scholarly journals Comparison of colon-cleansing methods in preparation for colonoscopy - Comparative efficacy of solutions of mannitol, sodium picosulfate and monobasic and dibasic sodium phosphates

2008 ◽  
Vol 23 (suppl 1) ◽  
pp. 108-111 ◽  
Author(s):  
Paulo Miki Jr ◽  
Carlos Renato dos Reis Lemos ◽  
Pedro Popoutchi ◽  
Ricardo Luiz dos Santos Garcia ◽  
José Joaquim Ribeiro da Rocha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Pulse Rate ◽  
Bowel Preparation ◽  
Sodium Phosphate ◽  
Clinical Signs ◽  
Phosphate Solution ◽  
Clinical Effects ◽  
Colon Cleansing ◽  
Sodium Picosulphate

PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10% manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10% manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10% manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.

scholarly journals Bowel preparation for colonoscopy: comparison of mannitol and sodium phosphate. Results of a prospective randomized study

1999 ◽  
Vol 54 (6) ◽  
pp. 187-192 ◽  
Author(s):  
Angelita Habr-Gama ◽  
Robert William de Azevedo Bringel ◽  
Sergio Carlos Nahas ◽  
Sergio Eduardo de Alonso Araújo ◽  
Afonso Henrique de Souza Junior ◽  
...  
Keyword(s):  
Side Effects ◽  
Bowel Preparation ◽  
Sodium Phosphate ◽  
Clinical Symptoms ◽  
Randomized Study ◽  
Phosphate Solution ◽  
Phosphate Ions ◽  
Before And After ◽  
Sodium Phosphate Solution

METHOD: Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750 ml of 10% mannitol (Group M) or 180 ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS: Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85% prepared with sodium phosphate versus 82.5% for mannitol (p=0.37). CONCLUSIONS: Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure.

scholarly journals Dexmedetomidine as an Adjunctive Analgesic with Bupivacaine in Paravertebral Analgesia for Breast Cancer Surgery

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. E589-E598 ◽  
Author(s):  
Sahar A. Mohamed
Keyword(s):  
Breast Cancer ◽  
Blood Pressure ◽  
Side Effects ◽  
Pulse Rate ◽  
Radical Mastectomy ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Postanesthesia Care Unit ◽  
Modified Radical Mastectomy ◽  
Group B

Background: There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia. The addition of adjunctive analgesics, such as fentanyl and clonidine, to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades, and decrease the dose of local anesthetic and supplemental analgesia. Objectives: Investigation of the safety and the analgesic efficacy of adding 1 µg/kg dexmedetomidine to bupivacaine 0.25% in thoracic paravertebral blocks (PVB) in patients undergoing modified radical mastectomy. Study Design: A randomized, double-blind trial. Setting: Academic medical center. Methods: Sixty American Society of Anesthesiologists physical status –I – III patients were randomly assigned to receive thoracicPVB with either 20 mL of bupivacaine 0.25% (Group B, n = 30), or 20 mL of bupivacaine 0.25% + 1 µg/kg dexmedetomidine (Group BD, n= 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 48 hours. Results: There was a significant reduction in pulse rate and diastolic blood pressure starting at 30 minutes in both groups, but more evidenced in group BD (P < 0.001). Intraoperative Systolic blood pressure showed a significant reduction at 30 minutes in both groups (P < 0.001) then returned to baseline level at 120 minutes in both groups. There was a significant increase in pulse rate starting 2 hours postoperative until 48 hours postoperatively in group B but only after 12 hours until 48 hours in group BD (P < 0.001). The time of the first rescue analgesic requirement was significantly prolonged in the group BD (8.16 ± 42 hours) in comparison to group B (6.48 ± 5.24 hours) (P = 0.04). The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst 48 hours postoperatively was significantly decreased in group BD (150.19 ± 76.98 mg) compared to group B (194.44 ± 63.91 mg) (P = 0.03). No significant serious adverse effects were recorded during the study. Limitations: This study is limited by its sample size. Conclusion: The addition of dexmedetomidine 1 µg/kg to bupivacaine 0.25% in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects. Key words: Dexmedetomidine, paravertebral block, postoperative analgesia, breast cancer surgery

scholarly journals Colon Cleansing before Colonoscopy: Does Oral Sodium Phosphate Solution Still Make Sense?

2009 ◽  
Vol 23 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Douglas K Rex ◽  
Stephen J Vanner
Keyword(s):  
Sodium Phosphate ◽  
The United States ◽  
Phosphate Solution ◽  
Over The Counter ◽  
Colon Cleansing ◽  
Sodium Phosphate Solution ◽  
Oral Sodium Phosphate ◽  
Colonoscopy Preparation ◽  
Oral Sodium ◽  
Oral Sodium Phosphate Solution

Oral sodium phosphate (NaP) solution has been withdrawn from the market in the United States but remains available for over-the-counter purchase for bowel preparation for colonoscopy in Canada. The present review summarizes recent data regarding the renal toxicity of oral NaP as well as its efficacy and tolerability relative to other preparations. Given the availability of effective alternatives to NaP solution, its use for colonoscopy preparation in Canada should be limited. Candidate patients for oral NaP solution should be assessed for eligibility and preparation instructions should adhere to the current recommendations for maximizing the safety of oral NaP.

scholarly journals Bowel Preparation for Colonoscopy with Sodium Phosphate Solution versus Polyethylene Glycol-Based Lavage: A Multicenter Trial

2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
Author(s):  
S. Schanz ◽  
W. Kruis ◽  
O. Mickisch ◽  
B. Küppers ◽  
P. Berg ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Adverse Events ◽  
Bowel Preparation ◽  
Sodium Phosphate ◽  
Vital Signs ◽  
Multicenter Trial ◽  
Phosphate Solution ◽  
Blinded Study ◽  
Sodium Phosphate Solution ◽  
Oral Sodium Phosphate

Background: Adequate bowel preparation is essential for accurate colonoscopy. Both oral sodium phosphate (NaP) and polyethylene glycol-based lavage (PEG-ELS) are used predominantly as bowel cleansing modalities. NaP has gained popularity due to low drinking volume and lower costs. The purpose of this randomized multicenter observer blinded study was to compare three groups of cleansing (NaP, NaP + sennosides, PEG-ELS + sennosides) in reference to tolerability, acceptance, and cleanliness. Patient and Methods: 355 outpatients between 18 and 75 years were randomized into three groups (A, B, C) receiving NaP = A, NaP, and sennosides = B or PEG-ELS and sennosides = C. Gastroenterologists performing colonoscopies were blinded to the type of preparation. All patients documented tolerance and adverse events. Vital signs, premedication, completeness, discomfort, and complications were recorded. A quality score (0–4) of cleanliness was generated. Results: The three groups were similar with regard to age, sex, BMI, indication for colonoscopy, and comorbidity. Drinking volumes (L) (A = 4.33 + 1.2, B = 4.56 + 1.18, C = 4.93 + 1.71) were in favor of NaP (P = .005). Discomfort from ingested fluid was recorded in A = 39.8% (versus C: P = .015), B = 46.6% (versus C: P = .147), and C = 54.6%. Differences in tolerability and acceptance between the three groups were statistically not significant. No differences in adverse events and the cleanliness effects occurred in the three groups (P = .113). The cleanliness quality scores 0–2 were calculated in A: 77.7%, B: 86.7%, and C: 85.2%. Conclusions: These data fail to demonstrate significant differences in tolerability, acceptance, and preparation quality between the three types of bowel preparation for colonoscopy. Cleansing with NaP was not superior to PEG-ELS.

scholarly journals Timing and Frequency of Bowel Activity in Patients Ingesting Sodium Picosulphate/Magnesium Citrate and Adjuvant Bisacodyl for Colon Cleansing Before Colonoscopy

2011 ◽  
Vol 25 (12) ◽  
pp. 663-666 ◽  
Author(s):  
Stephen Vanner ◽  
Lawrence C Hookey
Keyword(s):  
Bowel Preparation ◽  
Bowel Movement ◽  
Magnesium Citrate ◽  
Split Dose ◽  
Colon Cleansing ◽  
Sodium Picosulphate ◽  
Bowel Cleansing ◽  
Bowel Movements ◽  
Bowel Movement Frequency ◽  
The Mean

BACKGROUND: Despite the wealth of research investigating bowel cleansing efficacy, there are very little data on the timing or frequency of bowel movements after each agent is ingested.OBJECTIVE: To examine the effect of each component of a three-day combined sodium picosulphate/magnesium citrate (PSLX) and bisacodyl regimen on the timing and frequency of bowel activity in patients undergoing colonoscopy.METHODS: Outpatients booked for colonoscopy were asked to complete a diary of their bowel preparation that tracked the timing of bowel movements. Bowel preparation quality was assessed using the Ottawa Bowel Preparation Scale. Bowel activity was compared with baseline and correlated with colon cleansing. Subgroup analysis was performed examining the effect of timing of the procedure and split-dose regimens.RESULTS: One hundred patients undergoing colon cleansing received bisacodyl 10 mg at 17:00 three days and two days before the day of colonoscopy. In one group, both sachets of PSLX were given the night before colonoscopy, while the second group, whose colonoscopies were scheduled after 11:00, ingested one sachet the night before and the second sachet at 06:00 on the day of colonoscopy. Patients had a mean of 1.7 bowel movements per day in the seven days before starting the cleansing regimen. Both doses of bisacodyl tablets resulted in a significant increase in the mean number of bowel movements compared with baseline (3.3/day first dose; 3.8/day second dose [P=0.03 and 0.001, respectively]). Each dose of PSLX also resulted in a significant increase in bowel movement frequency compared with baseline, with means of 4.4, 6.3 and 4.5 bowel movements after each dose. The mean time to the final bowel movement following the second sachet of PSLX was 8.9 h when taken the night before, and 3.9 h when taken the morning of the procedure. Bowel preparation quality significantly correlated with bowel frequency when total bowel movements were considered and when only the effects of bisacodyl were accounted for (P<0.01 for each).DISCUSSION: These data demonstrate that the addition of bisacodyl before PSLX ingestion has a significant additive effect on bowel frequency and correlates with bowel cleansing quality. The timing of the resulting bowel movements have practical implications for sleep and travel times to endoscopy suites.

scholarly journals Randomized Controlled Trial of Polyethylene Glycol versus Oral Sodium Phosphate for Bowel Preparation in Unsedated Colonoscopy

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Dong Yang ◽  
Ke Tao ◽  
Geng Chen ◽  
Luping Zhang ◽  
Qingying He ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Bowel Preparation ◽  
Sodium Phosphate ◽  
Controlled Trial ◽  
Insertion Time ◽  
Phosphate Solution ◽  
Cleaning Efficiency ◽  
Significant Difference ◽  
Oral Sodium Phosphate ◽  
Oral Sodium

Aim. To identify the most effective laxative for bowel preparation in unsedated colonoscopy. Methods. Between April 2019 and April 2020, a total of 586 outpatients scheduled for unsedated colonoscopy at the First Hospital of Jilin University (Changchun, China) were randomized into one of two groups, namely, the polyethylene glycol (PEG) group or the oral sodium phosphate solution (OSP) group. The cleaning efficiency and other relevant clinical parameters were compared between the two groups. Results. Each group consisted of 293 patients. There were no significant differences in gender, body mass index, and history of abdominal surgery between the two groups. There were more cases of laxative intolerance in the PEG group than in the OSP group (7.5% vs. 0.7%, P<0.05). After tube insertion, we found that the cleaning efficiency of OSP was better than that of PEG (P<0.05). After cleaning, there was no significant difference in bowel cleanliness between the two groups (P>0.05). The colonoscopic insertion time of the PEG group was significantly shorter than that of the OSP group (10.0 vs. 12.0 min, P=0.002), and colonoscopic insertion was more difficult in the OSP group than in the PEG group (P=0.036). The VAS score of the PEG group patients was significantly lower than that of OSP group patients (4.0±1.3 vs. 5.2±1.7, P≤0.001). There were no significant differences in the cecal intubation rate and the detection rate of polyps and ulcers/erosion between the two groups. Conclusion. The cleaning efficiency and tolerability of OSP were preferable to those of PEG, but there was no significant difference in bowel cleanliness after washing the colon and suctioning the fluid. Compared with patients of the OSP group, those of the PEG group required a shorter colonoscopic insertion time and reported a more comfortable experience. Therefore, for cases that are tolerant of PEG, PEG is a better choice for unsedated colonoscopy.

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