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Colquhoun DA, Somsouk M, Chen CL. Does Propofol Improve Polyp Detection during Colonoscopy? The Promise and Peril of Clinical Registry Data. Anesthesiology 2024; 140:1062-1064. [PMID: 38629962 PMCID: PMC11104318 DOI: 10.1097/aln.0000000000004987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Douglas A Colquhoun
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ma Somsouk
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Catherine L Chen
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
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Wehrmann T, Riphaus A, Eckardt AJ, Klare P, Kopp I, von Delius S, Rosien U, Tonner PH. Updated S3 Guideline "Sedation for Gastrointestinal Endoscopy" of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) - June 2023 - AWMF-Register-No. 021/014. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e654-e705. [PMID: 37813354 DOI: 10.1055/a-2165-6388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Till Wehrmann
- Clinic for Gastroenterology, DKD Helios Clinic Wiesbaden, Wiesbaden, Germany
| | - Andrea Riphaus
- Internal Medicine, St. Elisabethen Hospital Frankfurt Artemed SE, Frankfurt, Germany
| | - Alexander J Eckardt
- Clinic for Gastroenterology, DKD Helios Clinic Wiesbaden, Wiesbaden, Germany
| | - Peter Klare
- Department Internal Medicine - Gastroenterology, Diabetology, and Hematology/Oncology, Hospital Agatharied, Hausham, Germany
| | - Ina Kopp
- Association of the Scientific Medical Societies in Germany e.V. (AWMF), Berlin, Germany
| | - Stefan von Delius
- Medical Clinic II - Internal Medicine - Gastroenterology, Hepatology, Endocrinology, Hematology, and Oncology, RoMed Clinic Rosenheim, Rosenheim, Germany
| | - Ulrich Rosien
- Medical Clinic, Israelite Hospital, Hamburg, Germany
| | - Peter H Tonner
- Anesthesia and Intensive Care, Clinic Leer, Leer, Germany
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Wehrmann T, Riphaus A, Eckardt AJ, Klare P, Kopp I, von Delius S, Rosien U, Tonner PH. Aktualisierte S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1246-1301. [PMID: 37678315 DOI: 10.1055/a-2124-5333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Till Wehrmann
- Klinik für Gastroenterologie, DKD Helios Klinik Wiesbaden, Wiesbaden, Deutschland
| | - Andrea Riphaus
- Innere Medizin, St. Elisabethen Krankenhaus Frankfurt Artemed SE, Frankfurt, Deutschland
| | - Alexander J Eckardt
- Klinik für Gastroenterologie, DKD Helios Klinik Wiesbaden, Wiesbaden, Deutschland
| | - Peter Klare
- Abteilung Innere Medizin - Gastroenterologie, Diabetologie und Hämato-/Onkologie, Krankenhaus Agatharied, Hausham, Deutschland
| | - Ina Kopp
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF), Berlin, Deutschland
| | - Stefan von Delius
- Medizinische Klinik II - Innere Medizin - Gastroenterologie, Hepatologie, Endokrinologie, Hämatologie und Onkologie, RoMed Klinikum Rosenheim, Rosenheim, Deutschland
| | - Ulrich Rosien
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - Peter H Tonner
- Anästhesie- und Intensivmedizin, Klinikum Leer, Leer, Deutschland
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Qanadli SD, Gudmundsson L, Gullo G, Ponti A, Saltiel S, Jouannic AM, Faouzi M, Rotzinger DC. Virtually Augmented Self-Hypnosis applied to endovascular interventions (VA-HYPO): Randomized Controlled Trial Protocol. PLoS One 2022; 17:e0263002. [PMID: 35196310 PMCID: PMC8865664 DOI: 10.1371/journal.pone.0263002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
Endovascular interventions (EVI) are increasingly performed as minimally-invasive alternatives to surgery and have many advantages, including a decreased need for general anesthesia. However, EVI can be stressful for patients and often lead to anxiety and pain related to the procedure. The use of local anesthetics, anxiolytics, and analgesic drugs can help avoid general anesthesia. Nevertheless, these drugs have potential side effects. Alternative nonpharmacological therapies can improve patients’ experience during conscious interventions and reduce the need for additional medications. The added value of virtually augmented self-hypnosis (VA-HYPO) and its potential to reduce pain and anxiety during peripheral and visceral arterial and venous EVI is unknown. This is a prospective two-arm trial designed to randomize 100 patients in two groups according to the use or not of VA-HYPO during peripheral EVI as a complementary nonpharmacological technique to improve patient comfort. The main objective is to compare per-procedural anxiety, and the secondary aim is to compare the rated per-procedural pain in both groups. The potential significance is that VA-HYPO may improve patients’ experience during peripheral and visceral arterial and venous EVI and other minimally invasive interventions performed under local anesthesia. Trial registration: Our study is registered on clinicaltrials.gov, with trial registration number: NCT04561596.
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Affiliation(s)
- Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- * E-mail: (DCR); (SDQ)
| | - Louis Gudmundsson
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giuseppe Gullo
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Ponti
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah Saltiel
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Marie Jouannic
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- * E-mail: (DCR); (SDQ)
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Is endoscopist-directed sedation for endoscopic retrograde cholangiopancreatography with balanced propofol solution (BPS) practical and safe? A prospective study from a tertiary care centre in India. GASTROENTEROLOGY REVIEW 2022; 16:324-329. [PMID: 34976240 PMCID: PMC8690956 DOI: 10.5114/pg.2021.111764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/30/2021] [Indexed: 11/17/2022]
Abstract
Introduction Endoscopist-directed, nurse-administered sedation using propofol, midazolam, and fentanyl for endoscopic retrograde cholangiopancreatography (ERCP) is being utilized worldwide. However, this is not usually employed in India by endoscopists. Aim To assess the efficacy, acceptability, and safety of this sedation in low to moderate risk patients undergoing ERCP. Material and methods This was a prospective study involving 500 patients with any indication for ERCP. The sedation was given by trained nurses. Results The sedative dosages per patient were as follows: propofol = 90 ±20 mg, fentanyl 0.75 ±0.25 mg (range: 0.25-1.00 mg), and midazolam 2 ±0.5 mg (range: 1-3 mg). Ninety-seven percent of patients achieved Richmond agitation sedation score of ≥ -3, and 96.8% achieved Gloucester comfort score of ≤ 2. 4.22% of the patients had mild adverse events (AE), and 2.11% had moderate AE. Two (0.4%) patients required intubation and intensive care unit admission. Mean recovery time was 15.3 min. 98.3% of the endoscopists were satisfied with the sedation achieved. 31.2% of the patients remembered the procedure. 93% of the patients were satisfied with the type of sedation. 92.75% of ERCPs were successful. 7.59% had procedure-related complications: in the form PEP - 5.290%, significant bleeding - 1.08%, and perforation - 0.43%. Conclusions Endoscopist-directed, nurse-administered sedation for ERCP with balanced propofol solution is practical, efficient, time saving, safe, and acceptable to patients.
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Saylan S, Akbulut UE. A comparison of ketamine-midazolam combination and propofol-fentanyl combination on procedure comfort and recovery process in pediatric colonoscopy procedures. Pak J Med Sci 2021; 37:483-488. [PMID: 33679936 PMCID: PMC7931286 DOI: 10.12669/pjms.37.2.2787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the efficacy and safety of midazolam-ketamine combination versus fentanyl-propofol combination in pediatric diagnostic colonoscopy. Methods This is a retrospective study of 68 children undergoing diagnostic gastroenterology with midazolam-ketamine combination (Group-K) or with fentanyl-propofol combination (Group-P) in the pediatric gastroentology department at a Turkish tertiary hospital between January 2015 and June 2017. An intravenous midazolam was administered one minute before ketamine administration in Group K. Intravenous fentanyl was given to Group P, followed by intravenous propofol. Results There were statistically no significant differences between the groups as for age, gender, weight, duration of colonoscopy and complications observed during procedure. Ramsay sedation score was significantly higher in Group K. Recovery time and the rate of complications during the recovery of Group-K (23 patients, 65.7%) was significantly higher than that of Group P (8 patients, 24.2%) (p= 0.001). Conclusions Colonoscopy procedures can be quite comfortable in children when using the midazolam-ketamine combination. However, adverse effects related to ketamine were observed during recovery.
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Affiliation(s)
- Sedat Saylan
- Sedat Saylan, MD. Faculty of Medicine, Department of Anesthesiology, Karadeniz Technical University, Trabzon, Turkey
| | - Ulas Emre Akbulut
- Ulas Emre Akbulut, Department of Pediatric Gastroenterology Hepatology & Nutrition, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
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Gotoda T, Akamatsu T, Abe S, Shimatani M, Nakai Y, Hatta W, Hosoe N, Miura Y, Miyahara R, Yamaguchi D, Yoshida N, Kawaguchi Y, Fukuda S, Isomoto H, Irisawa A, Iwao Y, Uraoka T, Yokota M, Nakayama T, Fujimoto K, Inoue H. Guidelines for sedation in gastroenterological endoscopy (second edition). Dig Endosc 2021; 33:21-53. [PMID: 33124106 DOI: 10.1111/den.13882] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022]
Abstract
Sedation in gastroenterological endoscopy has become an important medical option in routine clinical care. Here, the Japan Gastroenterological Endoscopy Society and the Japanese Society of Anesthesiologists together provide the revised "Guidelines for sedation in gastroenterological endoscopy" as a second edition to address on-site clinical questions and issues raised for safe examination and treatment using sedated endoscopy. Twenty clinical questions were determined and the strength of recommendation and evidence quality (strength) were expressed according to the "MINDS Manual for Guideline Development 2017." We were able to release up-to-date statements related to clinical questions and current issues relevant to sedation in gastroenterological endoscopy (henceforth, "endoscopy"). There are few reports from Japan in this field (e.g., meta-analyses), and many aspects have been based only on a specialist consensus. In the current scenario, benzodiazepine drugs primarily used for sedation during gastroenterological endoscopy are not approved by national health insurance in Japan, and investigations regarding expense-related disadvantages have not been conducted. Furthermore, including the perspective of beneficiaries (i.e., patients and citizens) during the creation of clinical guidelines should be considered. These guidelines are standardized based on up-to-date evidence quality (strength) and supports on-site clinical decision-making by patients and medical staff. Therefore, these guidelines need to be flexible with regard to the wishes, age, complications, and social conditions of the patient, as well as the conditions of the facility and discretion of the physician.
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Affiliation(s)
- Takuji Gotoda
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takuji Akamatsu
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Seiichiro Abe
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Yousuke Nakai
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Waku Hatta
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naoki Hosoe
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Yoshimasa Miura
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Ryoji Miyahara
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Naohisa Yoshida
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Shinsaku Fukuda
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Hajime Isomoto
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Atsushi Irisawa
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Yasushi Iwao
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Toshio Uraoka
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Kazuma Fujimoto
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Haruhiro Inoue
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
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El Hajj MC, Litwin SE. Echocardiography in the Era of Obesity. J Am Soc Echocardiogr 2020; 33:779-787. [PMID: 32359803 DOI: 10.1016/j.echo.2020.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/29/2022]
Abstract
Patients with obesity are at increased risk for coronary artery disease and heart failure and often present with symptoms of dyspnea, fatigue, edema, or chest pain. Echocardiography is frequently used to help distinguish whether these symptoms are due to cardiac disease. Unfortunately, obesity has a significant impact on image quality because of signal attenuation. Ultrasound-enhancing agents may improve the detection of structural remodeling and subclinical left ventricular dysfunction in patients with obesity. Assessment of chamber sizes and cardiac remodeling in severely obese subjects must be interpreted with caution, however, as the current recommendations for indexing cardiac chamber sizes to body size may lead to false conclusions about chamber volumes or mass, particularly in settings in which weight is changing. As a result of increases in stroke volume and cardiac output, obesity may exacerbate hemodynamic compromise in obstructive structural or valvular disease. With regard to assessment of ischemic heart disease, stress echocardiography can effectively risk-stratify patients with obesity and may have advantages over other noninvasive modalities. In general, transesophageal echocardiography is safe in patients with obesity, although some precautions should be observed. Stress echocardiography using the transesophageal approach is an alternative for preoperative or ischemia evaluation in patients with suboptimal transthoracic views.
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Affiliation(s)
- Milad C El Hajj
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sheldon E Litwin
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.
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Akbulut UE, Kartal S, Dogan U, Akcali GE, Kalayci S, Kirci H. Propofol with and without Midazolam for Diagnostic Upper Gastrointestinal Endoscopies in Children. Pediatr Gastroenterol Hepatol Nutr 2019; 22:217-224. [PMID: 31110954 PMCID: PMC6506432 DOI: 10.5223/pghn.2019.22.3.217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children. METHODS We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined. RESULTS Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010). CONCLUSION The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.
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Affiliation(s)
- Ulas Emre Akbulut
- Department of Pediatric Gastroenterology Hepatology and Nutrition, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Seyfi Kartal
- Department of Anesthesiology and Intensive Care Medicine, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ufuk Dogan
- Department of Anesthesiology and Intensive Care Medicine, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Gulgun Elif Akcali
- Department of Anesthesiology and Intensive Care Medicine, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Serap Kalayci
- Department of Anesthesiology and Intensive Care Medicine, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Hulya Kirci
- Department of Pediatric Gastroenterology Hepatology and Nutrition, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
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Feng LL, Ding WX, Sun YY, Zhang YY, Yuan NP, Zhang LJ, Han WJ, Xi HJ. Risk factors for hypoxemia during routine anesthesia for gastrointestinal endoscopy. Shijie Huaren Xiaohua Zazhi 2019; 27:427-434. [DOI: 10.11569/wcjd.v27.i7.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal endoscopy under anesthesia has been carried out as a routine procedure in China. Hypoxemia is still an adverse event with a high incidence in routine anesthesia for gastrointestinal endoscopy, but the incidence of hypoxemia varies greatly across countries (< 1% to 85%), and there is a lack of relevant high-quality reports in China. Propofol, as a sedative for anesthetic gastroscopy in outpatients, has been recognized for its safety and effectiveness and is recommended by the expert consensus on Sedation/Anesthesia for Digestive Endoscopic Diagnosis and Treatment in China (2014). However, there are still some debate over its safety in foreign countries. In this study, we used propofol as a sedative for gastroscopy in outpatients to observe its effect on the incidence of hypoxemia.
AIM To observe and analyze the incidence of and risk factors for hypoxemia in anesthesia for gastrointestinal endoscopy.
METHODS A total of 580 outpatients who were sedated with propofol from September 1, 2018 to November 30, 2018 in Digestive Endoscopy Center of Shanghai Changhai Hospital were included in the study. These patients were divided into either a hypoxemia (n = 110) group or a non-hypoxemia group (n = 470). The basic information, anesthesia procedure, and endoscopic operation related information of the two groups were recorded.
RESULTS The information of patients in the two groups was compared and analyzed. It was found that there were significantly differences between the two groups in snoring history, biopsy, age, body mass index, abdominal circumference, endoscopic operation time, propofol dosage, ASA classification, and endoscopic physician classification (P < 0.05). Multivariate Logistic regression analysis showed that age (>5 years, OR = 8.955, 95 %CI: 2.070-38.746) and propofol dosage (>197 mg, OR = 2.360, 95 %CI: 1.320-4.219) were independent risk factors for hypoxemia.
CONCLUSION Intervention is needed for elderly patients (especially patients over 75 years old) and patients requiring large amounts of propofol (especially > 197 mg) to prevent the occurrence of hypoxemia.
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Affiliation(s)
- Li-Li Feng
- Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China
| | - Wen-Xia Ding
- Digestive Endoscopy Center, Changhai Hospital, Shanghai 200433, China
| | - Yuan-Yuan Sun
- Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China
| | - Ying-Ying Zhang
- Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China
| | - Ning-Ping Yuan
- Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China
| | - Li-Jun Zhang
- Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China
| | - Wen-Jun Han
- Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China
| | - Hui-Jun Xi
- Digestive Endoscopy Center, Changhai Hospital, Shanghai 200433, China
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11
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Allampati S, Wen S, Liu F, Kupec JT. Recovery of cognitive function after sedation with propofol for outpatient gastrointestinal endoscopy. Saudi J Gastroenterol 2019; 25:188-193. [PMID: 30618439 PMCID: PMC6526733 DOI: 10.4103/sjg.sjg_369_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIM Most endoscopies performed in the United States utilize sedation. Anesthesia provides patient comfort and improved procedural quality but adds to the complexity of scheduling routine outpatient procedures. We aimed to assess the return of cognitive function after propofol administration in patients undergoing outpatient endoscopies. PATIENTS AND METHODS Cognitive recovery for patients undergoing endoscopy under monitored anesthesia care was evaluated using EncephalApp. Patients were tested before and after procedure and healthy controls were tested twice, 30 min apart. Results were tabulated in on state (on time) and off state (off time) and total time (on time + off time). The time difference between pre- and post-tests, "delta," was calculated for on, off, and total times. Wilcoxon rank test was used to check the difference in mean delta of all three test times between cases and controls and to check for statistical significance. RESULTS The difference in mean time between cases and controls was significant for off (P < 0.0001) and total (P = 0.0002) times. No statistically significant difference was noted in mean time for on time (P = 0.013) between cases and controls. Cognitive flexibility, a measure of on time, returned to baseline after procedural sedation even though psychomotor speed, a measure of off time and total time, had not. CONCLUSION Cognitive flexibility returns to baseline within 30-45 min after propofol sedation despite delayed return of psychomotor speed and reaction time.
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Affiliation(s)
- Sanath Allampati
- Department of Medicine, West Virginia University, WV, USA,Address for correspondence: Dr. Sanath Allampati, 1, Stadium Drive, Morgantown, WV - 26506, USA. E-mail:
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, WV, USA
| | - Feiyu Liu
- Department of Biostatistics, West Virginia University, WV, USA
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Khalila A, Shavit I, Shaoul R. Propofol Sedation by Pediatric Gastroenterologists for Endoscopic Procedures: A Retrospective Analysis. Front Pediatr 2019; 7:98. [PMID: 30972312 PMCID: PMC6445344 DOI: 10.3389/fped.2019.00098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 03/04/2019] [Indexed: 12/27/2022] Open
Abstract
Background: There is a substantial literature on the favorable outcome of propofol administration by non-anesthesiologists for endoscopy in adults; however, very few data are currently available on propofol sedation by pediatric gastroenterologists. Aims: to evaluate the safety of propofol sedation by pediatric gastroenterologists. Methods: A retrospective chart review of all children who were sedated by pediatric gastroenterologists in three Northern Israeli hospitals over a 4 years period Demographic and medical characteristics and any data regarding the procedure were extracted from patient's records. The main outcome measurements were procedure completion and reported adverse events. Results: Overall, 1,214 endoscopic procedures for were performed during this period. Complete data was available for 1,190 procedures. All children sedated by pediatric gastroenterologists were classified as ASA I or II. Propofol dosage (in mg/kg) inversely correlated with patient age. The younger the child the higher the dose needed to reach a satisfactory level of sedation (r = -0.397, p < 0.001). The addition of fentanyl significantly decreased propofol dosage needed to provide optimal sedation, p < 0.001. Nine (0.7%) reversible adverse events were reported. All the procedures were successfully completed and all patients were discharged home. Conclusions: We conclude that our approach is safe in children as it is in adults and can be implemented for children with ASA I, II.
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Affiliation(s)
- Aya Khalila
- Pediatric Gastroenterology and Nutrition Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Itai Shavit
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Pediatric Emergency Department, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Ron Shaoul
- Pediatric Gastroenterology and Nutrition Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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Qin Y, Li LZ, Zhang XQ, Wei Y, Wang YL, Wei HF, Wang XR, Yu WF, Su DS. Supraglottic jet oxygenation and ventilation enhances oxygenation during upper gastrointestinal endoscopy in patients sedated with propofol: a randomized multicentre clinical trial. Br J Anaesth 2018; 119:158-166. [PMID: 28974061 DOI: 10.1093/bja/aex091] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/14/2022] Open
Abstract
Background Hypoventilation is the main reason for hypoxia during upper gastrointestinal endoscopy procedures with sedation. The key to preventing hypoxia is to maintain normal ventilation during the procedure. We introduced supraglottic jet oxygenation and ventilation (SJOV) through a new Wei nasal jet tube (WNJ) to reduce the incidence of hypoxia in patients sedated with propofol during upper gastrointestinal endoscopy procedures. Methods In a multicentre, prospective randomized single-blinded study, 1781 outpatients undergoing routine upper gastrointestinal endoscopy who were sedated with propofol by an anaesthetist were randomized into the following three groups: the supplementary oxygen via nasal cannula group [nasal cannula oxygen: O 2 (2 litres min -1 ) was administered via a nasal cannula]; the supplementary oxygen via WNJ group [WNJ oxygen: O 2 (2 litres min -1 ) was administered through a WNJ]; and the SJOV via WNJ group (WNJ SJOV: SJOV was administered via WNJ) at three centres from March 2015 to July 2016. The primary outcome of interest was the incidence of hypoxia (peripheral oxygen saturation of 75-89%). Other adverse events were also recorded. Results Supraglottic jet oxygenation and ventilation decreased the incidence of hypoxia from 9 to 3% ( P <0.0001). No severe hypoxia occurred in the WNJ SJOV group, one instance occurred in the WNJ oxygen group, and two instances were observed in the nasal cannula oxygen supply control group. Supraglottic jet oxygenation and ventilation-related minor adverse events increased significantly within 1 min after the procedure but decreased 30 min later. Conclusions The use of SJOV during upper gastrointestinal endoscopy for patients who are sedated with propofol reduces the incidence of hypoxia, with minor and tolerable adverse events. Supraglottic jet oxygenation and ventilation has a favourable risk-to-benefit ratio and may improve patient safety. Clinical trial registration NCT02436018.
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Affiliation(s)
- Y Qin
- Department of Anaesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - L Z Li
- Department of Anaesthesiology, Pudong New Area People's Hospital, Shanghai 201200, China
| | - X Q Zhang
- Department of Anaesthesiology, Shanghai Tongji Hospital, Shanghai 200065, China
| | - Y Wei
- Department of Anaesthesiology, Pudong New Area People's Hospital, Shanghai 201200, China
| | - Y L Wang
- Department of Anaesthesiology, Shanghai Tongji Hospital, Shanghai 200065, China
| | - H F Wei
- Department of Anaesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - X R Wang
- Department of Anaesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - W F Yu
- Department of Anaesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - D S Su
- Department of Anaesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
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Zhang W, Zhu Z, Zheng Y. Effect and safety of propofol for sedation during colonoscopy: A meta-analysis. J Clin Anesth 2018; 51:10-18. [DOI: 10.1016/j.jclinane.2018.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 02/08/2023]
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15
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Shao LJZ, Liu SH, Liu FK, Zou Y, Hou HJ, Tian M, Xue FS. Comparison of two supplement oxygen methods during gastroscopy with intravenous propofol anesthesia in obese patients: study protocol for a randomized controlled trial. Trials 2018; 19:602. [PMID: 30382904 PMCID: PMC6211481 DOI: 10.1186/s13063-018-2994-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypoxemia is a major complication in obese patients undergoing gastrointestinal endoscopy under intravenous anesthesia or sedation due to altered airway anatomy. We design this randomized controlled trial (RCT) to compare efficacy and safety of the Wei nasal jet tube (WNJT) and nasal prongs for supplement oxygen during gastroscopy with intravenous propofol anesthesia in obese patients. METHODS The study will be a single-center, prospective RCT. A total of 308 obese patients will be recruited and randomly assigned to receive either the WNJT (group A) or nasal prongs (group B). During gastroscopy with intravenous propofol anesthesia, 5 L/min of oxygen will be delivered through the jet port of the WNJT in the group A and via the nasal prongs in the group B. The primary outcome is the incidence of hypoxemia and severe hypoxemia. The secondary outcomes are adverse events during the gastroscopy, postoperative complications, and satisfaction of the anesthetist, physician, and patient. DISCUSSION This RCT aims to clarify whether the WNJT can result in reduced incidences of hypoxemia and complications and provide improved satisfaction to the anesthetist, physician, and patient. Thus, it can be determined if the WNJT is a useful tool for supplement oxygen in obese patients undergoing gastroscopy with intravenous propofol anesthesia. The results will provide the evidence for anesthesiologists to make a decision regarding the choice of supplementary oxygen methods in this condition. TRIAL REGISTRATION Chinese Clinical Trial, ChiCTR-IOR-17013089 . Registered on 23 October 2017.
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Affiliation(s)
- Liu-Jia-Zi Shao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Shao-Hua Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Kun Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Yi Zou
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Hai-Jun Hou
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Ming Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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17
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Staffing at Ambulatory Endoscopy Centers in the United States: Practice, Trends, and Rationale. Gastroenterol Res Pract 2018; 2018:9463670. [PMID: 30302089 PMCID: PMC6158976 DOI: 10.1155/2018/9463670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/08/2018] [Indexed: 11/21/2022] Open
Abstract
Background Endoscopy nurse (RN) has a pivotal role in administration and monitoring of moderate sedation during endoscopic procedures. When sedation for the procedure is administered and monitored by an anesthesia specialist, the role of an RN is less clear. The guidelines on this issue by nursing and gastroenterology societies are contradictory. Methods Survey study of endoscopy lab managers and directors at outpatient endoscopy units in Texas. The questions related to staffing patterns for outpatient endoscopies and responsibilities of different personnel assisting with endoscopies. Results Responses were received from 65 endoscopy units (response rate 38%). 63/65 (97%) performed at least a few cases with an anesthesia specialist. Of these, 49/63 (78%) involved only an endoscopy technician, without an additional RN in the room. At 12/49 (25%) units, the RN performed tasks of an endoscopy technician. At 14/63 (22%), an additional RN was present during endoscopic procedures and performed tasks not directly related to patient care. Conclusions Many ambulatory endoscopy units do not have an RN present at all times when sedation is administered by an anesthesia specialist. An RN, when present, did not perform tasks commensurate with the education and training. This has implications about optimal utilization of nurses and cost of performing endoscopies.
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Essandoh MK, Mark GE, Aasbo JD, Joyner CA, Sharma S, Decena BF, Bolin ED, Weiss R, Burke MC, McClernon TR, Daoud EG, Gold MR. Anesthesia for subcutaneous implantable cardioverter‐defibrillator implantation: Perspectives from the clinical experience of a U.S. panel of physicians. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:807-816. [DOI: 10.1111/pace.13364] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/25/2018] [Accepted: 03/18/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Michael K. Essandoh
- Department of AnesthesiologyThe Ohio State University Wexner Medical Center Columbus OH USA
| | - George E. Mark
- Department of CardiologyCooper University Hospital Camden NJ USA
| | - Johan D. Aasbo
- The Heart Institute of ProMedica Toledo Hospital Toledo OH USA
| | - Charles A Joyner
- Department of CardiologyLevinson Heart Hospital at Chippenham and Johnston Willis Medical Center Richmond VA USA
| | - Saumya Sharma
- Department of ElectrophysiologyMcGovern Medical School ‐ University of Texas Health Science Center Houston TX USA
| | - Beningo F Decena
- Department of CardiologyTucson Medical Center and Northwest Medical Center Tucson AZ USA
| | - Eric D Bolin
- Department of Anesthesia and Perioperative MedicineMedical University of South Carolina Charleston SC USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical Center Columbus OH USA
| | | | | | - Emile G. Daoud
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical Center Columbus OH USA
| | - Michael R. Gold
- Division of CardiologyMedical University of South Carolina Charleston SC USA
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Sachar H, Pichetshote N, Nandigam K, Vaidya K, Laine L. Continued midazolam versus diphenhydramine in difficult-to-sedate patients: a randomized double-blind trial. Gastrointest Endosc 2018; 87:1297-1303. [PMID: 28159539 PMCID: PMC5537051 DOI: 10.1016/j.gie.2017.01.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/25/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Current guidelines recommend diphenhydramine in patients undergoing endoscopy who are not adequately sedated with a benzodiazepine and opioid combination. Because this practice has not been adequately assessed, we performed a randomized, double-blind trial comparing diphenhydramine with continued midazolam in such patients. METHODS Patients undergoing elective colonoscopy with moderate sedation were eligible. Sedation was measured with the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score with adequate sedation defined as 3 on a 0- to 5-point scale. Patients not adequately sedated with midazolam 5 mg and fentanyl 100 μg were randomly assigned to diphenhydramine 25 mg versus continued midazolam 1.5 mg. Adequacy of sedation was assessed 3 minutes after each study medication dose. If MOAA/S was 4 to 5, study medication was repeated, to a maximum of 3 doses. The primary endpoint was adequate sedation. RESULTS The planned enrollment of 200 patients (100 in each study group) was attained. Adequate sedation was achieved less often with diphenhydramine than midazolam (27% vs 65%, difference = -38%; 95% CI, -50% to -24%; P < .0001). After study medications were completed, more patients required additional medication for sedation or analgesia with diphenhydramine versus midazolam (84% vs 68%, P = .008), whereas the time to discharge from the recovery unit was similar (134 vs 129 minutes). Treatment effect was consistent across subgroups including age ≤55, substance abuse, benzodiazepine use, opioid use, and psychiatric medication use. CONCLUSIONS Endoscopists performing moderate sedation should continue midazolam rather than switching to diphenhydramine in patients who do not achieve adequate sedation with usual doses of midazolam and an opioid. (Clinical trial registration number: NCT01769586.).
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Affiliation(s)
| | | | | | | | - Loren Laine
- Yale School of Medicine, New Haven, CT,VA Connecticut Healthcare System, West Haven, CT
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20
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Sun X, Xu Y, Zhang X, Li A, Zhang H, Yang T, Liu Y. Topical pharyngeal anesthesia provides no additional benefit to propofol sedation for esophagogastroduodenoscopy: a randomized controlled double-blinded clinical trial. Sci Rep 2018; 8:6682. [PMID: 29703990 PMCID: PMC5923272 DOI: 10.1038/s41598-018-25164-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/12/2018] [Indexed: 01/27/2023] Open
Abstract
Propofol sedation has been applied during esophagogastroduodenoscopy procedures, but whether topical pharyngeal anesthesia should be administered at the same time has rarely been reported. Our study examined the role of topical pharyngeal anesthesia in sedated endoscopies in a randomized controlled double-blinded clinical trial. A total of 626 patients who underwent sedated esophagogastroduodenoscopy were randomized into the experimental group (n = 313) or the control group (n = 313). The discomfort score, immediately and one day after the procedure, was not statistically significant [7.2 (5-9) vs. 7.5 (6-9), P = 0.210; 2.3 (0-3) vs. 2.6 (0-4), P = 0.095, respectively]. Two patients in the experimental group and three patients in the control group needed oral medication for pharyngeal discomfort (P = 0.354). The satisfaction score was 9.2 (8-10) in the experimental group and 8.9 (7-10) in the control group (P = 0.778). Lidocaine topical pharyngeal anesthesia in propofol-sedated esophagogastroduodenoscopy did not further reduce the pharyngeal discomfort or improve the satisfaction. This clinical trial was registered at ClinicalTrials.gov (ClinicalTrials.gov ID: NCT03070379).
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Affiliation(s)
- Xiaotian Sun
- Department of Gastroenterology, 307 Hospital, Beijing, 100071, China.,Department of Internal Medicine, Clinic of August First Film Studio, Beijing, 100161, China
| | - Yang Xu
- Department of Gastroenterology, 307 Hospital, Beijing, 100071, China
| | - Xueting Zhang
- Department of Gastroenterology, 307 Hospital, Beijing, 100071, China
| | - Aitong Li
- Department of Gastroenterology, 307 Hospital, Beijing, 100071, China
| | - Hanqing Zhang
- Department of Gastroenterology, 307 Hospital, Beijing, 100071, China
| | - Teng Yang
- Department of Gastroenterology, 307 Hospital, Beijing, 100071, China
| | - Yan Liu
- Department of Gastroenterology, 307 Hospital, Beijing, 100071, China.
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Kim EH, Park JC, Shin SK, Lee YC, Lee SK. Effect of the midazolam added with propofol-based sedation in esophagogastroduodenoscopy: A randomized trial. J Gastroenterol Hepatol 2018; 33:894-899. [PMID: 29048708 DOI: 10.1111/jgh.14026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Although propofol has been widely used for sedation during esophagogastroduodenoscopy (EGD), adverse events including hypoxia and hypotension may be a concern in the propofol-based sedation. We aimed to analyze whether administration of midazolam would improve safety and efficacy of propofol-based sedation in EGD. METHODS One hundred twenty patients who were scheduled to undergo diagnostic EGD were randomly assigned to either midazolam plus propofol (MP) or propofol alone groups. In the MP group, 2 mg of midazolam and 10 mg of propofol were given initially. In the propofol alone group, 40-60 mg of propofol was given initially. In both groups, 20 mg of propofol was given repeatedly to maintain moderate sedation as needed. Vital signs including oxygen saturation were monitored every 2 min. After the patients fully recovered, satisfaction score was investigated from endoscopists, nurses, and patients, respectively. RESULTS The baseline characteristics did not differ between the MP and propofol alone groups. The mean required doses of propofol was (mean ± standard deviation) 0.3 ± 0.3 and 0.8 ± 0.2 mg/kg in the MP and propofol alone groups, respectively (P < 0.001). In addition, sedation-related adverse events and recovery time did not differ between the two groups. The proportion of satisfactory did not differ between the two groups (MP vs propofol alone; proportion; patient, 95.0% vs 93.3%, P > 0.999; endoscopist, 73.3% vs 80.0%, P = 0.064; nurse, 73.3% vs 76.7%, P = 0.551). CONCLUSION Adding midazolam to propofol did not reduced the safety and efficacy, and sedation using propofol alone could be suitable for sedation during diagnostic EGD.
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Affiliation(s)
- Eun Hye Kim
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kwan Shin
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Conigliaro R, Fanti L, Manno M, Brosolo P. Italian Society of Digestive Endoscopy (SIED) position paper on the non-anaesthesiologist administration of propofol for gastrointestinal endoscopy. Dig Liver Dis 2017; 49:1185-1190. [PMID: 28951114 DOI: 10.1016/j.dld.2017.08.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/30/2017] [Accepted: 08/24/2017] [Indexed: 12/11/2022]
Abstract
Propofol sedation by non-anesthesiologists in GI endoscopy, despite generally considered a safe procedure, is still a matter of debate. Benefits of propofol sedation include rapid onset of action, greater patient comfort and fast recovery with prompt discharge from the endoscopy unit. The use of propofol for sedation in GI endoscopy, preceded by dedicated training courses, has been approved by several anaesthesiologist and gastroenterologist societies but an Italian position paper taking into account the Italian law is lacking. In the present document, the Italian Society of Digestive Endoscopy (SIED) Sedation Group, on behalf of the SIED, presents a series of updated position statements concerning propofol sedation in GI endoscopy. The paper summarizes the advantages of propofol, how it should be administered and how patients should be monitored. Moreover, details concerning proper training of non-anaesthesiologist personnel involved in its use are provided. Protocols concerning propofol use s must be shared with the hospital's anaesthesiology staff and approved by the hospital's Executive Director.
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Affiliation(s)
- Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Ospedale S. Agostino-Estense Hospital/Hospital-University Institution, Modena, Italy.
| | - Lorella Fanti
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele, University-Scientific Institute San Raffaele, Milan, Italy
| | - Mauro Manno
- Digestive Endoscopy Unit, Ospedale di Carpi, Ramazzini Hospital, Carpi, Modena, Italy
| | - Piero Brosolo
- Gastroenterology Unit, Ospedale S. Maria degli Angeli Hospital, Pordenone, Italy
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Lin OS. Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction. Intest Res 2017; 15:456-466. [PMID: 29142513 PMCID: PMC5683976 DOI: 10.5217/ir.2017.15.4.456] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 02/07/2023] Open
Abstract
Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continue to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals (monitored anesthesia care) or whether properly trained non-anesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation. The deployment of non-anesthesia administered propofol sedation for low-risk procedures allows for optimal allocation of scarce anesthesia resources, which can be more appropriately used for more complex cases. This can address some of the current shortages in anesthesia provider supply, and can potentially reduce overall health care costs without sacrificing sedation quality. This review will discuss efficacy, safety, efficiency, cost and satisfaction issues with various modes of sedation for non-advanced, non-emergent endoscopic procedures, mainly esophagogastroduodenoscopy and colonoscopy.
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Affiliation(s)
- Otto S Lin
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
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Yamashita E, Murata T, Goto E, Fujiwara T, Sasaki T, Minami K, Nakamura K, Kumagai K, Naito S, Kario K, Oshima S. Inferior Vena Cava Compression as a Novel Maneuver to Detect Patent Foramen Ovale: A Transesophageal Echocardiographic Study. J Am Soc Echocardiogr 2017; 30:292-299. [DOI: 10.1016/j.echo.2016.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Indexed: 11/29/2022]
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Sathananthan D, Young E, Nind G, George B, Ashby A, Drummond S, Redel K, Green N, Singh R. Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy. Endosc Int Open 2017; 5:E110-E115. [PMID: 28210707 PMCID: PMC5305421 DOI: 10.1055/s-0042-121667] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Physician-directed nurse-administered balanced propofol sedation (PhD NAPS) in patients undergoing endoscopy and/or colonoscopy is being increasingly utilized worldwide. However, this method of sedation is not universally employed in Australian hospitals due to concerns surrounding its safety. The aim of this study was to assess the safety of PhD NAPS in low-risk patients undergoing endoscopy and/or colonoscopy. Patients and methods This study was conducted at a single tertiary teaching hospital in Adelaide, Australia. It was a prospective study involving 1000 patients with an ASA score of 1 - 3 presenting with any indication for endoscopy, colonoscopy or both. A total of 981 patients (451 male) with a mean age of 53 years (range: 16 - 87) were recruited from January 2010 to October 2012. 440 endoscopies, 420 colonoscopies, and 121 combined procedures were performed. The intra-procedural adverse events (AEs) were recorded. Results There were no major intra-procedural adverse events. Minor AEs occurred in 6.42 % of patients, and resolved spontaneously or with intravenous fluid boluses in all cases. Conclusion PhD NAPS is safe when the proceduralist and nursing staff are adequately trained and strict patient selection criteria are used.
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Affiliation(s)
| | - Edward Young
- University of Adelaide Medical School, Adelaide, South Australia
| | - Garry Nind
- Lyell McEwin Hospital – Gastroenterology, Adelaide, South Australia
| | - Biju George
- Lyell McEwin Hospital – Gastroenterology, Adelaide, South Australia
| | - Angelie Ashby
- University of Adelaide/Lyell McEwin Hospital, Endoscopy Unit, Elizabeth Vale, South Australia
| | - Sharon Drummond
- University of Adelaide/Lyell McEwin Hospital, Endoscopy Unit, Elizabeth Vale, South Australia
| | - Kasia Redel
- University of Adelaide/Lyell McEwin Hospital, Endoscopy Unit, Elizabeth Vale, South Australia
| | - Neville Green
- Lyell McEwin Hospital – Anaesthetics, Elizabeth Vale, South Australia
| | - Rajvinder Singh
- Lyell McEwin Hospital – Gastroenterology, Adelaide, South Australia
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Wadhwa V, Issa D, Garg S, Lopez R, Sanaka MR, Vargo JJ. Similar Risk of Cardiopulmonary Adverse Events Between Propofol and Traditional Anesthesia for Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2017; 15:194-206. [PMID: 27451091 DOI: 10.1016/j.cgh.2016.07.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Even though propofol use for gastrointestinal endoscopic procedures has increased over the past decade, there is a perception that it causes a higher rate of cardiopulmonary adverse events. The aim of this study was to compare the sedation-related adverse events associated with use of propofol vs nonpropofol agents for endoscopic procedures. We also wanted to determine the influence of duration or complexity of the procedures and endoscopist-directed (gastroenterologist) vs non-gastroenterologist-directed sedation on the outcomes. METHODS A search was conducted using Medline, EMBASE, and the Cochrane controlled trials registry. The following cardiopulmonary adverse events were assessed: hypoxia, hypotension, and arrhythmias. The procedures were divided into 2 groups based on the procedure length: a nonadvanced endoscopic procedure group consisting of esophagogastroduodenoscopy, colonoscopy, and sigmoidoscopy, and an advanced endoscopic procedures group including endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, balloon enteroscopy, and endoscopic submucosal dissection. Pooled odds ratios for complications were calculated for all the procedures combined and then separately for the 2 groups. Random-effects models were used for 2-proportion comparisons. RESULTS Of the 2117 citations identified, 27 original studies qualified for this meta-analysis and included 2518 patients. Of these, 1324 received propofol, and 1194 received midazolam, meperidine, pethidine, remifentanil, and/or fentanyl. Most of the included studies were randomized trials of moderate quality and nonsignificant heterogeneity (Cochran Q, 26.07; P = .13). Compared with traditional sedative agents, the pooled odds ratio with the use of propofol for developing hypoxia for all the procedures combined was 0.82 (95% confidence interval [CI], 0.63-1.07), and for developing hypotension was 0.92 (95% CI, 0.64-1.32). In the nonadvanced endoscopic procedure group, those who received propofol were 39% less likely to develop complications than those receiving traditional sedative agents (odds ratio, 0.61; 95% CI, 0.38-0.99). There was no difference in the complication rate for the advanced endoscopic procedure group (odds ratio, 0.86; 95% CI, 0.56-1.34). A subgroup analysis did not show any difference in adverse events when propofol was administered by gastroenterologists or nongastroenterologists. CONCLUSIONS Propofol sedation has a similar risk of cardiopulmonary adverse events compared with traditional agents for gastrointestinal endoscopic procedures. Propofol use in simple endoscopic procedures was associated with a decreased number of complications. When used for gastrointestinal endoscopic procedures of a complex nature and longer duration, propofol was not associated with increased rates of hypoxemia, hypotension, or arrhythmias. Administration of propofol by gastroenterologists does not appear to increase the complication rates.
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Affiliation(s)
- Vaibhav Wadhwa
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, Ohio
| | - Danny Issa
- Department of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia
| | - Sushil Garg
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Rocio Lopez
- Department of Biostatistics, Cleveland Clinic, Cleveland, Ohio
| | - Madhusudhan R Sanaka
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
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Safety of Propofol Used as a Rescue Agent During Colonoscopy. J Clin Gastroenterol 2016; 50:e77-80. [PMID: 26565970 DOI: 10.1097/mcg.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOAL The goal of this study was to evaluate the safety of propofol when used by gastroenterologists in patients who have an inadequate response to standard sedation (narcotics and benzodiazepines). BACKGROUND Many patients fail to achieve adequate sedation from narcotics and benzodiazepines during colonoscopy. The administration of propofol for colonoscopy is increasing, although its use by gastroenterologists is controversial. STUDY We performed a retrospective review of our hospital's colonoscopy records from January 2006 to December 2009 to identify 403 subjects undergoing screening colonoscopies who required propofol (20 to 30 mg every 3 min as needed) because of inadequate response to standard sedation. We also randomly selected 403 controls undergoing screening colonoscopies from the same time period that only required standard sedation. The incidence of adverse effects was then compared. RESULTS There were no major adverse events in either group. The rates of minor adverse events in the propofol and control group were 0.02 and 0.01, respectively (P=0.56). Adverse effects in the propofol group included: transient hypotension (n=1), nausea/vomiting (n=3), agitation (n=2), and rash (n=1). Adverse effects seen with standard sedation included: transient hypotension (n=2), nausea/vomiting (n=1), and oversedation (n=2). Patients who received propofol were more likely to be younger, had a history of illicit drug use, and a longer procedure time (P<0.05). CONCLUSIONS Adjunctive propofol administered by gastroenterologist for conscious sedation was not associated with increased incidence of adverse events. It may be of value in patients who do not respond to conventional sedation.
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Kashiwagi K, Hosoe N, Takahashi K, Nishino H, Miyachi H, Kudo SE, Martin JF, Ogata H. Prospective, randomized, placebo-controlled trial evaluating the efficacy and safety of propofol sedation by anesthesiologists and gastroenterologist-led teams using computer-assisted personalized sedation during upper and lower gastrointestinal endoscopy. Dig Endosc 2016; 28:657-64. [PMID: 27176122 DOI: 10.1111/den.12678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/28/2016] [Accepted: 05/09/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM No randomized controlled studies comparing propofol versus no sedation have been reported. Comparative data demonstrating the efficacy and safety of propofol sedation by anesthesiologists (ANES), and gastroenterologist-led teams (GLT) using computer-assisted personalized sedation (CAPS), during routine gastrointestinal (GI) endoscopy in Japan do not exist. We aimed to demonstrate the safety and efficacy of propofol sedation versus no sedation (PLCB) when propofol is given by ANES or GLT, during routine GI endoscopy. METHODS Two hundred and seventy two American Society of Anesthesiologists (ASA) class I or II adults were prospectively enrolled in this multicenter study and randomized into three groups (PLCB, ANES, GLT). Ability to maintain moderate sedation, defined as MOAA/S scores of 2-4 for ≥50% of all MOAA/S measurements from scope-in to scope-out, was the primary endpoint. Secondary endpoints included patient (PSSI) and clinician (CSSI) satisfaction. RESULTS Proportion of subjects maintained in moderate sedation by ANES (88.1%) and GLT (94.5%) was significantly higher than PLCB (21.6%; P < 0.001); there was no difference between the ANES and GLT groups (P = 0.116). Mean PSSI scores for subjects sedated by ANES (81.2 ± 12.5) and GLT (80.8 ± 14.1) were significantly higher than PLCB (65.3 ± 19.7; P < 0.001) and mean CSSI scores were also significantly higher in both active treatment groups (75.5 ± 10.2, 77.9 ± 10.3) than PLCB (60.8 ± 18.6; P < 0.001). CONCLUSION Moderate sedation can be achieved and maintained with propofol, improving both patient and physician satisfaction, when propofol is given by an anesthesiologist or a gastroenterologist-led team using CAPS.
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Affiliation(s)
- Kazuhiro Kashiwagi
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Keiji Takahashi
- Matsushima Clinic Coloproctology Center Matsushima Hospital, Yokohama-city, Japan
| | - Haruo Nishino
- Matsushima Clinic Coloproctology Center Matsushima Hospital, Yokohama-city, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama-city, Yokohama, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama-city, Yokohama, Japan
| | | | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
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Abstract
The term, non-operating room anesthesia, describes a location remote from the main operating suites and closer to the patient, including areas that offer specialized procedures, like endoscopy suites, cardiac catheterization laboratories, bronchoscopy suites, and invasive radiology suites. There has been an exponential growth in such procedures and they present challenges in both organizational aspects and administration of anesthesia. This article explores the requirements for the location, preoperative evaluation and patient selection, monitoring, anesthesia technique, and postoperative management at these sites. There is a need to better define the role of the anesthesia personnel at these remote sites.
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Affiliation(s)
- Sekar Bhavani
- Institute of Anesthesiology, CCLCM, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Servatius H, Höfeler T, Hoffmann BA, Sultan A, Lüker J, Schäffer B, Willems S, Steven D. Propofol sedation administered by cardiologists for patients undergoing catheter ablation for ventricular tachycardia. Europace 2016; 18:1245-51. [DOI: 10.1093/europace/euv303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/10/2015] [Indexed: 01/28/2023] Open
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Xie X, Bai JY, Fan CQ, Yang X, Zhao XY, Dong H, Yang SM, Yu J. Application of clip traction in endoscopic submucosal dissection to the treatment of early esophageal carcinoma and precancerous lesions. Surg Endosc 2016; 31:462-468. [PMID: 27126625 DOI: 10.1007/s00464-016-4939-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/09/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM It is usually difficult to obtain a good view of the dissection plane during esophageal endoscopic submucosal dissection (ESD). Therefore, the aim of this study was to investigate the efficacy and safety of clip traction in ESD for the treatment of early esophageal carcinoma (EEC) or precancerous lesions. METHODS This is a case-matched comparative study. We selected 100 EEC patients who had undergone ESD. Fifty cases underwent ESD without clip traction (non-clip group), and 50 cases underwent ESD with clip traction (clip group). The patient-related variables, dissection time, data regarding muscularis propria injury, etc. were statistically analyzed. RESULTS ESD was successful in all cases without complication. There were no significant differences between the two groups with respect to age, gender, the longitudinal diameter of the lesions, etc. Wide visual field exposure of the submucosal tissue below the lesion was obtained by applying clip traction. The dissection time of ESD was shorter in the clip group than in the non-clip group [22.02 (6.77) min vs 26.48 (12.56); P = 0.018] when the extent of lesion was less than half of the circumference of the esophagus; otherwise, there was no difference between the two groups (P = 0.252). Moreover, the muscularis propria injuries in the clip group were obviously less than the non-clip group (10 vs 30 %, P = 0.007). CONCLUSION Clip traction can decrease the rate of muscularis propria injury and shorten the dissection time. It is recommended as a safe and effective auxiliary procedure for the treatment of esophageal ESD.
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Affiliation(s)
- Xia Xie
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Jian-Ying Bai
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Chao-Qiang Fan
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Xin Yang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Xiao-Yan Zhao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Hui Dong
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Shi-Ming Yang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China.
| | - Jing Yu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China.
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Wernli KJ, Brenner AT, Rutter CM, Inadomi JM. Risks Associated With Anesthesia Services During Colonoscopy. Gastroenterology 2016; 150:888-94; quiz e18. [PMID: 26709032 PMCID: PMC4887133 DOI: 10.1053/j.gastro.2015.12.018] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/02/2015] [Accepted: 12/13/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS We aimed to quantify the difference in complications from colonoscopy with vs without anesthesia services. METHODS We conducted a prospective cohort study and analyzed administrative claims data from Truven Health Analytics MarketScan Research Databases from 2008 through 2011. We identified 3,168,228 colonoscopy procedures in men and women, aged 40-64 years old. Colonoscopy complications were measured within 30 days, including colonic (ie, perforation, hemorrhage, abdominal pain), anesthesia-associated (ie, pneumonia, infection, complications secondary to anesthesia), and cardiopulmonary outcomes (ie, hypotension, myocardial infarction, stroke), adjusted for age, sex, polypectomy status, Charlson comorbidity score, region, and calendar year. RESULTS Nationwide, 34.4% of colonoscopies were conducted with anesthesia services. Rates of use varied significantly by region (53% in the Northeast vs 8% in the West; P < .0001). Use of anesthesia service was associated with a 13% increase in the risk of any complication within 30 days (95% confidence interval [CI], 1.12-1.14), and was associated specifically with an increased risk of perforation (odds ratio [OR], 1.07; 95% CI, 1.00-1.15), hemorrhage (OR, 1.28; 95% CI, 1.27-1.30), abdominal pain (OR, 1.07; 95% CI, 1.05-1.08), complications secondary to anesthesia (OR, 1.15; 95% CI, 1.05-1.28), and stroke (OR, 1.04; 95% CI, 1.00-1.08). For most outcomes, there were no differences in risk with anesthesia services by polypectomy status. However, the risk of perforation associated with anesthesia services was increased only in patients with a polypectomy (OR, 1.26; 95% CI, 1.09-1.52). In the Northeast, use of anesthesia services was associated with a 12% increase in risk of any complication; among colonoscopies performed in the West, use of anesthesia services was associated with a 60% increase in risk. CONCLUSIONS The overall risk of complications after colonoscopy increases when individuals receive anesthesia services. The widespread adoption of anesthesia services with colonoscopy should be considered within the context of all potential risks.
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Affiliation(s)
- Karen J. Wernli
- Group Health Research Institute, Seattle, Washington,Department of Health Services, University of Washington, Seattle, Washington
| | - Alison T. Brenner
- Department of Health Services, University of Washington, Seattle, Washington,Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington
| | - Carolyn M. Rutter
- Group Health Research Institute, Seattle, Washington,RAND Corporation, Santa Monica, California
| | - John M. Inadomi
- Department of Health Services, University of Washington, Seattle, Washington,Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington
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Affiliation(s)
- Douglas K Rex
- Department of Medicine, Indiana University Hospital, Indianapolis, Indiana.
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Pérez-Cuadrado Robles E, González Ramirez A, Lancho Seco Á, Martí Marqués E, Dacal Rivas A, Castro Ortiz E, González Soler R, Álvarez Suárez B, Tardáguila García D, López Baz A, Fernández López A, López Roses L. Safety and risk factors for difficult endoscopist-directed ERCP sedation in daily practice: a hospital-based case-control study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:240-5. [DOI: 10.17235/reed.2016.4206/2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nonaka S, Kawaguchi Y, Oda I, Nakamura J, Sato C, Kinjo Y, Abe S, Suzuki H, Yoshinaga S, Sato T, Saito Y. Safety and effectiveness of propofol-based monitored anesthesia care without intubation during endoscopic submucosal dissection for early gastric and esophageal cancers. Dig Endosc 2015; 27:665-73. [PMID: 25652131 DOI: 10.1111/den.12457] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/02/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) becomes more difficult with an increased risk of complications if patient sedation is insufficient. We assessed the safety and effectiveness of propofol-based monitored anesthesia care (MAC) without intubation during ESD for early esophageal cancer (EEC) or early gastric cancer (EGC) in the endoscopy room. METHODS We investigated 1013 consecutive patients with 1126 lesions who underwent ESD for EGC/EEC with either MAC or regular sedation by endoscopists (control group) between July 2010 and March 2013. Patient characteristics, endoscopic findings, technical results, body movement, oxygen saturation (SpO2 ), and drug dosages were then examined. RESULTS MAC was carried out in 137 EGC (16%) and 82 EEC patients (57%), whereas regular sedation was used in 731 EGC (84%) and 63 EEC patients (43%). MAC was conducted in 21% of all ESD procedures. In the MAC and control groups, body movement requiring a third person for control occurred in 30 (22%) and 533 (72%) cases during gastric ESD (P < 0.0001) and in 36 (44%) and 53 (84%) cases during esophageal ESD (P < 0.0001), respectively. The median minimum SpO2 was significantly lower in the MAC group than in the control group during both gastric and esophageal ESD (96% vs 98%, P < 0.0001; 96% vs 98%, P < 0.0004, respectively). MAC did not cause any adverse effects requiring prolongation of hospitalization. CONCLUSIONS Propofol-based MAC without intubation provided a safer treatment environment by significantly reduced body movement and was very effective for difficult cases requiring longer procedure times or more powerful sedation.
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Affiliation(s)
- Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yosuke Kawaguchi
- Departments of Anesthesiology and Critical Care Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Nakamura
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Chiko Sato
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuzuru Kinjo
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Tetsufumi Sato
- Departments of Anesthesiology and Critical Care Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Chan MTV, Wu WKK, Tang RSY. Optimizing depth of sedation for colonoscopy. Can J Anaesth 2015; 62:1143-8. [PMID: 26307188 DOI: 10.1007/s12630-015-0462-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/13/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- Matthew T V Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - William K K Wu
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Digestive Disease, Department of Medicine & Therapeutics and LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raymond S Y Tang
- State Key Laboratory of Digestive Disease, Department of Medicine & Therapeutics and LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Garah J, Adiv OE, Rosen I, Shaoul R. The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children. J Clin Monit Comput 2015; 29:773-8. [PMID: 25666393 DOI: 10.1007/s10877-015-9665-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 01/27/2015] [Indexed: 12/15/2022]
Abstract
The Integrated Pulmonary Index (IPI) is an algorithm included in commercially available monitors that constitutes a representation of 4 parameters: EtCO2, RR, SpO2 and PR. The IPI index has been validated for adults and children older than 1 year of age. In this study we aimed to study the value of IPI monitoring during pediatric endoscopic procedures. Our data consisted of 124 measurements of 109 patients undergoing different procedures (upper endoscopy 84 patients, colonoscopy 6 patients, both 9 patients). The data was divided into 3 groups based on the drug type used: propofol only, 5 patients (group 1); propofol & midazolam, 89 patients (group 2); propofol, midazolam and Fentanyl, 15 patients (group 3). Patients in group 2 and 3 had significantly higher IPI levels than group 1. Significantly lower IPI values were found between ages 4-6 compared to 7-12 years old. High midazolam dose was associated with lower IPI levels during the procedure. No significant differences were found for propofol doses. Patients who had an anesthetist present had lower IPI levels during the procedure compared to those who did not. No differences were noted between the different procedures. IPI alerted all apnea episodes (58 events, IPI = 1) and hypoxia (26 events, IPI ≤ 3) episodes, whereas pulse oximetry captured only the hypoxia episodes (IPI sensitivity = 1, specificity 0.98, positive predictive value 0.95). Younger patient age, use of propofol alone, higher midazolam doses and presence of anesthetist are all associated with lower IPI levels.
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Affiliation(s)
- Jamal Garah
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel.,Technion Faculty of the Medicine, Haifa, Israel
| | - Orly Eshach Adiv
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel.,Technion Faculty of the Medicine, Haifa, Israel
| | - Irit Rosen
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel.,Technion Faculty of the Medicine, Haifa, Israel
| | - Ron Shaoul
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel. .,Technion Faculty of the Medicine, Haifa, Israel.
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Imagawa A, Hata H, Nakatsu M, Matsumi A, Ueta E, Suto K, Terasawa H, Sakae H, Takeuchi K, Fujihara M, Endo H, Yasuhara H, Ishihara S, Kanzaki H, Jinno H, Kamada H, Kaji E, Moriya A, Ando M. A target-controlled infusion system with bispectral index monitoring of propofol sedation during endoscopic submucosal dissection. Endosc Int Open 2015; 3:E2-6. [PMID: 26134767 PMCID: PMC4423246 DOI: 10.1055/s-0034-1377519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/11/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Propofol administration via a target-controlled infusion system with bispectral index monitoring (BIS/TCI system) is expected to prevent complications from sedation during complex and long endoscopic procedures. We evaluated the feasibility of setting the BIS/TCI system for non-anesthesiologist administration of propofol (NAAP) during endoscopic submucosal dissection (ESD). PATIENTS AND METHODS From May 2009 to February 2013, 250 patients with esophagogastric neoplasms were treated with ESD using the BIS/TCI system with NAAP. In the TCI system, the initial target blood concentration of propofol was set at 1.2 μg/mL. The titration speed of propofol was adjusted according to the BIS score and the movement of the patient. The BIS target level ranged from moderate to deep sedation, at which a stable BIS score between 60 and 80 was obtained. RESULTS In 80.4 % of patients, it was possible to maintain stable sedation with a blood concentration of propofol of less than 1.6 µg/mL using TCI throughout the ESD procedure. The default setting for ideal blood concentration of propofol was 1.2 μg/mL, because the medians of the lower and upper bounds of blood concentration were 1.2 μg/mL (range 0.6 - 1.8 μg/mL) and 1.4 μg/mL (range 1.0 - 3.8 μg/mL), respectively. Although hypotension occurred in 27 patients (10.8 %), oxygen desaturation occurred in only nine patients (3.6 %), and severe desaturation in only two patients (0.8 %). CONCLUSIONS Using our settings, it is possible for a non-anesthesiologist to maintain stable sedation during a lengthy endoscopic procedure through propofol sedation with a BIS/TCI system.
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Affiliation(s)
- Atsushi Imagawa
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan,Corresponding author Atsushi Imagawa, MD PhD Department of GastroenterologyMitoyo General Hospital708 HimehamaToyohamaKan-onjiKagawaJapan 769-1695+81-875-524936
| | - Hidenori Hata
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Morihito Nakatsu
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Akihiro Matsumi
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Eijiro Ueta
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Kozue Suto
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Hiroyuki Terasawa
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Hiroyuki Sakae
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Keiko Takeuchi
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Manabu Fujihara
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Hitomi Endo
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Hisae Yasuhara
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Shinichi Ishihara
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Hideki Jinno
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Hidenori Kamada
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Eisuke Kaji
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Akio Moriya
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
| | - Masaharu Ando
- Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan
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Capnography improves detection of apnea during procedural sedation for percutaneous transhepatic cholangiodrainage. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2014; 27:582-6. [PMID: 24106730 DOI: 10.1155/2013/852454] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Capnography provides noninvasive monitoring of ventilation and can enable early recognition of altered respiration patterns and apnea. OBJECTIVE To compare the detection of apnea and the prediction of oxygen desaturation and hypoxemia using capnography versus clinical surveillance during procedural sedation for percutaneous transhepatic cholangiodrainage (PTCD). METHODS Twenty consecutive patients scheduled for PTCD were included in the study. All patients were sedated during the procedure using midazolam and propofol. Aside from standard monitoring, additional capnographic monitoring was used and analyzed by an independent observer. RESULTS The mean (± SD) cumulative duration of apnea demonstrated by capnography was significantly longer than the mean cumulative duration of clinically detected apnea (207.5 ± 348.8 s versus 8.2 ± 17.9 s; P=0.015). The overall number of detected episodes of apnea was also significantly different (113 versus seven; P=0.012). There were 15 events of oxygen desaturation (decrease in oxygen saturation [SaO2] ≥ 5%), which were predicted in eight of 15 cases by capnography and in one of 15 cases by clinical observation. There were three events of hypoxemia (SaO2 <90%) that were predicted in three of three cases by capnography and in one of three cases by clinical observation. CONCLUSION Capnographic monitoring was superior to clinical surveillance in the detection of apnea and in the prediction of oxygen desaturation during procedural sedation for PTCD.
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Lee TH, Lee CK. Endoscopic sedation: from training to performance. Clin Endosc 2014; 47:141-50. [PMID: 24765596 PMCID: PMC3994256 DOI: 10.5946/ce.2014.47.2.141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 12/24/2022] Open
Abstract
Adequate sedation and analgesia are considered essential requirements to relieve patient discomfort and pain and ultimately to improve the outcomes of modern gastrointestinal endoscopic procedures. The willingness of patients to undergo sedation during endoscopy has increased steadily in recent years and standard sedation practices are needed for both patient safety and successful procedural outcomes. Therefore, regular training and education of healthcare providers is warranted. However, training curricula and guidelines for endoscopic sedation may have conflicts according to varying legal frameworks and/or social security systems of each country, and well-recognized endoscopic sedation training systems are not currently available in all endoscopy units. Although European and American curricula for endoscopic sedation have been extensively developed, general curricula and guidelines for each country and institution are also needed. In this review, an overview of recent curricula and guidelines for training and basic performance of endoscopic sedation is presented based on the current literature.
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Affiliation(s)
- Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Chang Kyun Lee
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Calderwood AH, Chapman FJ, Cohen J, Cohen LB, Collins J, Day LW, Early DS. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointest Endosc 2014; 79:363-72. [PMID: 24485393 PMCID: PMC3980655 DOI: 10.1016/j.gie.2013.12.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 12/12/2022]
Abstract
Historically, safety in the gastrointestinal (GI) endoscopy unit has focused on infection control, particularly around the reprocessing of endoscopes. Two highly publicized outbreaks where the transmission of infectious agents were related to GI endoscopy have highlighted the need to address potential gaps along the endoscopy care continuum that could impact patient safety.
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Sieg A, Beck S, Scholl SG, Heil FJ, Gotthardt DN, Stremmel W, Rex DK, Friedrich K. Safety analysis of endoscopist-directed propofol sedation: a prospective, national multicenter study of 24 441 patients in German outpatient practices. J Gastroenterol Hepatol 2014; 29:517-23. [PMID: 24716213 DOI: 10.1111/jgh.12458] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Since 2008, there exists a German S3-guideline allowing non-anesthesiological administration of propofol for gastrointestinal endoscopy. In this prospective, national, multicenter study, we evaluated the safety of endoscopist-administered propofol sedation (EDP) in German outpatient practices of Gastroenterology. METHODS In this multicenter survey of 53 ambulatory practices of Gastroenterology, we prospectively evaluated 24 441 patients that had received EDP. We recorded adverse events during the endoscopic procedure and additionally retrieved questionnaires investigating subjective parameters 24 h after the endoscopic procedure. RESULTS In 24 441 patients 13 793 colonoscopies, 6467 esophagogastroduodenoscopies, and 4181 double examinations were performed. In this study, 52.1% of the patients received propofol mono-sedation, and 47.9% received a combination of midazolam and propofol. Major adverse events occurred in four patients (0.016%) enrolled to this study (three mask ventilations and one laryngospasm). Minor adverse events were observed in 112 patients (0.46%) with hypoxemia being the most common minor event. All patients with adverse events recovered without persistent impairment. Minor adverse events occurred more frequently in patients sedated with propofol mono compared to propofol and midazolam (P < 0.0001) and correlated with increasing propofol dosages (P < 0.001; Pearson correlation coefficient r = 0.044). Twenty-four hours after the endoscopy, patients sedated with propofol plus midazolam stated a significantly reduced sensation of pain (P < 0.01) and improved symptoms of dizziness, nausea and vomiting (P < 0.001) compared to patients having received propofol mono-sedation. CONCLUSION Four years after the implementation of a German S3-Guideline for endoscopic sedation, we demonstrated that EDP is a safe procedure.
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Chiaretti A, Benini F, Pierri F, Vecchiato K, Ronfani L, Agosto C, Ventura A, Genovese O, Barbi E. Safety and efficacy of propofol administered by paediatricians during procedural sedation in children. Acta Paediatr 2014; 103:182-7. [PMID: 24138461 DOI: 10.1111/apa.12472] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/23/2013] [Accepted: 10/16/2013] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to determine the safety and the efficacy of paediatrician-administered propofol in children undergoing different painful procedures. METHODS We conducted a retrospective study over a 12-year period in three Italian hospitals. A specific training protocol was developed in each institution to train paediatricians administering propofol for painful procedures. RESULTS In this study, 36,516 procedural sedations were performed. Deep sedation was achieved in all patients. None of the children experienced severe side effects or prolonged hospitalisation. There were six calls to the emergency team (0.02%): three for prolonged laryngospasm, one for bleeding, one for intestinal perforation and one during lumbar puncture. Nineteen patients (0.05%) developed hypotension requiring saline solution administration, 128 children (0.4%) needed O2 ventilation by face mask, mainly during upper endoscopy, 78 (0.2%) patients experienced laryngospasm, and 15 (0.04%) had bronchospasm. There were no differences in the incidence of major complications among the three hospitals, while minor complications were higher in children undergoing gastroscopy. CONCLUSION This multicentre study demonstrates the safety and the efficacy of paediatrician-administered propofol for procedural sedation in children and highlights the importance of appropriate training for paediatricians to increase the safety of this procedure in children.
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Affiliation(s)
- Antonio Chiaretti
- Department of Paediatrics; Catholic University Medical School; Rome Italy
| | - Franca Benini
- Department of Paediatrics; Paediatric Pain and Palliative Care Service; University of Padua; Padua Italy
| | - Filomena Pierri
- Department of Paediatric Oncology; Catholic University Medical School; Rome Italy
| | - Katy Vecchiato
- Paediatric Residency; University of Trieste; Trieste Italy
| | - Luca Ronfani
- Epidemiology and Biostatistics Unit; Institute for Maternal and Child Health - “IRCCS “Burlo Garofolo”; Trieste Italy
| | - Caterina Agosto
- Department of Paediatrics; Paediatric Pain and Palliative Care Service; University of Padua; Padua Italy
| | - Alessandro Ventura
- Department of Paediatrics; Institute for Maternal and Child Health - “IRCCS “Burlo Garofolo”; Trieste Italy
| | - Orazio Genovese
- Paediatric Intensive Care Unit; Catholic University Medical School; Rome Italy
| | - Egidio Barbi
- Department of Paediatrics; Institute for Maternal and Child Health - “IRCCS “Burlo Garofolo”; Trieste Italy
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Dietrich CG, Kottmann T, Diedrich A, Drouven FM. Sedation-associated complications in endoscopy are not reduced significantly by implementation of the German S-3-guideline and occur in a severe manner only in patients with ASA class III and higher. Scand J Gastroenterol 2013; 48:1082-7. [PMID: 23834761 DOI: 10.3109/00365521.2013.812237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The German guideline for sedation in gastrointestinal endoscopy was published in 2008. Several recommendations in this guideline, especially concerning staffing and structural requirements for sedation, have low evidence and therefore are subject to discussion in the field. AIM Comparison of endoscopic complications in a department specialized for gastrointestinal and pulmological diseases before and after implementation of the German guideline grouped in sedation-associated and non-sedation-associated complications. METHODS Prospective documentation of complications with retrospective analysis of two patient groups (before guideline: 1.5.2008-30.4.2010; after guideline: 1.5.2010-30.4.2012) at which the sedation technique remained the same (balanced propofol sedation, BPS). RESULTS Both investigation periods covered almost 7000 procedures. Interventional and general complications were nonsignificantly elevated in the latter group (1.27% before vs. 1.55% after guideline, p = 0.08). Saturation decline (in both groups 0.26%) was unchanged, and circulation-associated complications (0.27% vs. 0.13%, p = 0.07) were reduced nonsignificantly. Necessity for the administration of flumazenil and for intensive care monitoring was reduced in a nonsignificant manner after the implementation of the guideline. Severe complications (reanimation, apnea, and death) were unchanged, and no patient with ASA I-II suffered from a severe complication. Propofol consumption was higher after guideline implementation. CONCLUSIONS The recommendations of the new German sedation guideline do not significantly reduce complications in endoscopic procedures. Especially, procedures involving patients with ASA classes I and II do not require an additional staff member solely for sedation. Prospective randomized studies might be necessary to optimize the utilization of resources.
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Affiliation(s)
- Christoph G Dietrich
- Medical Clinic, Bethlehem-Hospital, Academic Affiliated Hospital of the Technical University Aachen, Stolberg/Rhld, Germany.
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Umar M, Ali Khan H, Ahmed M, tul-Bushra H, Nisar G. Safety of Nonanesthesiologist-administered Propofol
Sedation in Endoscopic Ultrasound. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
IMPORTANCE Deep sedation for endoscopic procedures has become an increasingly used option but, because of impairment in patient response, this technique also has the potential for a greater likelihood of adverse events. The incidence of these complications has not been well studied at a population level. DESIGN Population-based study. SETTING AND PARTICIPANTS Using a 5% random sample of cancer-free Medicare beneficiaries who resided in one of the regions served by a SEER (Surveillance, Epidemiology, and End Results) registry, we identified all procedural claims for outpatient colonoscopy without polypectomy from January 1, 2000, through November 30, 2009. INTERVENTION Colonoscopy without polypectomy, with or without the use of deep sedation (identified by a concurrent claim for anesthesia services). MAIN OUTCOME MEASURES The occurrence of hospitalizations for splenic rupture or trauma, colonic perforation, and aspiration pneumonia within 30 days of the colonoscopy. RESULTS We identified a total of 165 527 procedures in 100 359 patients, including 35 128 procedures with anesthesia services (21.2%). Selected postprocedure complications were documented after 284 procedures (0.17%) and included aspiration (n = 173), perforation (n = 101), and splenic injury (n = 12). (Some patients had >1 complication.) Overall complications were more common in cases with anesthesia assistance (0.22% [95% CI, 0.18%-0.27%]) than in others (0.16% [0.14%-0.18%]) (P < .001), as was aspiration (0.14% [0.11%-0.18%] vs 0.10% [0.08%-0.12%], respectively; P = .02). Frequencies of perforation and splenic injury were statistically similar. Other predictors of complications included age greater than 70 years, increasing comorbidity, and performance of the procedure in a hospital setting. In multivariate analysis, use of anesthesia services was associated with an increased complication risk (odds ratio, 1.46 [95% CI, 1.09-1.94]). CONCLUSIONS AND RELEVANCE Although the absolute risk of complications is low, the use of anesthesia services for colonoscopy is associated with a somewhat higher frequency of complications, specifically, aspiration pneumonia. The differences may result in part from uncontrolled confounding, but they may also reflect the impairment of normal patient responses with the use of deep sedation.
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Affiliation(s)
- Gregory S Cooper
- Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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Al-Awabdy B, Wilcox CM. Use of anesthesia on the rise in gastrointestinal endoscopy. World J Gastrointest Endosc 2013; 5:1-5. [PMID: 23330047 PMCID: PMC3547114 DOI: 10.4253/wjge.v5.i1.1] [Citation(s) in RCA: 22] [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: 08/02/2012] [Revised: 09/25/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023] Open
Abstract
Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate sedation. Often time's deep sedation is required for procedures such as endoscopic retrograde cholangiography which necessitates higher doses of narcotics and benzodiazepines or even use of other medications such as ketamine. Given its pharmacologic properties, propofol was rapidly adopted worldwide to gastrointestinal endoscopy for complex procedures and more recently to routine upper and lower endoscopy. Many studies have shown superiority for both the physician and patient compared to standard sedation. Nevertheless, its use remains highly controversial. A number of studies worldwide show that propofol can be given safely by endoscopists or nurses when well trained. Despite this wealth of data, at many centers its use has been prohibited unless administered by anesthesiology. In this commentary, we review the use of anesthesia support for endoscopy in the United States based on recent data and its implications for gastroenterologists worldwide.
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Affiliation(s)
- Basil Al-Awabdy
- Basil Al-Awabdy, C Mel Wilcox, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
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A much sought-after drug--propofol sedation for GI endoscopy: always better but who cares? Dig Dis Sci 2012; 57:1980-2. [PMID: 22744431 DOI: 10.1007/s10620-012-2282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 06/07/2012] [Indexed: 12/09/2022]
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Beitz A, Riphaus A, Meining A, Kronshage T, Geist C, Wagenpfeil S, Weber A, Jung A, Bajbouj M, Pox C, Schneider G, Schmid RM, Wehrmann T, von Delius S. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol 2012; 107:1205-12. [PMID: 22641306 DOI: 10.1038/ajg.2012.136] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this randomized study was to determine whether intervention based on additional capnographic monitoring reduces the incidence of arterial oxygen desaturation during propofol sedation for colonoscopy. METHODS Patients (American Society of Anesthesiologists classification (ASA) 1-3) scheduled for colonoscopy under propofol sedation were randomly assigned to either a control arm with standard monitoring (standard arm) or an interventional arm in which additional capnographic monitoring (capnography arm) was available. In both study arms, detection of apnea or altered respiration induced withholding propofol administration, stimulation of the patient, chin lift maneuver, or further measures. The primary study end point was the incidence of arterial oxygen desaturation (defined as a fall in oxygen saturation (SaO(2)) of ≥5% or <90%); secondary end points included the occurrences of hypoxemia (SaO(2) <90%), severe hypoxemia (SaO(2) ≤85%), bradycardia, hypotension, and the quality of sedation (patient cooperation and patient satisfaction). RESULTS A total of 760 patients were enrolled at three German endoscopy centers. The intention-to-treat analysis revealed a significant reduction of the incidence of oxygen desaturation in the capnography arm in comparison with the standard arm (38.9% vs. 53.2%; P<0.001). The numbers of patients with a fall in SaO(2) <90% and ≤85% were also significantly different (12.5% vs. 19.8%; P=0.008 and 3.7 vs. 7.8%; P=0.018). There were no differences regarding the rates of bradycardia and hypotension. Quality of sedation was similar in both groups. Results of statistical analyses were maintained for the per-protocol population. CONCLUSIONS Additional capnographic monitoring of ventilatory activity reduces the incidence of oxygen desaturation and hypoxemia during propofol sedation for colonoscopy.
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Affiliation(s)
- Analena Beitz
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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