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Mariotti AL, Pattee J, Edmundowicz SA, Hardesty TD, Sharma SM, Lemley MG, Rist SD, Weitzel N, Faruki AA. Operational outcomes of propofol sedation versus fentanyl, midazolam and diphenhydramine sedation for endoscopies and colonoscopies at an academic medical center. PLoS One 2023; 18:e0294418. [PMID: 38011117 PMCID: PMC10681235 DOI: 10.1371/journal.pone.0294418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND On July 1st, 2021, the University of Colorado Hospital (UCH) implemented new sedation protocols in the luminal gastrointestinal (GI) suite. GI proceduralist supervised, Nurse Administered Sedation with fentanyl, midazolam, and diphenhydramine (NAS) sedation was transitioned to Monitored Anesthesia Care with propofol under physician anesthesiologist supervision (MAC). OBJECTIVE To determine if there are statistically significant reductions in Sedation-Start to Scope-In time (SSSI) when using Monitored Anesthesia Care with propofol (MAC) versus Nurse Administered Sedation with fentanyl, midazolam, and diphenhydramine (NAS). Secondary objectives were to determine if statistically significant improvements to other operational times, quality measures, and satisfaction metrics were present. METHOD This study was a retrospective analysis of a natural experiment resultant of a change from NAS to MAC sedation protocols. Outcomes for NAS protocols from 1/1/21-6/30/21 were compared to outcomes of MAC protocols from the dates 8/1/21-10/31/21. Results were analyzed using Quasi-Poisson regression analysis and stratified based on upper GI, lower GI, and combined procedures. Patient demographic data including age, biological sex, comorbidities, and BMI, were adjusted for in the analysis. ASA matching was not performed as nursing sedation does not use ASA classifications. Pre-anesthesia co-morbidities were assessed via evaluation of a strict set of comorbidities abstracted from the electronic medical record. Perioperative operational outcomes include Sedation Start to Scope-In (SSSI), In-Room to Scope-In Time (IRSI), Scope Out to Out of Room (SOOR), Total Case Length (TCL), and Post Anesthesia Care Unit Length of Stay (PACU LOS). Quality outcomes include PACU Administered Medications (PAM), and Clinician Satisfaction Scores (CSS). RESULTS A total of 5,582 gastrointestinal (GI) endoscopic cases (upper, lower, and combined endoscopies) were observed. Statistically significant decreases in SSSI of 2.5, 2.1, and 2.2 minutes for upper, lower, and dual GI procedures were observed when using MAC protocols. A statistically significant increase in satisfaction scores of 47.0 and 19.6 points were observed for nurses and proceduralists, respectively, when using MAC. CONCLUSION MAC protocols for endoscopic GI procedures at UCH led to statistically significant decreases in the time required to complete procedures thus increasing operational efficiency.
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Affiliation(s)
- Andrew L. Mariotti
- School of Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - Jack Pattee
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, United States of America
| | - Steven A. Edmundowicz
- Department of Gastroenterology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | | | - Savita M. Sharma
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - M. G. Lemley
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Scott D. Rist
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Nathaen Weitzel
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Adeel A. Faruki
- Department of Anesthesiology, MD Anderson Cancer Center, Houston, Texas, United States of America
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Shao LJZ, Hong FX, Liu FK, Wan L, Xue FS. Prospective, randomized comparison of two supplemental oxygen methods during gastro scopy with propofol mono-sedation in obese patients. World J Clin Cases 2021; 9:5479-5489. [PMID: 34307602 PMCID: PMC8281412 DOI: 10.12998/wjcc.v9.i20.5479] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypoxemia is a common complication in obese patients during gastroscopy with sedation. The Wei nasal jet tube (WNJT) is a new special nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channels. The aim of this study was to compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese patients.
AIM To compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese patients.
METHODS A total of 103 obese patients with a body mass index of 30 kg/m2 or more undergoing elective gastroscopy under propofol mono-sedation were randomly assigned to receive supplemental oxygen at 5 L/min through either a WNJT (WNJT group, n = 51) or a nasal cannula (nasal cannula group, n = 52). The lowest pulse oxygen saturation (SpO2) and mild and severe hypoxemia during gastroscopy were recorded. The primary outcome was the incidence of hypoxemia.
RESULTS The lowest SpO2 during gastroscopy with propofol mono-sedation was significantly increased in the WNJT group compared with the nasal cannula group. The incidence of mild hypoxemia and total incidence of hypoxemia were significantly lower in the WNJT group than in the nasal cannula group. Other than a higher incidence of epistaxis in the WNJT group, the occurrence of adverse events was similar between the devices. While neither device demonstrated a statistically significant difference in satisfaction among patients, the WNJT did result in improved satisfaction among anesthetists and physicians.
CONCLUSION During gastroscopy with propofol mono-sedation in obese patients, the WNJT, when compared with a nasal cannula for supplemental oxygen, can significantly reduce the occurrence of hypoxemia and improve both arterial oxygenation and satisfaction among anesthetists and physicians. The use of the WNJT may, however, lead to epistaxis in a few patients. In view of this clinically acceptable risk-benefit ratio, the WNJT may be recommended as an alternative tool for supplemental oxygen for the prevention of hypoxemia during gastroscopy with propofol mono-sedation in obese patients.
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Affiliation(s)
- Liu-Jia-Zi Shao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Fang-Xiao Hong
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Fu-Kun Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lei Wan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Shao LJZ, Zou Y, Liu FK, Wan L, Liu SH, Hong FX, Xue FS. Comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in patients with a normal body mass index. World J Gastroenterol 2020; 26:6867-6879. [PMID: 33268967 PMCID: PMC7684457 DOI: 10.3748/wjg.v26.i43.6867] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/10/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypoxemia due to respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common concern. The Wei nasal jet tube (WNJT) is a new nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channel. The available evidence indicates that with a low oxygen flow, compared with nasal cannula, the WNJT does not decrease the occurrence of hypoxemia during upper gastrointestinal endoscopy with propofol sedation. To date, there has been no study assessing the performance of WNJT for supplemental oxygen during upper gastrointestinal endoscopy with sedation when a moderate oxygen flow is used.
AIM To determine whether the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided in patients with a normal body mass index.
METHODS This study was performed in 291 patients undergoing elective gastroscopy with propofol mono-sedation. Patients were randomized into one of two groups to receive either the WNJT (WNJT group, n = 147) or the nasal cannula (nasal cannula group, n = 144) for supplemental oxygen at a 5-L/min flow during gastroscopy. The lowest SpO2 during gastroscopy was recorded. The primary endpoint was the incidence of hypoxemia or severe hypoxemia during gastroscopy.
RESULTS The total incidence of hypoxemia and severe hypoxemia during gastroscopy was significantly decreased in the WNJT group compared with the nasal cannula group (P = 0.000). The lowest median SpO2 during gastroscopy was significantly higher (98%; interquartile range, 97-99) in the WNJT group than in the nasal cannula group (96%; interquartile range, 93-98). Epistaxis by device insertion in the WNJT group occurred in 7 patients but stopped naturally without any treatment. The two groups were comparable in terms of the satisfaction of physicians, anesthetists and patients.
CONCLUSION With a moderate oxygen flow, the WNJT is more effective for the prevention of hypoxemia during gastroscopy with propofol mono-sedation compared with nasal prongs, but causing slight epistaxis in a few patients.
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Affiliation(s)
- Liu-Jia-Zi Shao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yi Zou
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Fu-Kun Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lei Wan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Shao-Hua Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Fang-Xiao Hong
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Protopapas AA, Stournaras E, Neokosmidis G, Stogiannou D, Filippidis A, Protopapas AN. Endoscopic sedation practices of Greek gastroenterologists: a nationwide survey. Ann Gastroenterol 2020; 33:366-373. [PMID: 32624656 PMCID: PMC7315718 DOI: 10.20524/aog.2020.0494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Sedation in gastrointestinal endoscopy is rapidly evolving worldwide. However, this has led to significant disagreements, especially regarding the use of propofol by non-anesthesiologists. The aim of this study was to document the practices of Greek gastroenterologists regarding sedation and compare them to previous surveys. Methods: The study was conducted in 2 periods, December 2015 and June 2018. In each period, the same online questionnaire regarding endoscopic sedation practices was sent to all registered Greek gastroenterologists (509 and 547 gastroenterologists, respectively). Results: The response rates were 38.3% and 47.1%, respectively. In each period, 25.1% and 16.7% of physicians did not use sedation. Most gastroenterologists (approx. 70% in both instances) answered that they “almost never” collaborate with an anesthesiologist during endoscopy. Midazolam was by far the most popular sedation agent, used by almost 90% of physicians in both periods. Propofol was used by 30.8% and 27% of physicians, respectively. Physicians using propofol were significantly more satisfied with the sedation than other physicians, while propofol was the agent selected by most physicians if they were to undergo endoscopy themselves. Most physicians cited medicolegal reasons and inadequate training as chief reasons for not using propofol. Conclusions: Sedation use is widespread among Greek gastroenterologists. Although midazolam is the most commonly used agent, propofol is preferred (theoretically) by most physicians and achieves the best satisfaction. The introduction of a strict training curriculum for endoscopic sedation can effectively eliminate the barriers preventing gastroenterologists from administering propofol, while at the same time ensuring optimal patient safety during endoscopy.
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Affiliation(s)
- Adonis A Protopapas
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
| | - Evangelos Stournaras
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas).,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom (Evangelos Stournaras)
| | - Georgios Neokosmidis
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
| | - Dimitrios Stogiannou
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
| | - Athanasios Filippidis
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
| | - Andreas N Protopapas
- First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Adonis A. Protopapas, Evangelos Stournaras, Georgios Neokosmidis, Dimitrios Stogiannou, Athanasios Filippidis, Andreas N. Protopapas)
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Romagnoli S, Fanelli F, Barbani F, Uberoi R, Esteban E, Lee MJ, Nielsen PT, Mahnken AH, Morgan R. CIRSE Standards of Practice on Analgesia and Sedation for Interventional Radiology in Adults. Cardiovasc Intervent Radiol 2020; 43:1251-1260. [PMID: 32556610 DOI: 10.1007/s00270-020-02536-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/25/2020] [Indexed: 11/24/2022]
Abstract
This CIRSE Standards of Practice document provides best practices for the safe administration of procedural sedation and analgesia for interventional radiology procedures in adults. The document is aimed at health professionals involved in the provision of sedation and analgesia during interventional radiology procedures. The document has been developed by a writing group consisting of physicians with internationally recognised expertise in interventional radiology, and analgesia and sedation.
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Affiliation(s)
- Stefano Romagnoli
- Health Science Department, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Fabrizio Fanelli
- Vascular and Interventional Radiology Department, "Careggi" University Hospital, Florence, Italy.
| | - Francesco Barbani
- Department of Anesthesia and Critical Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Raman Uberoi
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Enrique Esteban
- Vascular and Interventional Radiology Department, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont, Ireland
| | - Peter Thomas Nielsen
- Department of Anaesthesia and Critical Care, Hull and East Yorkshire Hospitals NHS Trust, Kingston Upon Hull, UK
| | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany
| | - Robert Morgan
- Department of Interventional Radiology, St George's University of London, London, UK
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Naseri-Salahshour V, Taher M, Karimy M, Abedi A, Fayazi N, Sajadi M, Abredari H. The effect of presence of family members on the anxiety level of candidates for esophagogastroduodenoscopy: A randomized controlled trial. Med J Islam Repub Iran 2019; 33:62. [PMID: 31456986 PMCID: PMC6708088 DOI: 10.34171/mjiri.33.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Anxiety and its control is a public health problem worldwide. This study was conducted to determine the effect of family members' presence on the anxiety level of patients who were candidates for esophagogastroduodenoscopy (EGD). Methods: This randomized controlled trial study was performed in Shahid Chamran hospital in city of Saveh in IR Iran. In this study, 96 patients who were candidates for EGD and met the inclusion criteria were assigned into control and intervention groups by simple random sampling method. The demographic questionnaire and Spiel Berger's State and Trait Anxiety Questionnaire (STAI) were used to measure anxiety. Results: No significant difference was found between the 2 groups in the mean level of anxiety before intervention (p= 0.13). After intervention, the level of anxiety decreased significantly in the intervention group (p= 0.001). However, the mean level of anxiety was not significant in the control group after intervention (p= 0.09). Conclusion: The results of the present study showed that the presence of family members during endoscopy may reduce the patient's anxiety level, and thus it is recommended as a non-pharmaceutical, beneficial, and safe intervention.
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Affiliation(s)
- Vahid Naseri-Salahshour
- Medical-Surgical Nursing Department, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Mohammad Taher
- Medical-Surgical Nursing Department, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
| | - Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Ahmadreza Abedi
- Traditional and Complementary Medicine Research Center (TCMRC), Medical-Surgical Nursing Department, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Neda Fayazi
- Critical Care Nursing Department, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
| | - Mahbobeh Sajadi
- Pediatrics Nursing Department, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Hamid Abredari
- Medical-Surgical Nursing Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Patel J, Fang J, Taylor LJ, Adler DG, Gawron AJ. Safety and efficacy of non-anesthesiologist administration of propofol sedation during esophagogastroduodenoscopy in the intensive care unit. Endosc Int Open 2019; 7:E625-E629. [PMID: 30993168 PMCID: PMC6461546 DOI: 10.1055/a-0829-6284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/15/2018] [Indexed: 12/17/2022] Open
Abstract
Background and study aims Propofol sedation is an increasingly popular method of sedation for gastrointestinal endoscopic procedures. The safety and efficacy of the non-anesthesiologist administration of propofol (NAAP) sedation has been demonstrated in the ambulatory setting. However, NAAP sedation in intensive care unit (ICU) patients has not been reported. The purpose of this study is to determine safety and efficacy of NAAP sedation in an ICU population. Methods We retrospectively reviewed esophagogastroduodenoscopies (EGD) performed with NAAP sedation in our intensive care units from June 2014 to September 2016. All EGDs were performed for evaluation of gastrointestinal bleeding. The primary end point of this study was to analyze the incidence of sedation-related adverse events (AEs). The secondary end points included successful completion of procedure and any endoscopic interventions performed. Results Two of 161 procedures (1.2 %) had sedation-related AEs requiring procedure termination. One hundred forty-six of 161 procedures (90.7 %) were successfully completed. Incomplete procedures were due to excess heme, retained food or obstructive lesions (13/161, 8.1 %). Endoscopic intervention was performed successfully in 17/24 cases (70.8 %) that had endoscopically treated lesions identified. One hundred six of 161 patients (66 %) were American Society of Anesthesiologists (ASA) classification III or IV. Conclusion Our retrospective analysis demonstrated that EGDs can be successfully completed in ICU patients using NAAP sedation. When procedures cannot be completed, it is rarely due to sedation-related AEs. NAAP sedation further allows adequate examination and successful treatment of high-risk lesions. NAAP sedation appears safe and effective for endoscopic procedures in the ICU setting.
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Affiliation(s)
- Janaki Patel
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - John Fang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Linda J. Taylor
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Douglas G. Adler
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Andrew J. Gawron
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States,Corresponding author Andrew J. Gawron 30 N 1900 E, SOM 4R118Salt Lake City, UT 84132+1-801-581-7476
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Murakami T, Yamaji H, Numa K, Kawamura H, Murakami M, Higashiya S, Kamikawa S, Hina K, Hirohata S, Kusachi S. Adaptive-servo ventilation combined with deep sedation is an effective strategy during pulmonary vein isolation. Europace 2013; 15:951-6. [PMID: 23419657 DOI: 10.1093/europace/eut007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS Pulmonary vein isolation (PVI) by catheter ablation for atrial fibrillation (AF) requires suppression of patient restlessness by sufficient sedation in addition to maintaining stable respiration. We applied adaptive-servo ventilation (ASV) and examined the effects of ASV combined with deep propofol sedation on PVI using a NavX. METHODS AND RESULTS We analysed 75 paroxysmal AF (PAF) patients (62 ± 11 years; 53 men and 22 women) who underwent PVI for treatment of PAF using an ASV system combined with deep sedation (ASV group). Control patients included 75 consecutive PAF patients (62 ± 11 years; 51 men and 24 women) who underwent PVI just before introduction of the ASV system. Deep sedation was defined as a Ramsay sedation score of 6. The ASV group had a lower frequency of restless body movements compared with the control group during PVI (1.5 ± 0.7 vs. 7.8 ± 1.4 times, P < 0.01). The frequency of respiratory compensation and EnGuide alignment of catheter position by the NavX was lower in the ASV (4.2 ± 3.3 and 8.8 ± 7.1 times) than control group (7.1 ± 5.1 and 15.2 ± 10.0 times, P < 0.05 and <0.01, respectively). Consequently, significantly lower total electrical energy supply (48.7 ± 6.0 KJ) was required in the ASV than control group (64.5 ± 24.9 KJ, P < 0.01). Further, significantly shorter fluoroscopy and procedural times were observed in the ASV (28 ± 5 and 109 ± 25 min) than the control group (33 ± 6 and 141 ± 38 min, respectively, P < 0.01) and the AF recurrence rate was significantly lower in the ASV than the control group (12 vs. 25%, P < 0.01). CONCLUSION ASV combined with deep sedation is an effective strategy during PVI using the NavX in patients with PAF.
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Agrawal A, Sharma BC, Sharma P, Uppal R, Sarin SK. Randomized controlled trial for endoscopy with propofol versus midazolam on psychometric tests and critical flicker frequency in people with cirrhosis. J Gastroenterol Hepatol 2012; 27:1726-32. [PMID: 22861074 DOI: 10.1111/j.1440-1746.2012.07231.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM People with cirrhosis are at increased risk of development of complications related to sedation. The aim of the present study was to compare the effects of sedation for upper gastrointestinal endoscopy (UGIE) with propofol and midazolam on psychometric tests and critical flicker frequency (CFF) in people with cirrhosis. METHODS A total of 127 people with cirrhosis were randomized into three groups: propofol group (n = 40), midazolam group (n = 42) and no sedation (n = 45). All patients underwent CFF test and combination of psychometry (number connection test-A and B [NCT-A,B]; digit symbol test [DST], line tracing test [LTT] and serial dotting test [SDT]) at baseline and at 2 h post-endoscopy. CFF was done at 30 min and repeated every 30 min for 2 h. RESULTS In the propofol group there was no deterioration in psychometry (NCT-A [55.6 ± 18.7 vs 56.4 ± 19.0 s], NCT-B [98.2 ± 35.1 vs 97.8 ± 34.6 s], DST [26.7 ± 5.7 vs 26.3 ± 5.3], LTT [112.9 ± 35.7 vs 113.7 ± 36.6 s], SDT [94.6 ± 34.1 vs 95.2 ± 34.5 s]). Significant deterioration from baseline (39.8 ± 2.9 Hz) was seen in CFF at 30 min (38.8 ± 2.3 Hz) and 1 h (39.2 ± 2.4 Hz), P = 0.01 but no difference thereafter. In the midazolam group, significant deterioration was observed on psychometry (NCT-A [56.0 ± 18.5 vs 60.4 ± 19.8 s], NCT-B [99.9 ± 29.1 vs 105.9.6 ± 30.3 s], DST [26.1 ± 4.7 vs 25.2 ± 4.3], LTT [129.1 ± 34.5 vs 132.9 ± 35.4 s], SDT [95.6 ± 34.2]). No deterioration was observed in psychometry and CFF in people with cirrhosis without sedation. CONCLUSIONS Propofol sedation for UGIE was associated with earlier recovery compared with midazolam, which causes deterioration of psychometric tests and CFF for a longer time in comparison with propofol.
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Affiliation(s)
- Amit Agrawal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Kweon TD. Update of sedation in view of Joint Commission International standards. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.12.1284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tae Dong Kweon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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Pediatric sedation: a global challenge. Int J Pediatr 2010; 2010:701257. [PMID: 20981309 PMCID: PMC2958496 DOI: 10.1155/2010/701257] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/06/2010] [Accepted: 08/16/2010] [Indexed: 11/17/2022] Open
Abstract
Pediatric sedation is a challenge which spans all continents and has grown to encompass specialties outside of anesthesia, radiology and emergency medicine. All sedatives are not universally available and local and national regulations often limit the sedation practice to specific agents and those with specific credentials. Some specialties have established certification and credentials for sedation delivery whereas most have not. Some of the relevant sedation guidelines and recommendations of specialty organizations worldwide will be explored. The challenge facing sedation care providers moving forward in the 21st century will be to determine how to apply the local, regional and national guidelines to the individual sedation practices. A greater challenge, perhaps impossible, will be to determine whether the sedation community can come together worldwide to develop standards, guidelines and recommendations for safe sedation practice.
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Inadomi JM, Gunnarsson CL, Rizzo JA, Fang H. Projected increased growth rate of anesthesia professional-delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015. Gastrointest Endosc 2010; 72:580-6. [PMID: 20630511 DOI: 10.1016/j.gie.2010.04.040] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 04/23/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anesthesia professional-delivered sedation has become increasingly common when performing colonoscopy and EGD. OBJECTIVE To provide an estimate of anesthesia professional-participation rates in colonoscopy and EGD procedures and to examine rate changes over time and geographic variations for both procedures. DESIGN Retrospective sample design. SETTING National survey data from i3 Innovus for the period 2003 to 2007 on the use rate of anesthesia professionals in both procedures. PATIENTS A sample of 3688 observations included 3-digit zip code-level information on anesthesia professional use rates. INTERVENTIONS Data were linked to the Bureau of Health Professions' Area Resource File to control for sociodemographic factors and provider supply characteristics for anesthesia professional use rates. MAIN OUTCOME MEASUREMENTS Multivariable regression analyses were performed to identify factors predicting the use rate of anesthesia professionals in these procedures and to forecast use rates for the years 2009 to 2015. RESULTS For colonoscopy and EGD, anesthesia professional participation is projected to grow from 23.9% and 24.4% in 2007 to 53.4% and 52.9% by 2015, respectively. Average growth rates were highest in the northeast for colonoscopy (145.8%) and EGD (146.6%). Anesthesia professional use rates were significantly greater in areas having a higher percentage of older subjects (45 years and older), higher per capita income and lower unemployment rates, and higher per capita inpatient admissions and were significantly lower in areas having more per capita outpatient visits for both procedures. LIMITATIONS Nonexperimental retrospective sample study design. Database sample may not be nationally representative. Market area characteristics were used to control for socioeconomic and demographic factors. However, there may remain some important market factors that we were unable to control. CONCLUSIONS Anesthesia professional-delivered sedation is projected to grow substantially for both procedures.
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Affiliation(s)
- John M Inadomi
- University of California, San Francisco, California, USA
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Dies DF. Nurse-administered propofol sedation: differences in perspective. Hepatology 2010; 51:2233. [PMID: 20077565 DOI: 10.1002/hep.23492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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