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Autonomic nervous responses in colorectal polypectomy: Randomized controlled trial comparing air and carbon dioxide insufflation
Author(s) -
Murakami Kenji,
Kataoka Hiromi,
Hayano Junichiro,
Fukuta Hidekatsu,
Mori Yoshinori,
Nishiwaki Hirotaka,
Mizoshita Tsutomu,
Tanaka Mamoru,
Okamoto Yasuyuki,
Shimura Takaya,
Hirata Yoshikazu,
Mizushima Takashi,
Ebi Masahide,
Joh Takashi
Publication year - 2016
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12577
Subject(s) - medicine , insufflation , heart rate variability , autonomic nervous system , anesthesia , randomized controlled trial , heart rate , sympathetic nervous system , colonoscopy , polypectomy , abdominal pain , surgery , blood pressure , colorectal cancer , cancer
Background and Aim Carbon dioxide (CO 2 ) insufflation devices are commonly used for endoscopic examination and treatment. In this prospective randomized controlled trial (RCT), we compared patient acceptance, cardiovascular tolerance, and autonomic nervous responses between patients receiving air insufflation and CO 2 insufflation. Methods We initially enrolled 170 patients and, of these, 158 patients in total were analyzed (air group, 83; CO 2 group, 75). Autonomic nervous responses were evaluated by analysis of heart rate variability (HRV). Primary end point was superiority in the effects of CO 2 insufflation on the autonomic nervous system by HRV analysis. Results Visual analog scale disclosed significantly less abdominal pain and abdominal fullness with CO 2 . Percentage heart rate change rate at 1 h and 4 h after the procedure was also significantly lower in the CO 2 group than in the air group (1 h after: P < 0.01, 4 h after: P < 0.05). Comparison based on age showed that % heart rate change was significantly lower in the younger CO 2 patients (just after colonoscopy and 1 h after: P < 0.01, 4 h after: P < 0.05), but this difference was not apparent in an older group of patients. Conclusions This is the first RCT showing that colorectal polypectomy using CO 2 insufflation significantly decreases abdominal pain and abdominal fullness common in such patients with lowered stress to the autonomous nervous system. The effects using CO 2 insufflation on the sympathetic nervous system also seemed to be more prominent among younger patients.