of patients' concerns related to GI endoscopy. Am J Gastro- enterol 1996; 91: 287-91.