Systematic review: The use of nitrous oxide gas for lower gastrointestinal endoscopy

Sophie Welchman (1) , Sean Cochrane (2) , Gary Minto (3) , Stephen Lewis (2)

1 Surgery
2 Gastroenterology
3 Anaesthesia

Background Nitrous oxide gas (N2O) has been proposed as an alternative to intravenous (iv) analgesia in patients undergoing lower gastrointestinal endoscopy. Aims We performed a systematic review of randomized studies where N2O had been compared against control in patients undergoing either flexible sigmoidoscopy or colonoscopy. Methods Electronic databases were searched; reference lists checked and letters sent to authors requesting data. Methodological quality was assessed. Data was tabulated on the duration and difficulty of the procedure, quality of sedation and speed of patient recovery. Results 11 studies were identified containing 623 patients. No differences were seen between groups for duration, difficulty of procedure or complications. Patient reported pain was similar for N2O when undergoing flexible sigmoidoscopy vs no sedation and when undergoing colonoscopy vs iv sedation. Differences in delivery of N2O were identified. In all studies N2O was associated with a more rapid recovery than iv sedation. Conclusion For patients undergoing colonoscopy N2O provides comparable analgesia to iv sedation. The rapid psychomotor recovery with N2O enables quicker patient discharge, and removes the need for a patient to be chaperoned. Benefit was not seen from N2O in patients undergoing flexible sigmoidoscopy possibly because it was delivered on demand rather than continuously.

Mots clés: Medicine

Sophie Welchman, Sean Cochrane, Gary Minto, Stephen Lewis. Systematic review: The use of nitrous oxide gas for lower gastrointestinal endoscopy. Alimentary Pharmacology and Therapeutics, 2010, 32 (3), pp.324. ⟨10.1111/j.1365-2036.2010.04359.x⟩. ⟨hal-00552574⟩