Analysis of a case series of anesthetic management of colonoscopies in middle-aged patients, Аналіз серії клінічних випадків анестезіологічного забезпечення колоноскопій у пацієнтів середнього віку

<jats:p>Background. According to data from the National Cancer Registry, colorectal cancer ranked fourth among men and women in Ukraine in terms of incidence in 2023. This pathology can be detected at early stages using colonoscopy. Pharmacological sedation during this type of examination ensures patient comfort, amnesia, increases the safety of the procedure, improves visualization of the colon, and increases the detection rate of neoplasms of the rectum and colon. At present, there is no single unified type of anesthesia to ensure the performance of this procedure. Objective: based on the analysis of international practices of pharmacological sedation during elective colonoscopies and the authors’ own clinical cases, to compare proposed anesthetic techniques in terms of analgesic efficacy, ventilation, hemodynamic changes, occurrence of complications, and satisfaction with the procedure in middle-aged patients. ­Materials and methods. An analysis of clinical cases of pharmacological procedural sedation during colonoscopy was conducted in middle-aged patients (45–60 years). They received anesthesia with different drug combinations (random allocation): group 1 (10 patients): propofol + fentanyl; group 2 (10 patients): midazolam + fentanyl. Components of the venous blood acid-base status, dyna­mics of glucose and lactate levels, and cardio-respiratory monitoring parameters at predefined time intervals were assessed, as well as the incidence of complications. Statistical analysis was performed using standard statistical methods. Results. The analysis of the authors’ own clinical cases revealed a lower depressive effect of a combination of midazolam and fentanyl on intraprocedural respiration, namely: a lesser impact on respiratory rate, fewer and shorter episodes of apnea, and better indicators of respiratory homeostasis. Changes in the acid-base status of the blood were also recorded, including a more rapid development of respiratory acidosis and its slower compensation in the post-procedural period. Conclusions. The results of the obtained clinical data and the reviewed literature substantiate the need for further scientific research aimed at optimizing the anesthetic ma­nagement protocol for this type of endoscopic procedures.</jats:p>