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Abstract
BACKGROUND In this study, we aimed to assess the diagnostic yield of terminal ileum intubation during routine colonoscopy. MATERIALS AND METHODS We routinely performed terminal ileum intubation in all patients who underwent colonoscopy at Dokuz Eylul University Hospital between February 2014 and June 2015. Two gastroenterology fellows performed colonoscopies in the Central Endoscopy Unit. Demographic data of patients, indications of colonoscopies, cecum and ileum intubation rate/time, and endoscopic and histopathologic findings of the terminal ileum were all assessed. RESULTS A total of 1310 consecutive patients (726 female and 584 male, median age: 55.79±14.29 years) underwent colonoscopy during this study period. The colonoscopy was successfully completed in 1144 (87.3%) cases. The terminal ileum was successfully intubated in 1032 (90.2%) cases. The mean time taken to reach the ileum from the cecum was 63.08±64.16 s. Endoscopic abnormalities on the terminal ileum were present in 62 (6%) cases, and biopsies were taken from these patients. However, endoscopic abnormalities were found in 7 and 3.3% of patients who were symptomatic and asymptomatic, respectively. There were statistically significant differences between symptomatic and asymptomatic patients (P=0.02). Clinically significant histopathologic findings were observed in 22 cases, and 12 of the 22 cases were diagnosed as having Crohn's disease. CONCLUSION Terminal ileum intubation is particularly indicated in symptomatic patients. In cases of chronic diarrhea, iron-deficiency anemia, abdominal pain, and suspected inflammatory bowel disease, terminal ileum intubation should be done.
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Anesthesia for Upper GI Endoscopy Including Advanced Endoscopic Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol 2018; 35:6-24. [DOI: 10.1097/eja.0000000000000683] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Shin S, Park CH, Kim HJ, Park SH, Lee SK, Yoo YC. Patient satisfaction after endoscopic submucosal dissection under propofol-based sedation: a small premedication makes all the difference. Surg Endosc 2016; 31:2636-2644. [DOI: 10.1007/s00464-016-5276-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/04/2016] [Indexed: 12/30/2022]
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Tetzlaff JE, Maurer WG. Preprocedural Assessment for Sedation in Gastrointestinal Endoscopy. Gastrointest Endosc Clin N Am 2016; 26:433-41. [PMID: 27372768 DOI: 10.1016/j.giec.2016.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The role of the anesthesia service in sedation for gastrointestinal endoscopy (GIE) has been steadily increasing. The goals of preprocedural assessment are determined by the specific details of the procedure, the issues related to the illness that requires the endoscopy, comorbidities, the goals for sedation, and the risk of complications from the sedation and the endoscopic procedure. Rather than consider these issues as separate entities, they should be considered as part of a continuum of preparation for GIE. This is told from the perspective of an anesthesiologist who regularly participates in the full range of sedation for GIE.
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Affiliation(s)
- John E Tetzlaff
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of General Anesthesia, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
| | - Walter G Maurer
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of General Anesthesia, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
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Shin S, Oh TG, Chung MJ, Park JY, Park SW, Chung JB, Song SY, Cho J, Park SH, Yoo YC, Bang S. Conventional versus Analgesia-Oriented Combination Sedation on Recovery Profiles and Satisfaction after ERCP: A Randomized Trial. PLoS One 2015; 10:e0138422. [PMID: 26402319 PMCID: PMC4581832 DOI: 10.1371/journal.pone.0138422] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/27/2015] [Indexed: 12/28/2022] Open
Abstract
Background The importance of providing effective analgesia during sedation for complex endoscopic procedures has been widely recognized. However, repeated administration of opioids in order to achieve sufficient analgesia may carry the risk of delayed recovery after propofol based sedation. This study was done to compare recovery profiles and the satisfaction of the endoscopists and patients between conventional balanced propofol sedation and analgesia-oriented combination sedation for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods Two hundred and two adult patients scheduled for ERCP were sedated by either the Conventional (initial bolus of meperidine with propofol infusion) or Combination (repeated bolus doses of fentanyl with propofol infusion) method. Recovery profiles, satisfaction levels of the endoscopists and patients, drug requirements and complications were compared between groups. Results Patients of the Combination Group required significantly less propofol compared to the Conventional Group (135.0 ± 68.8 mg vs. 165.3 ± 81.7 mg, P = 0.005). Modified Aldrete scores were not different between groups throughout the recovery period, and recovery times were also comparable between groups. Satisfaction scores were not different between the two groups in both the endoscopists and patients (P = 0.868 and 0.890, respectively). Conclusions Considering the significant reduction in propofol dose, the non-inferiority of recovery profiles and satisfaction scores of the endoscopists and patients, analgesia oriented combination sedation may be a more safe yet effective sedative method compared to conventional balanced propofol sedation during ERCP.
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Affiliation(s)
- Seokyung Shin
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Tak Geun Oh
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Jeong Youp Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Seung Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Jae Bok Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Si Young Song
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Jooyoun Cho
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Sang-Hun Park
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Young Chul Yoo
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
- * E-mail: (SB); (YCY)
| | - Seungmin Bang
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
- * E-mail: (SB); (YCY)
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Park CH, Shin S, Lee SK, Lee H, Lee YC, Park JC, Yoo YC. Assessing the stability and safety of procedure during endoscopic submucosal dissection according to sedation methods: a randomized trial. PLoS One 2015; 10:e0120529. [PMID: 25803441 PMCID: PMC4372558 DOI: 10.1371/journal.pone.0120529] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/21/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although endoscopic submucosal dissection (ESD) is routinely performed under sedation, the difference in ESD performance according to sedation method is not well known. This study attempted to prospectively assess and compare the satisfaction of the endoscopists and patient stability during ESD between two sedation methods. METHODS One hundred and fifty-four adult patients scheduled for ESD were sedated by either the IMIE (intermittent midazolam/propofol injection by endoscopist) or CPIA (continuous propofol infusion by anesthesiologist) method. The primary endpoint of this study was to compare the level of satisfaction of the endoscopists between the two groups. The secondary endpoints included level of satisfaction of the patients, patient's pain scores, events interfering with the procedure, incidence of unintended deep sedation, hemodynamic and respiratory events, and ESD outcomes and complications. RESULTS Level of satisfaction of the endoscopists was significantly higher in the CPIA Group compared to the IMIE group (IMIE vs. CPIA; high satisfaction score; 63.2% vs. 87.2%, P=0.001). The incidence of unintended deep sedation was significantly higher in the IMIE Group compared to the CPIA Group (IMIE vs. CPIA; 17.1% vs. 5.1%, P=0.018) as well as the number of patients showing spontaneous movement or those requiring physical restraint (IMIE vs. CPIA; spontaneous movement; 60.5% vs. 42.3%, P=0.024, physical restraint; 27.6% vs. 10.3%, P=0.006, respectively). In contrast, level of satisfaction of the patients were found to be significantly higher in the IMIE Group (IMIE vs. CPIA; high satisfaction score; 85.5% vs. 67.9%, P=0.027). Pain scores of the patients, hemodynamic and respiratory events, and ESD outcomes and complications were not different between the two groups. CONCLUSION Continuous propofol and remifentanil infusion by an anesthesiologist during ESD can increase the satisfaction levels of the endoscopists by providing a more stable state of sedation. TRIAL REGISTRATION ClinicalTrials.gov NCT01806753.
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Affiliation(s)
- Chan Hyuk Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Seokyung Shin
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Lee
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
| | - Young Chul Yoo
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Shin S, Lee SK, Min KT, Kim HJ, Park CH, Yoo YC. Sedation for interventional gastrointestinal endoscopic procedures: are we overlooking the “pain”? Surg Endosc 2014; 28:100-7. [PMID: 23959522 DOI: 10.1007/s00464-013-3133-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 07/19/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although interventional gastrointestinal (GI) endoscopic procedures are known to cause greater pain and discomfort than diagnostic procedures, the efficacy of adequate pain control or the difference in pain and amount of analgesic required according to type of intervention is not well known. This study was done to investigate the safety and efficacy of combining fentanyl with propofol for interventional GI endoscopic procedures and determine whether this method is superior to propofol monosedation. METHODS The data of 810 patients that underwent interventional GI endoscopic procedures under sedation with either propofol alone (Group P, n = 499) or propofol/fentanyl (Group PF, n = 311) at a single tertiary-care hospital between May 2012 and December 2012 were retrospectively reviewed. Rates of respiratory and cardiovascular events, propofol and fentanyl requirements, and risk factors of respiratory events of the two groups were analyzed. RESULTS The incidence of respiratory events (P = 0.001), number of cases in which the procedure had to be interrupted for assisted mask bagging (P = 0.044), and propofol infusion rates were significantly lower in Group PF compared to Group P (P < 0.0001). The amount of fentanyl required for diagnostic procedures was significantly lower than that for interventional procedures (P < 0.001). Patients of Group PF showed a lower risk of developing respiratory events compared to Group P (OR 0.224, 95 % CI 0.069–0.724). CONCLUSIONS Combining fentanyl with propofol seems to reduce the risk of respiratory events compared with propofol monosedation during GI endoscopic procedures by providing effective analgesia.
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Tetzlaff JE, Vargo JJ, Maurer W. Nonoperating room anesthesia for the gastrointestinal endoscopy suite. Anesthesiol Clin 2014; 32:387-394. [PMID: 24882126 DOI: 10.1016/j.anclin.2014.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Anesthesia services are increasingly being requested for gastrointestinal (GI) endoscopy procedures. The preparation of the patients is different from the traditional operating room practice. The responsibility to optimize comorbid conditions is also unclear. The anesthetic techniques are unique to the procedures, as are the likely events that require intervention by the anesthesia team. The postprocedure care is also unique. The future needs for anesthesia services in GI endoscopy suite are likely to expand with further developments of the technology.
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Affiliation(s)
- John E Tetzlaff
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - John J Vargo
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Walter Maurer
- Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Coadministration of the AMPAKINE CX717 with propofol reduces respiratory depression and fatal apneas. Anesthesiology 2013; 118:1437-45. [PMID: 23542802 DOI: 10.1097/aln.0b013e318291079c] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Propofol (2,6-diisopropylphenol) is used for the induction and maintenance of anesthesia in human and veterinary medicine. Propofol's disadvantages include the induction of respiratory depression and apnea. Here, the authors report a clinically feasible pharmacological solution for reducing propofol-induced respiratory depression via a mechanism that does not interfere with anesthesia. Specifically, they test the hypothesis that the AMPAKINE CX717, which has been proven metabolically stable and safe for human use, can prevent and rescue from propofol-induced severe apnea. METHODS The actions of propofol and the AMPAKINE CX717 were measured via (1) ventral root recordings from newborn rat brainstem-spinal cord preparations, (2) phrenic nerve recordings from an adult mouse in situ working heart-brainstem preparation, and (3) plethysmographic recordings from unrestrained newborn and adult rats. RESULTS In vitro, respiratory depression caused by propofol (2 μM, n = 11, mean ± SEM, 41 ± 5% of control frequency, 63 ± 5% of control duration) was alleviated by CX717 (n = 4, 50-150 μM). In situ, a decrease in respiratory frequency (44 ± 9% of control), phrenic burst duration (66 ± 7% of control), and amplitude (78 ± 5% of control) caused by propofol (2 μM, n = 5) was alleviated by coadministration of CX717 (50 μM, n = 5). In vivo, pre- or coadministration of CX717 (20-25mg/kg) with propofol markedly reduced propofol-induced respiratory depression (n = 7; 20mg/kg) and propofol-induced lethal apnea (n = 6; 30 mg/kg). CONCLUSIONS Administration of CX717 before or in conjunction with propofol provides an increased safety margin against profound apnea and death.
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Backman ES, Triant VA, Ehrenfeld JM, Lu Z, Arpino P, Losina E, Gandhi RT. Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy. HIV Med 2013; 14:379-84. [PMID: 23332038 DOI: 10.1111/hiv.12014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Because of concerns regarding interactions between midazolam and antiretroviral therapy (ART), alternative sedatives are sometimes used during procedural sedation. Our objective was to compare outcomes in patients on ART who received intravenous (iv) midazolam vs. iv diazepam, a second-line agent, during colonoscopy. METHODS We conducted a retrospective analysis of adult HIV-positive patients who underwent colonoscopy over a 3.5-year period. Primary outcomes were sedation duration, nadir systolic blood pressure (SBP), nadir oxygen saturation, abnormal cardiac rhythm, and change in level of consciousness using a standardized scale. We calculated rates of adverse events according to benzodiazepine use and identified risk factors for complications using univariate and multivariate analyses. RESULTS We identified 136 patients for this analysis: 70 received midazolam-based sedation and 66 received a diazepam-based regimen. There were no significant differences between the two groups with respect to sedation duration (mean 48.0 vs. 45.7 minutes for the midazolam and diazepam groups, respectively; P = 0.68), nadir SBP (mean 97.0 vs. 101.6 mmHg; P = 0.06), nadir oxygen saturation (mean 94.6 vs. 94.8%; P = 0.72) or rate of abnormal cardiac rhythm (11.4 vs. 19.7%; P = 0.18). More patients in the midazolam group experienced a depressed level of consciousness (91% vs. 74% in the diazepam group; P = 0.0075), but no patient required reversal of sedation or became unresponsive. CONCLUSIONS We did not find evidence that patients who received midazolam for procedural sedation had clinical outcomes statistically different from those who received diazepam. These findings should be confirmed in prospective studies or in a randomized controlled trial.
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Affiliation(s)
- E S Backman
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA 02114, USA.
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Fabbri LP, Nucera M, Marsili M, Al Malyan M, Becchi C. Ketamine, propofol and low dose remifentanil versus propofol and remifentanil for ERCP outside the operating room: is ketamine not only a "rescue drug"? Med Sci Monit 2012; 18:CR575-80. [PMID: 22936194 PMCID: PMC3560648 DOI: 10.12659/msm.883354] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 01/17/2012] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography ERCP is a painful and long procedure requiring transient deep analgesia and conscious sedation. An ideal anaesthetic that guarantees a rapid and smooth induction, good quality of maintenance, lack of adverse effects and rapid recovery is still lacking. This study aimed to compare safety and efficacy of a continuous infusion of low dose remifentanil plus ketamine combined with propofol in comparison to the standard regimen dose of remifentanil plus propofol continuous infusion during ERCP. MATERIAL/METHODS 322 ASAI-III patients, 18-85 years old and scheduled for planned ERCP were randomized. Exclusion criteria were a predictable difficult airway, drug allergy, and ASA IV-V patients. We evaluated Propofol 1 mg/kg/h plus Remifentanil 0.25 µg/kg/min (GR) vs. Propofol 1 mg/kg/h plus Ketamine 5 µg/kg/min and Remifentanil 0.1 µg/kg/min (GK). Main outcome measures were respiratory depression, nausea/vomiting, quality of intraoperative conditions, and discharge time. P≤0.05 was statistically significant (95% CI). RESULTS Respiratory depression was observed in 25 patients in the GR group compared to 9 patients in the GK group (p=0.0035). ERCP was interrupted in 9 cases of GR vs. no cases in GK; patients ventilated without any complication. Mean discharge time was 20±5 min in GK and 35±6 min in GR (p=0.0078) and transfer to the ward delayed because of nausea and vomiting in 30 patients in GR vs. 5 patients in GK (p=0.0024). Quality of intraoperative conditions was rated highly satisfactory in 92% of GK vs. 67% of GR (p=0.028). CONCLUSIONS The drug combination used in GK confers clinical advantages because it avoids deep sedation, maintains adequate analgesia with conscious sedation, and achieves lower incidence of postprocedural nausea and vomiting with shorter discharge times.
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Affiliation(s)
- Lea Paola Fabbri
- Anaesthesia and Intensive Care, Departmen. of Medical and Surgical Specialties, AOUC Careggi, Florence, Italy
| | - Maria Nucera
- Anaesthesia and Intensive Care, Departmen. of Medical and Surgical Specialties, AOUC Careggi, Florence, Italy
| | - Massimo Marsili
- Anaesthesia and Intensive Care, Departmen. of Medical and Surgical Specialties, AOUC Careggi, Florence, Italy
| | | | - Chiara Becchi
- Anaesthesia and Intensive Care, Departmen. of Medical and Surgical Specialties, AOUC Careggi, Florence, Italy
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González-Huix Lladó F, Giné Gala JJ, Loras Alastruey C, Martinez Bauer E, Dolz Abadia C, Gómez Oliva C, Llach Vila J. [Position statement of the Catalan Society of Digestology on sedation in gastrointestinal endoscopy]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:496-511. [PMID: 22633657 DOI: 10.1016/j.gastrohep.2012.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 03/21/2012] [Indexed: 12/27/2022]
Affiliation(s)
- Ferran González-Huix Lladó
- Servei d'Aparell Digestiu, Unitat d'Endoscòpia, Hospital Universitari Doctor Josep Trueta, Girona, España.
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Schaufele MK, Marín DR, Tate JL, Simmons AC. Adverse events of conscious sedation in ambulatory spine procedures. Spine J 2011; 11:1093-100. [PMID: 21920824 DOI: 10.1016/j.spinee.2011.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 05/20/2011] [Accepted: 07/29/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Interventional spine procedures are commonly performed in the ambulatory surgical setting, often using conscious sedation. The rate of adverse events with conscious sedation has not been previously assessed in the interventional spine procedure setting. PURPOSE The goal of this study was to determine the rate of adverse events when using conscious sedation in the ambulatory interventional spine setting. STUDY DESIGN A retrospective cohort chart review analysis was performed on all interventional spine procedures performed during one calendar year at a university-affiliated ambulatory surgery center by six nonanesthesia-trained spine interventionalists. PATIENT SAMPLE Of the 3,342 procedures performed that year, 2,494 charts (74.6%) were available for review. OUTCOME MEASURES Adverse events were documented immediately after the procedure and at a maximum 3-day follow-up phone call. METHODS The rate and type of adverse events were analyzed and compared between those who received conscious sedation with local anesthesia and those who received local anesthesia alone. RESULTS Of the 2,494 cases reviewed, 1,228 spine procedures were performed with local anesthesia and conscious sedation, and 1,266 procedures were performed with local anesthesia alone. Of these cases, 66 immediate adverse events (5.12%) were documented in the conscious sedation group, and 61 immediate adverse events (4.82%) were documented in the local anesthesia alone group. At maximum 3-day follow-up, 670 patients of the conscious sedation group were available for contact, and 699 patients were available from the local anesthesia group. Thirty-two adverse events (4.77%) were noted in the conscious sedation group, and 28 adverse events (4.00%) were noted in the local anesthesia group. Comparison of these rates found no significant statistical difference. However, patients in the local anesthesia group had a significantly higher rate of postoperative hypertension. Adverse events reported both immediately and at follow-up were determined to be mild, with no serious adverse events reported. CONCLUSION The findings of this study suggest that mild to moderate conscious sedation in interventional spine procedures is associated with low rates of adverse events when established protocols are followed.
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Affiliation(s)
- Michael K Schaufele
- Emory Orthopaedics & Spine Center, Emory Healthcare, 59 Executive Park South, Atlanta, GA 30329, USA.
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Zubek L, Szabó L, Gál J, Lakatos PL, Papp J, Elo G. [General anesthesia during double balloon enteroscopy--Hungarian experiences]. Orv Hetil 2010; 151:1976-82. [PMID: 21084249 DOI: 10.1556/oh.2010.28935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Double balloon enteroscopy needs sufficient sedation technique, because the examination is uncomfortable and lengthy. The most prevalent sedation method is conscious sedation world-wide. AIM To demonstrate that double balloon enteroscopy examination can also be safely performed in general anesthesia with intubation and that this method can be an option in patients with severe multiple morbidities. METHODS A retrospective evaluation of intubation narcosis in patients undergoing double balloon enteroscopy was performed at the 1st Department of Internal Medicine, Semmelweis University. Patients were grouped based on gender, age and physical state. Anesthesia records included the duration of anesthesia, the quantities of medications used and anesthesia-related complications. RESULTS Data obtained from 108 general anesthesia cases were analyzed. There were no permanent anesthesia-related complications in the period examined. The most frequent side effects of anesthesia were hypotension (30.55%), desaturation (21.29%), and apnea (17.59%). These complications were significantly more frequent among patients with multiple morbidities; however, their incidence was not proportional with the quantity of the medications used or the duration of anesthesia. CONCLUSION The findings confirm that the most important advantage of general anesthesia over other methods is that it ensures stable airways, which makes it easy to counter-act frequent complications such as desaturation, apnea and aspiration. The number of complications of anesthesia was higher among patients with multiple morbidities, but these complications could be easily overcome in all patient groups. Therefore, this method is highly recommended for patients with multiple morbidities. Intubation narcosis can be also a viable option of conscious sedation for patients without co-morbidities.
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Affiliation(s)
- László Zubek
- Semmelweis Egyetem, Általános Orvostudományi Kar Aneszteziológiai és Intenzív Terápiás Klinika Budapest Kútvölgyi út 4. 1125.
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Abstract
A 2007 survey of members of the Society of Gastroenterology Nurses and Associates identified a need for more evidence regarding sedation medications including propofol. Therefore, the Cochrane Database of Systematic Reviews, Cochrane Database of Randomized Clinical Trials, MEDLINE, CINAHL, EMBASE, and the National Guideline Clearinghouse (http://www.guideline.gov) databases were individually searched using the term propofol, limited to human, English, 2000-2009, review articles, and randomized clinical trials. A total of 46 resources contributed to this review, with emphasis on 16 studies ranging from retrospective chart reviews to double-blind, randomized controlled trials. Nonanesthesia personnel-administered propofol, including that administered by specially trained nurses under the supervision of an endoscopist, appears to be safe with minor, easily resolved, adverse events occurring in less than 1% of patients. These minor adverse events included four studies reporting hypoxemia requiring occasional intervention, three studies reporting hypotension, and two studies reporting bradycardia. No patients required tracheal intubation, and no deaths were reported.
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Zubek L, Szabo L, Lakatos PL, Papp J, Gal J, Elo G. Double balloon enteroscopy examinations in general anesthesia. World J Gastroenterol 2010; 16:3418-22. [PMID: 20632445 PMCID: PMC2904889 DOI: 10.3748/wjg.v16.i27.3418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 04/26/2010] [Accepted: 05/03/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To demonstrate that the double balloon enteroscopy (DBE) can be safely performed in general anesthesia with intubation. METHODS We performed a retrospective examination between August 2005 and November 2008 among patients receiving intubation narcosis due to DBE examination. The patients were grouped based on sex, age and physical status. Anesthesia records included duration of anesthesia, quantity of medication used and anesthesia-related complications. We determined the frequency of complications in the different groups and their relation with the quantity of medication used and the duration of anesthesia. RESULTS We compiled data for 108 cases of general anesthesia with intubation. We did not observe any permanent anesthesia-related complications; the most frequent side effects of anesthesia were hypotension (30.55%), desaturation (21.29%), and apnea (17.59%). These complications were significantly more frequent among patients with multiple additional diseases [hypotension (23.1% vs 76.9%, P = 0.005), de-saturation (12.3% vs 69.2%, P < 0.001) and apnea (7.7% vs 53.8%, P = 0.001)], however, their incidence was not proportional to the quantity of medication used or the duration of anesthesia. CONCLUSION General anesthesia with intubation is definitely a viable option among DBE methods. It is highly recommended in patients with multiple additional diseases.
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Abstract
Traditionally, sedation for gastrointestinal endoscopic procedures was provided by the gastroenterologist. Increasingly, however, complex procedures are being performed on seriously ill patients. As a result, anesthesiologists now are providing anesthesia and sedation in the gastrointestinal endoscopy suite for many of these patients. This article reviews the challenges encountered in this environment and anesthetic techniques that can be used successfully for these procedures.
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Affiliation(s)
- Daniel T Goulson
- Department of Anesthesiology, University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY 40536, USA.
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Schmittner MD, Janke A, Weiss C, Beck GC, Bussen DG. Practicability and patients' subjective experiences of low-dose spinal anaesthesia using hyperbaric bupivacaine for transanal surgery. Int J Colorectal Dis 2009; 24:827-36. [PMID: 19283391 DOI: 10.1007/s00384-009-0681-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2009] [Indexed: 02/04/2023]
Abstract
PURPOSE The safety, effectiveness and long lasting post-operative analgesia make spinal anaesthesia in saddle block technique an "ideal" method for transanal surgery. To improve patient satisfaction and offer reliable operation conditions to surgeons, this study quantifies practicability and patients' subjective experiences with this technique. METHODS Within a 5-month period, 400 consecutive patients undergoing transanal surgery in saddle block technique were evaluated by a standardised questionnaire. RESULTS The success rate of spinal anaesthesia was 99.5%. Side effects occurred far less frequently as mentioned in the literature. The duration of the sensory block was about twice as long as the time until first mobilisation and micturition. Despite some negative experiences during the procedure, 92% of the investigated patients would choose a saddle block again. CONCLUSIONS Both from reasons of practicability and from patients' view, spinal anaesthesia in saddle block technique can be thoroughly recommended for transanal surgery. Patients undergoing a stapler haemorrhoidectomy should receive additional opioids.
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Affiliation(s)
- Marc D Schmittner
- Clinic of Anaesthesiology and Critical Care Medicine, University Hospital Mannheim, Mannheim, Germany.
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Peláez R, Aguilar JL, Segura C, Fermández S, Mendiola MA, Forner JC. [Experience of an interdisciplinary anesthesiology and nursing team for providing anesthesia outside the operating room]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:92-96. [PMID: 19334657 DOI: 10.1016/s0034-9356(09)70338-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To report on the creation and development of an interdisciplinary anesthesiology and nursing team to provide anesthesia outside the operating room. MATERIAL AND METHODS We describe the creation of an interdisciplinary team and preanesthesia evaluation protocols for using nurses specializing in anesthesia for procedures outside the operating room. We analyzed the anesthetic procedures performed outside the operating room, the rate of suspensions due to failure of the procedure, and their impact on the rate of associated complications, from October 2006 to October 2007. RESULTS Since the start of the project, 586 procedures outside the operating room have been performed. No suspensions or delays were observed that were due to comorbidity not detected in the preanesthesia evaluation carried out by the nurses. The incidences of complications and inadequate sedations were comparable to those reported for other similar interdisciplinary groups in this area. CONCLUSIONS The creation of an interdisciplinary team of anesthesiologists and specialized nurses for providing anesthesia outside the operating room optimizes resources and improves routine clinical practice. It has allowed for universal preanesthesia evaluation, improved the distribution of resources, and proven a stimulus to the care-giving process.
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Affiliation(s)
- R Peláez
- Servicio de Anestesiología, Reanimación y Terapia del dolor, Hospital Son Llàtzer
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