Adult and pediatric anesthesia/sedation for gastrointestinal procedures outside of the operating room

Acute and Chronic Effects of Fin Amputation on Behavior Performance of Adult Zebrafish in 3D Locomotion Test Assessed with Fractal Dimension and Entropy Analyses and Their Relationship to Fin Regeneration

Simple Summary

Fin amputation is a routinely conducted procedure for various experiments, especially in zebrafish. However, no study compares the acute and chronic effects of the amputation of each fin on their behaviors. In addition, although some analgesics have been applied after the fin amputation procedure, the long-term effects of these drugs in have not been evaluated yet. In this study, we found that amputation in the caudal fin resulted in the most pronounced behavior alterations and their behavior was fully recovered before the caudal fin was fully regenerated, indicating that these behavioral changes came from pain elicited from the fin amputation. Finally, while lidocaine treatment could ameliorate the behavioral effects after the amputation procedure, it did not accelerate the behavior recovery process; instead, it caused the fish to display some slight side effects.

Abstract

The fin is known to play an important role in swimming for many adult fish, including zebrafish. Zebrafish fins consist of paired pectoral and pelvic with unpaired dorsal, anal, and caudal tail fins with specific functions in fish locomotion. However, there was no study comparing the behavior effects caused by the absence of each fin. We amputated each fin of zebrafish and evaluated their behavior performance in the 3D locomotion test using fractal dimension and entropy analyses. Afterward, the behavior recovery after the tail fin amputation was also evaluated, together with the fin regeneration process to study their relationship. Finally, we conducted a further study to confirm whether the observed behavior alterations were from pain elicited by fin amputation procedure or not by using lidocaine, a pain-relieving drug. Amputation in the caudal fin resulted in the most pronounced behavior alterations, especially in their movement complexity. Furthermore, we also found that their behavior was fully recovered before the caudal fin was fully regenerated, indicating that these behavioral changes were not majorly due to a mechanical change in tail length; instead, they may come from pain elicited from the fin amputation, since treatment with lidocaine could ameliorate the behavioral effects after the amputation procedure. However, lidocaine did not accelerate the behavior recovery process; instead, it caused the fishes to display some slight side effects. This study highlights the potential moderate severity of fin amputation in zebrafish and the importance of analgesia usage. However, side effects may occur and need to be considered since fin amputation is routinely conducted for various research, especially genomic screening.

Effects of intravenous lidocaine on alfentanil consumption during procedural sedation for colonoscopy in patients with inflammatory bowel disease: a randomized controlled trial

Background: Procedural sedation and analgesia (PSA) is used during colonoscopy to facilitate the procedure and relieve patient’s discomfort. The foremost risk of PSA is respiratory depression. Lidocaine could be a promising additional analgesic in IBD patients to minimise side effects of PSA. Objective: Our primary objective was to investigate whether i.v. lidocaine reduces the amount of alfentanil used during PSA in IBD patients. Additionally, we investigated whether lidocaine reduces cardiorespiratory incidents and the amount of propofol required during the procedure. Design: A randomized, double-blind, placebo controlled study. Setting: Single-center study from November 2016 to December 2018. Methods: Seventy-six patients with IBD, ASA 1 or 2, between 18 and 65 years, scheduled for colonoscopy with PSA were included. Exclusion criteria were: pregnancy, emergency colonoscopy, allergies for study medication, rhythm disorders, cardiomyopathy, BMI < 18 kg m -2 , BMI > 35 kg m -2 , obstructive sleep apnea syndrome and uncontrolled hypertension. Patients received lidocaine 1.5 mg kg -1 followed by a continuous infusion of 2 mg kg -1 h -1 (intervention group, n=38) or 0.9% saline in equivalent volumes (control group, n=38) during colonoscopy. Main outcome measures: Amount of alfentanil and propofol used during the interventional procedure. Cardiorespiratory events as defined in methods during the colonoscopy. Results: There was a not statistically significant reduction in the use of alfentanil [327 µg (95%CI=-31-505, p=0.082)] and propofol [39 mg (95%CI=-5-83, p=0.083)] in the lidocaine group compared with the control group. Ten patients (26%) in the control group and 8 patients in the lidocaine group (21%) experienced a period of hypoxia (p=0.788). In both groups, no periods of hypotension were noted. Conclusion: Our investigation has shown a trend for reduced alfentanil and propofol consumption in patients receiving lidocaine during colonoscopy under sedation. The differences were not statistically significant. Lidocaine did not reduce the incidence of cardiorespiratory events.

Evaluation of bispectral index monitoring efficacy in endoscopic patients who underwent retrograde cholangiopancreatography and received sedoanalgesia

Introduction

Bispectral index (BIS) monitoring provides an objective, non-invasive measurement of the level of consciousness in a sedated patient.

Aim

In this prospective study, we aimed to investigate the hypothesis that risk of respiratory depression could be reduced and the desired level of sedation with minimal doses of propofol could be achieved by using BIS monitoring in endoscopic retrograde cholangiopancreatography (ERCP) procedures.

Material and methods

Sixty patients in the ASA 1–2 category, who were scheduled for an ERCP with sedation, were randomly divided into two groups. The procedure was performed, and sedation was administered so that the patient’s Ramsay Sedation Score (RSS) would be 4–5 in the first group (group 1) and the patient’s BIS value would be 65–75 in the second group (group 2). Cardiopulmonary complications, the total duration of the procedure, and the total amount of propofol administered were recorded.

Results

The mean SpO₂ measurements at the third minute, fifth minute, and 10^th minute were higher in the BIS group (p < 0.001) (p < 0.05). The mean number of respirations during the third, fifth, 10^th, and 15^th minute of sedation was significantly higher in the RSS group than in the BIS group (p < 0.05). There was no difference between the groups in terms of recovery time, total propofol amount, and additional doses of bolus propofol.

Conclusions

BIS monitoring during sedation with propofol for ERCP did not reduce total propofol use, but it may be an efficient guide for the timing of additional dose administration, which could reduce the risk of respiratory depression, and it could be used safely as an objective method in the follow-up of level of sedation.

Sedation Strategies for Procedures Outside the Operating Room

With the rapid development of diagnostic and therapeutic procedures performed outside the operating room (OR), the need for appropriate sedation care has emerged in importance to ensure the safety and comfort of patients and clinicians. The preparation and administration of sedatives and sedation care outside the OR require careful attention, proper monitoring systems, and clinically useful sedation guidelines. This literature review addresses proper monitoring and selection of sedatives for diagnostic and interventional procedures outside the OR. As the depth of sedation increases, respiratory depression and cardiovascular suppression become serious, necessitating careful surveillance using appropriate monitoring equipment.

Non-Operating Room Anesthesia in the Endoscopy Unit

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.