1
|
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
| |
Collapse
|
2
|
Lorenz P, Wehrmann T, Riphaus A, Eckardt AJ, Klare P, Koop I, Fischer N, Jansen PL. Leitlinienreport der aktualisierten S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e628-e653. [PMID: 37678314 DOI: 10.1055/a-2124-5746] [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)
- Pia Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - 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 Koop
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Deutschland
| | - Nadine Fischer
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| |
Collapse
|
3
|
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
| |
Collapse
|
4
|
Eknemar M, Persson F, Nilsson A. Patients' Experiences of Patient-Controlled Sedation: An Interview Study of Patients who Underwent Endoscopy. J Perianesth Nurs 2022; 37:883-888. [PMID: 35595604 DOI: 10.1016/j.jopan.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Patient-controlled sedation (PCS) allows patients to self-administer sedative drugs during endoscopic retrograde cholangiopancreatography (ERCP). There is a paucity of research on the experiences of patients who used PCS. Therefore the purpose of this study was to describe the perioperative experiences of patients who used PCS during ERCP. DESIGN Prospective study using semi-structured interviews. METHODS Qualitative content analysis facilitated a latent understanding of the manifest content. FINDINGS Eleven interviews revealed three main themes and underlying categories that summarized the patient experience: participation (control and perioperative sedation); communication (personnel, information, safety, insecurity, and concern); and sensation (effects and side effects). CONCLUSIONS The participatory experience of PCS resulted not from the opportunity for patient involvement but, rather, the establishment of a patient-professional relationship. Specifically, the interactions between patients and health care professionals played a vital role in the patients' overall experience of PCS.
Collapse
Affiliation(s)
- Marcus Eknemar
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, Malmö, Sweden
| | - Fredrik Persson
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, Linköping, Region Östergötland, Sweden
| | - Andreas Nilsson
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, Linköping, Region Östergötland, Sweden.
| |
Collapse
|
5
|
Matsubayashi M, Nakamura K, Sugawara M, Kamishima S. Nursing Difficulties and Issues in Endoscopic Sedation: Qualitative Research in Japan. Gastroenterol Nurs 2022; 45:174-183. [PMID: 34310465 PMCID: PMC9154304 DOI: 10.1097/sga.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/30/2021] [Indexed: 11/27/2022] Open
Abstract
Gastrointestinal endoscopic treatments have increased in Japan. Respiratory depression is as an unexpected development during sedation. This study aimed to clarify the sedation-related difficulties encountered by nurses involved in endoscopic treatment. Participants were five nurses who had worked for more than a year in the endoscopy department of a gastrointestinal endoscopy specialist guidance facility in Sapporo. Semistructured interviews were conducted. The number of recording units obtained was 129, which were divided into 12 categories and subdivided into 42 subcategories. The nursing practice difficulties related to sedation in endoscopic treatment were classified into two major categories: "difficulties in nursing practice" and "system difficulties." All of the "difficulty in nursing practice" items were role-fulfilling difficulties involved in protecting patient safety and reducing anxiety and discomfort. Four of these items reflected difficulties related particularly to the role of the nurse in charge of the sedated patient in the endoscopy room. To reduce the difficulties encountered by nurses, a treatment environment system must be devised to ensure patient safety and improve the education support system for nurses with regard to sedation.
Collapse
Affiliation(s)
- Miki Matsubayashi
- Correspondence to: Miki Matsubayashi, MSN, Social Medical Corporation Sousei Hospital, 288 Oazakitajima, Kadoma City, Osaka, Japan ()
| | - Keiko Nakamura
- Miki Matsubayashi, MSN, is Clinical Nurse, Social Medical Corporation Sousei Hospital, Kadoma City, Osaka, Japan
- Keiko Nakamura, DNP, is Specially Appointed Professor, Acute Illness, Adult Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
- Miki Sugawara, DNP, is Associate Professor, Acute Illness, Adult Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
- Shigeko Kamishima, DNP, is Associate Professor, Acute Illness, Adult Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| | - Miki Sugawara
- Miki Matsubayashi, MSN, is Clinical Nurse, Social Medical Corporation Sousei Hospital, Kadoma City, Osaka, Japan
- Keiko Nakamura, DNP, is Specially Appointed Professor, Acute Illness, Adult Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
- Miki Sugawara, DNP, is Associate Professor, Acute Illness, Adult Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
- Shigeko Kamishima, DNP, is Associate Professor, Acute Illness, Adult Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| | - Shigeko Kamishima
- Miki Matsubayashi, MSN, is Clinical Nurse, Social Medical Corporation Sousei Hospital, Kadoma City, Osaka, Japan
- Keiko Nakamura, DNP, is Specially Appointed Professor, Acute Illness, Adult Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
- Miki Sugawara, DNP, is Associate Professor, Acute Illness, Adult Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
- Shigeko Kamishima, DNP, is Associate Professor, Acute Illness, Adult Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| |
Collapse
|
6
|
Wang P, Chen Y, Guo Y, Cao J, Wang H, Mi W, Xu L. Comparison of propofol-nalbuphine and propofol-fentanyl sedation for patients undergoing endoscopic retrograde cholangiopancreatography: a double-blind, randomized controlled trial. BMC Anesthesiol 2022; 22:47. [PMID: 35172747 PMCID: PMC8848940 DOI: 10.1186/s12871-022-01578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly used to treat patients with biliary/pancreatic duct obstruction or stricture outside the operating room. Effective and safe sedation techniques are needed because of painful stimuli and the long duration of the ERCP procedure.Nalbuphine has been shown to cause less respiratory depression during sedation than similar cases without nalbuphine. This study compared the effects of propofol-nalbuphine (PN) and propofol-fentanyl (PF) sedation in patients undergoing ERCP. Methods Four hundred patients scheduled for ERCP procedures were divided into two groups: the PF group (receiving PF sedation,n = 199) and the PN group (receiving PN sedation,n = 201). Vital signs, adverse events during surgery, patient movement scores, pain scores, and adverse events one day post-ERCP were recorded. Results Stable haemodynamics were observed in both groups.Compared to the PF group, the PN group showed significantly decreased respiratory depression (P < 0.0001) and surgical interruptions (P = 0.048).Nalbuphine decreased patient movement by reducing pain from ERCP. Conclusion Nalbuphine, instead of fentanyl, precipitated less respiratory depression while permitting adequate/equivalent sedation for ERCP and therefore provides more efficient and safer sedation. Trial registration ChiCTR, ChiCTR1800016018, Registered 7 May 2018, http://www.chictr.org.cn/showproj.aspx?proj=27085
Collapse
Affiliation(s)
- Peiqi Wang
- Department of Anaesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yan Chen
- Department of Anaesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ying Guo
- Department of Anaesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiangbei Cao
- Department of Anaesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hong Wang
- Department of Anaesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Weidong Mi
- Department of Anaesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Longhe Xu
- Department of Anaesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China. .,Department of Anaesthesiology, The Third Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| |
Collapse
|
7
|
Dietrich CF, Bekkali NL, Burmeister S, Dong Y, Everett SM, Hocke M, Ignee A, On W, Hebbar S, Oppong K, Sun S, Jenssen C, Braden B. Controversies in ERCP: Indications and preparation. Endosc Ultrasound 2021; 11:186-200. [PMID: 34677145 PMCID: PMC9258020 DOI: 10.4103/eus-d-21-00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of the series of papers on controversies of biliopancreatic drainage procedures is to discuss the pros and cons of the varying clinical practices and techniques in ERCP and EUS for drainage of biliary and pancreatic ducts. The first part focuses on indications, clinical and imaging prerequisites before ERCP, sedation options, post-ERCP pancreatitis (PEP) prophylaxis, and other related technical topics. In the second part, specific procedural ERCP-techniques including precut techniques and its timing as well as management algorithms are discussed. In addition, controversies in EUS-guided bile duct and pancreatic drainage procedures are under preparation.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, China; Johann Wolfgang Goethe University, Frankfurt/Main, Germany; Department of Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Noor L Bekkali
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sean Burmeister
- Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Meiningen, Germany
| | - Andre Ignee
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany
| | - Wei On
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Srisha Hebbar
- University Hospitals of North Midlands, North Midlands, United Kingdom
| | - Kofi Oppong
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Markisch-Oderland, Strausberg; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| |
Collapse
|
8
|
Patient-Controlled Sedation Versus Clinician-Administered Sedation for Endoscopic Retrograde Cholangiopancreatography: A Systematic Review. Anesth Analg 2021; 134:765-772. [PMID: 34543253 DOI: 10.1213/ane.0000000000005766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patient-controlled sedation (PCS) has been explored as a sedation method in endoscopic retrograde cholangiopancreatography (ERCP), yet a comprehensive review article on this topic is lacking. We performed a systematic review to compare PCS against clinician-administered sedation. The primary objectives are to compare the sedative dosage used and the sedation depth, while secondary objectives are to compare sedation failure rates, clinician intervention rates, and patient satisfaction. A systematic literature search was conducted on MEDLINE, EMBASE, and the Cochrane Library Database using the terms "ERCP," "Sedation," "Patient-controlled," and related terms. Randomized controlled trials comparing PCS against clinician-administered sedation in adults undergoing ERCP were included. Articles without English full texts were excluded. Studies were reviewed by 2 independent reviewers. The Cochrane Risk of Bias tool was used for quality assessment of individual included trials. This systematic review is registered in the International Prospective Register of Systematic Reviews (CRD42020198647). A total of 2619 articles were identified from the literature search. A total of 2615 articles were excluded based on the exclusion criteria. Four articles (comprised of 4 independent trials involving 425 patients) were included in analysis. When compared with clinician-administered sedation, PCS in ERCP may lead to lower propofol dosage used and lower sedation depth. The sedation failure rates appear to be higher in PCS, whereas lower rates of airway maneuvers are required. No significant difference was observable for patient satisfaction rates between PCS and clinician-administered sedation. The included studies demonstrated unclear to high risk of bias, particularly in randomization, incomplete outcome data, and outcome measurement. PCS appears to be a feasible option for sedation in ERCP. Nonetheless, large-scale, high-quality trials will be required before PCS can be regularly implemented in ERCP.
Collapse
|
9
|
Grossmann B, Nilsson A, Sjöberg F, Bernfort L, Nilsson L. Response Letter to the editor. Acta Anaesthesiol Scand 2021; 65:279-280. [PMID: 33296499 PMCID: PMC8221024 DOI: 10.1111/aas.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin Grossmann
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
- Department of Anaesthesia and Intensive Care Linköping University Hospital Linköping Sweden
| | - Andreas Nilsson
- Department of Anaesthesia and Intensive Care Linköping University Hospital Linköping Sweden
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Folke Sjöberg
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
- Department of Hand and Plastic Surgery and Intensive Care Linköping University Hospital Linköping Sweden
| | - Lars Bernfort
- Division of Health Care Analysis Linköping University Linköping Sweden
| | - Lena Nilsson
- Department of Anaesthesia and Intensive Care Linköping University Hospital Linköping Sweden
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| |
Collapse
|
10
|
Patient-controlled Sedation During Flexible Bronchoscopy: A Randomized Controlled Trial. J Bronchology Interv Pulmonol 2020; 27:77-85. [PMID: 31478938 DOI: 10.1097/lbr.0000000000000610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patient-controlled sedation (PCS) is a documented method for endoscopic procedures considered to facilitate early recovery. Limited data have been reported, however, on its use during flexible bronchoscopy (FB). METHODS This study hypothesized that PCS with propofol during FB would facilitate early recovery, with similar bronchoscopist and patient satisfaction compared with nurse-controlled sedation (NCS) with midazolam. A total of 150 patients were randomized 1:1:1 into a control group (premedication with morphine-scopolamine and NCS with midazolam), PCS-MS group (premedication with morphine-scopolamine and PCS with propofol), and PCS-G group (premedication with glycopyrronium and PCS with propofol). RESULTS The procedures included transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy, and/or multistation endobronchial ultrasound. FB duration values in median (range) were 40 (10 to 80), 39 (12 to 68), and 44 (10 to 82) minutes for the groups NCS, PCS-MS, and PCS-G, respectively. An overall 81% of the patients in the combined PCS groups were ready for discharge (modified Post Anaesthetic Discharge Scoring System, score 10) 2 hours after bronchoscopy compared with 40% in the control group (P<0.0001). Between PCS groups, 96% of the PCS-G group patients were ready for discharge compared with 65% in the PCS-MS group (P=0.0002) at 2 hours. Bronchoscopists' and patients' satisfaction scores were high in all groups. Postdischarge quality scores showed no differences among the groups. CONCLUSION PCS with propofol during FB is feasible, as it shortened recovery time without compromising procedure conditions for bronchoscopists or patients. A rapid postsedation stabilization of vital signs facilitates surveillance before the patient leaves the hospital.
Collapse
|
11
|
Grossmann B, Nilsson A, Sjöberg F, Bernfort L, Nilsson L. Patient-controlled sedation with propofol for endoscopic procedures-A cost analysis. Acta Anaesthesiol Scand 2020; 64:53-62. [PMID: 31436310 DOI: 10.1111/aas.13463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patient-controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation. METHODS Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine-scopolamine or glycopyrronium. RESULTS Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine-scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups. CONCLUSION Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.
Collapse
Affiliation(s)
- Benjamin Grossmann
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
- Department of Anaesthesia and Intensive Care Linköping University Hospital Linköping Sweden
| | - Andreas Nilsson
- Department of Anaesthesia and Intensive Care Linköping University Hospital Linköping Sweden
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Folke Sjöberg
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
- Department of Hand and Plastic Surgery and Intensive Care Linköping University Hospital Linköping Sweden
| | - Lars Bernfort
- Division of Health Care Analysis Linköping University Linköping Sweden
| | - Lena Nilsson
- Department of Anaesthesia and Intensive Care Linköping University Hospital Linköping Sweden
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| |
Collapse
|
12
|
Kreienbühl L, Elia N, Pfeil-Beun E, Walder B, Tramèr MR. Patient-Controlled Versus Clinician-Controlled Sedation With Propofol: Systematic Review and Meta-analysis With Trial Sequential Analyses. Anesth Analg 2019; 127:873-880. [PMID: 29750696 DOI: 10.1213/ane.0000000000003361] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sedation with propofol is frequently used to facilitate diagnostic and therapeutic procedures. Propofol can be administrated by the patient (patient-controlled sedation [PCS]) or by a clinician (clinician-controlled sedation [CCS]). We aimed to compare these 2 techniques. METHODS PubMed, Embase, CENTRAL, and trial registries were searched up to October 2017 for randomized controlled trials comparing PCS with CCS with propofol. The primary end points were the risks of presenting at least 1 episode of oxygen desaturation, arterial hypotension, and bradycardia, and the risk of requiring a rescue intervention (pharmacologic therapies or physical maneuvers) for sedation-related adverse events. Secondary end points were the dose of propofol administrated, operator and patient satisfaction, and the risk of oversedation. A random-effects model and an α level of .02 to adjust for multiple analyses were used throughout. Trial sequential analyses were performed for primary outcomes. Quality of evidence was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation system. RESULTS Thirteen trials (1103 patients; median age, 47 years; American Society of Anesthesiologists physical status I-III) describing various diagnostic and therapeutic procedures with propofol sedation were included. PCS had no impact on the risk of oxygen desaturation (11 trials, 31/448 patients [6.9%] with PCS versus 46/481 [9.6%] with CCS; risk ratio, 0.74 [98% confidence interval, 0.35-1.56]) but decreased the risk of requiring a rescue intervention for adverse events (11 trials, 29/449 patients [6.5%] with PCS versus 74/482 [15.4%] with CCS; risk ratio, 0.45 [98% confidence interval, 0.25-0.81]). For both outcomes, Trial sequential analyses suggested that further trials were unlikely to change the results, although the quality of evidence was graded very low for all primary outcomes. For the risk of arterial hypotension and bradycardia, the required sample size for a definitive conclusion had not been reached. Analysis of secondary outcomes suggested that PCS decreased the risk of oversedation and had no impact on propofol dose administrated, or on operator or patient satisfaction. CONCLUSIONS PCS with propofol, compared with CCS with propofol, had no impact on the risk of oxygen desaturation, but significantly decreased the risk of rescue interventions for sedation-related adverse events. Further high-quality trials are required to assess the risks and benefits of PCS.
Collapse
Affiliation(s)
- Lukas Kreienbühl
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Elia
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Elvire Pfeil-Beun
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Bernhard Walder
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Martin R Tramèr
- From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
13
|
Jokelainen J, Ismail S, Kylänpää L, Udd M, Mustonen H, Lindström O, Pöyhiä R. Effect And Predictive Value Of Routine Preoperative Laboratory Testing For Endoscopic Retrograde Cholangiopancreatography. Scand J Surg 2019; 109:115-120. [PMID: 30654725 DOI: 10.1177/1457496918822616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Several studies and guidelines are questioning routine preoperative laboratory tests in surgical and endoscopic procedures. Their effect in endoscopic retrograde cholangiopancreatography is not currently known. This study was carried out to evaluate the risk of adverse effects in endoscopic retrograde cholangiopancreatography and their association with preoperative lab tests. MATERIALS AND METHODS A single-center, prospective observational study on all 956 patients undergoing 1196 endoscopic retrograde cholangiopancreatographies in the Endoscopy Unit of Helsinki University Central Hospital from 1 March 2012 to 28 February 2013. Routine preoperative laboratory test results (basic blood count, creatinine, potassium, sodium, international normalized ratio/thromboplastin time, and amylase), health status, medication, and demographic information of all patients were analyzed in relation to adverse effects related to endoscopic retrograde cholangiopancreatography and procedural sedation. RESULTS Multivariate analysis showed post-endoscopic retrograde cholangiopancreatography pancreatitis (43 cases, 3.6%) to have no association with abnormal routine preoperative laboratory tests. Respiratory depression caused by sedation (128 cases, 11%) was not associated with abnormal routine preoperative laboratory tests, and anemia was found to be a slightly protecting factor. Cardiovascular depression caused by sedation was associated with thrombocytopenia (odds ratio = 1.87, p = 0.025) and, in male patients, hyponatremia (odds ratio = 3.66, p < 0.001). Incidence of other adverse effects was too low for statistical analysis. CONCLUSION Routine universal preoperative lab testing was not found to be successful in predicting adverse effects in endoscopic retrograde cholangiopancreatography procedures. Laboratory testing should be done focusing on each patient's individual needs.
Collapse
Affiliation(s)
- J Jokelainen
- University of Helsinki, Helsinki, Finland.,Department of Anesthesia and Intensive Care Medicine, South Karelia Central Hospital, Lappeenranta, Finland
| | - S Ismail
- University of Helsinki, Helsinki, Finland.,Department of Gastroenterological and General Surgery, Helsinki University Hospital, Helsinki, Finland
| | - L Kylänpää
- University of Helsinki, Helsinki, Finland.,Department of Gastroenterological and General Surgery, Helsinki University Hospital, Helsinki, Finland
| | - M Udd
- University of Helsinki, Helsinki, Finland.,Department of Gastroenterological and General Surgery, Helsinki University Hospital, Helsinki, Finland
| | - H Mustonen
- University of Helsinki, Helsinki, Finland.,Department of Gastroenterological and General Surgery, Helsinki University Hospital, Helsinki, Finland
| | - O Lindström
- University of Helsinki, Helsinki, Finland.,Department of Gastroenterological and General Surgery, Helsinki University Hospital, Helsinki, Finland
| | - R Pöyhiä
- University of Helsinki, Helsinki, Finland.,Kauniala Hospital, Kauniainen, Finland
| |
Collapse
|
14
|
Li S, Sheng G, Teng Y, Sun M. Systematic review of anaesthetic medication for ERCP based on a network meta-analysis. Int J Surg 2018; 51:56-62. [PMID: 29367034 DOI: 10.1016/j.ijsu.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/30/2017] [Accepted: 01/02/2018] [Indexed: 12/21/2022]
Abstract
AIMS We performed a systematic review of various anaesthetic medications for endoscopic retrograde cholangiopancreatography (ERCP) and aimed to make a comprehensive comparison based on a network meta-analysis. METHODS We searched globally recognized electronic databases, including PubMed, Cochrane Central and EMBASE, to retrieve relevant randomized controlled trials (RCTs) of anaesthetic medications for ERCP. Network meta-analysis was conducted by evaluating the procedure time, adverse effects and drug requirements. The cumulative probability P value was utilized to rank the medications under examination. RESULTS Seventeen RCTs that examined 1877 patients were included in this research. Under good convergence and efficiency, data analysis was performed using a consistency model. For the comparison of procedure times, we found that a combination of dexmedetomidine and ketamine (P = 0.19) or propofol plus pethidine (P = 0.18) seemed to be the two best medications for reducing procedure time. Additionally, midazolam combined with dexmedetomidine plus pethidine seemed to be the safest application for ERCP (P = 0.36). Propofol plus alfentanil also exhibited a good safety value (P = 0.28). For evaluation of drug requirements, the whole network connection could not be established; thus, comparisons in two subgroups were conducted. The results showed that midazolam combined with dexmedetomidine plus pethidine (P = 0.41) and propofol plus refentanil (P = 0.94) were superior to others in decreasing drug requirements. CONCLUSIONS Based on the objective results and our conclusions, we deemed that a combination of midazolam and dexmedetomidine was recommended, and propofol plus opioids also revealed great clinical value. However, we are still expecting more clinical research in the future.
Collapse
Affiliation(s)
- Shuangxi Li
- Hepatobiliary and Pancreatic Surgery Three Wards, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan Province, PR China
| | - Guotao Sheng
- Department of General Surgery, Second People's Hospital of Bengbu City, Bengbu, 233000, Anhui Province, PR China
| | - Yishan Teng
- Hepatobiliary and Pancreatic Surgery Three Wards, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan Province, PR China
| | - Min Sun
- Hepatobiliary and Pancreatic Surgery Three Wards, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan Province, PR China.
| |
Collapse
|