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Screening colonoscopy for colorectal cancer (CRC) is recommended in several countries, but uptake rates are often low. Fear of pain and also time-consuming costly sedation are barriers for colonoscopy, and thus development of colonoscopy equipment that decreases patient discomfort is worthwhile. This randomized controlled trial investigated the performance of an ultrathin colonoscope in CRC screening.Consecutive participants in a colonoscopy screening trial were randomized to examination with an ultrathin prototype colonoscope or a standard colonoscope. The main outcome measure was pain during the examination. Participants rated pain (no, slight, moderate, severe) using a validated questionnaire.From 187 enrolled participants (80 women [43 %]), 162 (87 %) responded to the questionnaire. The study groups were similar regarding baseline characteristics. Pain scores were significantly lower in the prototype instrument group compared with the standard group (78 % vs. 29 % of patients with no pain in prototype and standard groups, respectively; odds ratio [OR] 0.11; 95 % confidence interval [CI] 0.06 - 0.23; P0.001). Cecal intubation rate was 98 % in the prototype group and 92 % in the standard group (P = 0.085). Sedation was used in 2 % and 7 % in the prototype and standard groups respectively (P = 0.12). Adenoma detection rate was 13 % in the prototype group vs. 24 % in the standard group (P = 0.052).The new ultrathin Olympus colonoscope decreases patient pain during screening colonoscopy. This feature may improve uptake and patient satisfaction in screening colonoscopy. Further study is needed to evaluate the lower adenoma detection rate.

Background Colonoscopy is associated with pain and discomfort, and intravenous analgesics and sedatives are widely used. There are several disadvantages regarding this practice, including risk of complications, resources demanded, and amnesia after sedation. In spite of promising results in previous studies, nitrous oxide is rarely used at endoscopy centers around the world. Objective To investigate the efficiency of nitrous oxide versus placebo as an analgesic during colonoscopy without sedation. Design A double-blind, randomized, placebo-controlled trial. Setting The endoscopy unit at Oslo University Hospital Rikshospitalet, Oslo, Norway, between June 2006 and May 2008. Patients This study involved patients undergoing elective colonoscopy. Intervention Patients inhaled nitrous oxide or placebo on demand. Main Outcome Measurements The participants filled in a questionnaire regarding their experiences with the examination. Pain was graded from 1 (no pain) to 4 (severe pain). Results We recruited 199 patients. We randomized 97 patients to the nitrous oxide group and 102 to the control group. The groups were comparable regarding demographic factors. Median patient-reported pain was 2 in both the nitrous oxide group and the control group (interquartile range 2-3 in both groups). Additional sedatives and analgesics were given equally often and in similar doses in both groups. No side effects related to administration of nitrous oxide were reported. Limitations The questionnaire was returned by 76% of the patients. The study gas was given on demand, not continuously. Conclusion Nitrous oxide given intermittently is not an effective substitution for intravenous on-demand sedation and analgesics in the setting of colonoscopy without sedation. (Clinical trial registration number: NCT00318825.)

Therapeutic hypothermia is used primarily to limit the ischemic damage following cardiac arrest. The main goal for the treatment is the brain. Therapeutic hypothermia is resource demanding and is therefore done in intensive care units with strong competence in treatment and monitoring of critically ill patients. This review focuses mainly on physiological and pharmacological aspects of therapeutic hypothermia.A literature search was conducted using the PubMed database and the reference lists in relevant articles were searched manually.Biochemical changes during hypothermia lead to increased tolerance to ischemic episodes and can reduce post-ischemic reperfusion injury to the central nervous system. Knowledge of pharmacological changes during hypothermia is limited, and hypothermic patients are often given doses of drugs recommended for normothermic patients. Reduced enzyme activity during hypothermia, reduced perfusion of liver and kidney and reduced bile-production also contribute to slower elimination of drugs. For some drugs the distribution volume is altered. Consequently, the dosing of several drugs should be reduced during hypothermia. Knowledge about the influence of hypothermia on receptors is sparse. Little is also known about the effects of reheating, but one has to assume that the process will be reversed and that the dosing therefore has to be increased upon reheating. The need for additional studies of the pharmacology of therapeutic hypothermia is obvious.

We kindly refer to the paper by Schroy and colleagues on the “Your Disease Risk” (YDR) tool ([1][1]), which we have read with great interest. We appreciate the great work the authors have done to validate the YDR tool. Valid tools to stratify the general population with regard to their risk of