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Miao Y, Zheng M, Li Q, Xiong L, Feng J, Liu X, Fan G, Chaturvedi R, Zhang F, Yin N. Comparison of propofol-esketamine versus propofol-sufentanil for deep sedation and analgesia in children with autism: A randomized double-blind clinical trial. Autism Res 2024; 17:1356-1364. [PMID: 38850067 DOI: 10.1002/aur.3172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/17/2024] [Indexed: 06/09/2024]
Abstract
Propofol sedation, routinely used for endoscopic procedures, is safe and acceptable for children. Adjuvants, such as esketamine or sufentanil, are commonly added to improve the efficacy and safety of propofol sedation. This study aimed to compare the clinical efficacy and safety of propofol-esketamine (PE) versus propofol-sufentanil (PS) for deep sedation and analgesia in children with autism undergoing colonoscopy procedure. One hundred and twenty-four children with autism undergoing colonoscopy procedure were included in the study. Patients were randomly assigned to receive one of the two adjuvants: esketamine (0.3 mg/kg) or sufentanil (0.2 μg/kg), subsequently administered propofol 2.0 mg/kg to induce anesthesia. Additional doses of propofol (0.5-1.0 mg/kg) were administered as needed to ensure patient tolerance for the remaining duration of the procedure. Movement during the procedure, hemodynamic variables, the total dose of propofol, recovery time, and adverse events were recorded. The PE group exhibited a significantly lower incidence of severe movement during the procedure compared with the PS group (14.52% vs. 32.26%, p = 0.020). The PE group showed significantly lower incidence of respiratory depression, hypotension, and severe injection pain of propofol than the PS group during the procedure (all p < 0.05). The mean arterial pressure (MAP) decreased significantly after anesthesia induction in the PS group and remained lower than baseline (all p < 0.05). Compared with the combination of low-dose sufentanil (0.2 μg/mg) with propofol, the low-dose esketamine (0.3 mg/kg) combined with propofol provided more stable hemodynamics, higher quality of sedation, and fewer adverse events in children with autism undergoing colonoscopy procedure.
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Affiliation(s)
- Yanxiang Miao
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Minghui Zheng
- Department of Microbiota Medicine and Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Qing Li
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Lixia Xiong
- Department of Microbiota Medicine and Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- Division of Microbiotherapy, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Jinxiang Feng
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoyu Liu
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Guoxiang Fan
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Rupesh Chaturvedi
- Department of Clinical Medicine, School of International Education, Nanjing Medical University, Nanjing, China
| | - Faming Zhang
- Department of Microbiota Medicine and Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- Division of Microbiotherapy, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Ning Yin
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
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Chen Y, Chen J, Wang Q, Lyu H, Chen X, Liu R, Wang T, Dan L, Huang H, Duan G. Safety and tolerability of esketamine in propofol based sedation for endoscopic variceal ligation with or without injection sclerotherapy: Randomized controlled trial. Dig Endosc 2023; 35:845-854. [PMID: 36808150 DOI: 10.1111/den.14539] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Esketamine is an S (+) enantiomer of ketamine with greater potency and similar psychomimetic effects compared to racemic ketamine. We aimed to explore the safety of esketamine in different doses as an adjuvant to propofol in patients undergoing endoscopic variceal ligation (EVL) with or without injection sclerotherapy. METHODS One hundred patients were randomized to receive sedation with propofol 1.5 mg/kg in combination with sufentanil 0.1 μg/kg (group S), esketamine 0.2 mg/kg (group E0.2), esketamine 0.3 mg/kg (group E0.3), or esketamine 0.4 mg/kg (group E0.4) for EVL (n = 25 each). Hemodynamic and respiratory parameters were recorded during the procedure. The primary outcome was the incidence of hypotension; secondary outcomes included the incidence of desaturation, positive and negative syndrome scale (PANSS) after the procedure, pain score after the procedure, and secretion volume. RESULTS The incidence of hypotension was significantly lower in groups E0.2 (36%), E0.3 (20%), and E0.4 (24%) than in group S (72%). The incidence of SpO2 ≤94% was significantly lower in group E0.4 (4%) than in group S (32%). No significant intergroup difference was found in the PANSS assessment. CONCLUSIONS Combining 0.4 mg/kg esketamine with propofol sedation was optimal to facilitate EVL with stable hemodynamic status and better respiratory function during the procedure, without significant psychomimetic side-effects. TRIAL REGISTRATION Chinese Clinical Trial Registry (Trial ID: ChiCTR2100047033, http://www.chictr.org.cn/showproj.aspx?proj=127518).
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Affiliation(s)
- Yuanjing Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jie Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Quankai Wang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hongyao Lyu
- Department of Preventive Medicine, West China School of Public Health, Sichuan University, Chengdu, China
| | - Xuehan Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Rui Liu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ting Wang
- Department of Psychology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ling Dan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - He Huang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Yao J, Song C, Zhou C, He H, Quan Z. Different Doses of Oxycodone for Endoscopic Injection Sclerotherapy of Esophageal Varices. Med Sci Monit 2021; 27:e929111. [PMID: 33727522 PMCID: PMC7983318 DOI: 10.12659/msm.929111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of the present study was to evaluate the effects of different doses of oxycodone during endoscopic injection sclerotherapy (EIS) for esophageal varices with painless sclerosing agents. Material/Methods A total of 119 patients were randomly divided into 3 groups: Group A, midazolam and 0.075 mg/kg oxycodone (n=40); Group B, midazolam and 0.1 mg/kg oxycodone (n=40); and Group C, midazolam and 0.125 mg/kg oxycodone (n=39). The main observation index was the incidence of body movement during the perioperative period. The secondary indices were additional propofol usage; postoperative analgesic usage; other adverse effects, such as hypoxia, myoclonus, and cough; and satisfaction scores for surgeons and patients. Results The incidence rates for body movement during the perioperative period in groups A, B, and C were 33%, 13%, and 0, respectively (P<0.001). The satisfaction scores for surgeons and patients were highest in Group C (0.125 mg/kg oxycodone). The incidence rates for hypoxia before EIS were 15%, 8%, and 33% (P=0.026) and during EIS were 23%, 3%, and 0% (P<0.001), respectively. There were no significant between-group differences with respect to other adverse effects. Conclusions The ideal dose of oxycodone for perioperative analgesia during EIS for esophageal varices is 0.125 mg/kg.
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Affiliation(s)
- Jie Yao
- Department of Anesthesiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China (mainland)
| | - ChunXiao Song
- Department of Joint Surgery, Jizhong Energy Xingtai Mig General Hospital, Xingtai, Hebei, China (mainland)
| | - Chen Zhou
- Department of Zoology and Physiology, University of Wyoming, Laramie, WY, USA
| | - HaiLi He
- Department of Anesthesiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China (mainland)
| | - ZheFeng Quan
- Department of Anesthesiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China (mainland)
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Aghadavoudi O, Shetabi H, Dezfouli ZS. Comparison of the Analgesic and Sedative Effects of Midazolam-Ketamine and Propofol-Sufentanil Combinations in Painful Procedures of Children with Haematologic Malignancy. Turk J Anaesthesiol Reanim 2019; 48:120-126. [PMID: 32259143 PMCID: PMC7101195 DOI: 10.5152/tjar.2019.42402] [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] [Received: 10/14/2018] [Accepted: 05/08/2019] [Indexed: 12/04/2022] Open
Abstract
Objective Bone marrow aspiration and lumbar puncture play essential roles in the diagnosis and treatment of haematological disorders. These repeated invasive procedures lead to considerable pain and stress in children, which is emotionally stressful for their parents. This study aimed to compare the effectiveness and outcomes of two combinations of midazolam-ketamine (MK) and propofol-sufentanil (PS) in painful procedures of children with haematologic malignancy. Methods In this prospective, randomised, double-blind clinical trial, we enrolled 80 eligible patients with haematologic malignancy aged 2–14 years. We randomly allocated them to the MK and PS groups. We recorded and compared the level of sedation, pain severity, hemodynamic indices, the onset of effect, duration of recovery and complications during and after procedure in the two groups. We analysed the data using the SPSS software. We used Mann–Whitney U, independent t-test, chi-square and Fisher’s exact tests to compare continuous and categorical variables. Results From initially enrolled patients, 68 patients completed the study (38 in PS and 30 in MK group). The levels of sedation and the mean score of pain intensity were significantly lower in the MK group than those in the PS group (p<0.05). Movements and the needs to repeat the dose were significantly lower in the MK group than those in the PS group (p<0.05). Conclusion During bone marrow aspiration and lumbar puncture procedures in children with haematologic malignancy, the findings of this trial suggest that MK combination therapy provides better sedation and analgesia than PS.
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Affiliation(s)
- Omid Aghadavoudi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Shetabi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Saedi Dezfouli
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Yu J, Xiang B, Song Y, Chen H, Li Y, Liu C. ED50 of propofol in combination with low-dose sufentanil for intravenous anaesthesia in hysteroscopy. Basic Clin Pharmacol Toxicol 2019; 125:460-465. [PMID: 31231918 DOI: 10.1111/bcpt.13280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/03/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Sufentanil has favourable pharmacodynamic and pharmacokinetic properties as an opioid, and it is usually co-administered with propofol as intravenous anaesthesia for hysteroscopic examination or therapeutic surgery. However, the optimal dosage of propofol when it is co-administered with low-dose sufentanil has not yet been established. This study was designed to find the median effective dose of propofol for intravenous anaesthesia when combined with low-dose sufentanil. METHODS Fifty-four patients were enrolled and randomized into two groups in this prospective study. Sufentanil 0.2 μg/kg (Group A) or 0.1 μg/kg (Group B) was given intravenously before speculum placement. The initial propofol dose was set at 2 mg/kg and varied by 0.1 mg/kg according to the sequential allocation up-and-down rule designed by Dixon and Massey. Respiratory depression, duration of initial dose of propofol, total drug quantity administered and recovery time were recorded. RESULTS The ED50 of propofol was 1.651 mg/kg (95% CI, 1.561-1.722 mg/kg) in Group A and 1.991 mg/kg (95% CI, 1.902-2.081 mg/kg) in Group B. The ED95 of propofol was 1.827 mg/kg (95% CI, 1.746-2.236 mg/kg) in Group A and 2.153 mg/kg (95% CI, 2.070-2.73 7 mg/kg) in Group B. The initial and total dosage of propofol in Group A were significantly lower than those in Group B, but the incidence of respiratory depression in Group A (26.67%) was significantly higher than that in Group B (4.17%). CONCLUSION The ED50 values for propofol when co-administered with low-dose sufentanil for intravenous anaesthesia in hysteroscopy were 1.651 mg/kg (sufentanil 0.2 μg/kg) and 1.991 mg/kg (sufentanil 0.1 μg/kg). (www.chictr.org.cn, registration number: ChiCTR1900021224).
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Affiliation(s)
- Jin Yu
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Bo Xiang
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yun Song
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Hu Chen
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Youchang Li
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Chun Liu
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
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