1
|
Popa-Ion DA, Chiuțu LC, Denicu MM, Gheonea DI. The Role of Analgesia in the Identification and Treatment of Digestive Tract Lesions: A Randomized, Prospective, Double-Blind Study. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:19-27. [PMID: 37780189 PMCID: PMC10541072 DOI: 10.12865/chsj.49.01.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/24/2023] [Indexed: 10/03/2023]
Abstract
The association of sedation with analgesia in endoscopic procedures represents the ideal combination of anesthetic drugs, which allows these exploratory procedures to be carried out safely, in an outpatient setting. The aim of this study is to compare the results of the use of simple Propofol or Propofol associated with Fentanyl in order to ensure optimal sedation necessary for the detection of benign or malignant lesions of the digestive tract. In this study, 80 patients aged between 18 and 80 years were included, 40 in Group 1 who were administered Propofol alone and 40 in Group 2 in which Propofol was administered associated with Fentanyl. The onset of anesthetic sleep was 19.3±5.1 seconds in Lot 2 versus 29.6±9.1 seconds in Lot 1. The average dose of Propofol used was 203.6±82.8 mg in Lot 1 and in Lot 2 it was lower, 166.3±8.3mg. Cardio respiratory changes were more frequent in Lot 2. The wake-up time was 3.2±1.2 minutes in Lot 1 as a result of the administration of Propofol alone and 7±1.4 minutes in Lot 2. The discharge time was equal for patients in both groups. The degree of postanesthesia safisfaction was 10 for all patients from Lot 2, due to the analgesia provided by the administration of Fentanyl. The use of Propofol associated with Fentanyl in gastrointestinal endoscopic procedures is associated with a rapid recovery of cognitive function at the time of discharge and minimal adverse events, ensuring optimal conditions of analgesia and stability of vital functions.
Collapse
Affiliation(s)
- Denisa-Ancuța Popa-Ion
- Resident physician, PhD student, University of Medicine and Pharmacy of Craiova, Romania
| | - Luminița Cristina Chiuțu
- Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Dan-Ionuț Gheonea
- Department of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| |
Collapse
|
2
|
Xin N, Yan W, Jin S. Efficacy of Analgesic Propofol/Esketamine and Propofol/Fentanyl for Painless Induced Abortion: A Randomized Clinical Trial. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5095282. [PMID: 35722469 PMCID: PMC9203225 DOI: 10.1155/2022/5095282] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
Background Patients have widely accepted abortion as a remedy for contraceptive failure all over the world. Esketamine is a new anesthetic, sedative, and analgesic drug. Fentanyl is an opioid receptor agonist and a commonly used sedative. It is necessary to choose appropriate sedative drugs for painless abortion. Methods We selected 238 cases of painless induced abortion from January 2020 to January 2022. We collected surgical parameters, the performance of sedation, and postoperative scales with complications before and after the operation. SPSS 21.0 was used to analyze data. Results Surgical indicators between intervention and control groups had no difference; the preoperative indicators including intraoperative bispectral index (BIS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse oxygen saturation (SpO2) had no difference between the two groups. But after surgery, experiment groups had a higher value than the control group in these four indicators. The incidence of postoperative complications including nausea and vomit had no significant difference while the experiment group had a lower r-value than the control group in hypotension, bradycardia, decreased oxygen saturation, and respiratory depression. The postoperative VAS score and Ramsay score in the experimental group were lower than those in the control group. Conclusion Since esketamine had better sedation performance, reduce the risk of cardiovascular and respiratory depression during sedation, and reduce the pain scale compared with fentanyl, we supported that propofol/esketamine is a good choice for patients receiving a painless induced abortion, and it is a sedation plan worth promoting and further analysis.
Collapse
Affiliation(s)
- Naixing Xin
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, China
| | - Wei Yan
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, China
| | - Shuangfen Jin
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, China
| |
Collapse
|
3
|
Piro R, Casalini E, Fontana M, Galeone C, Ruggiero P, Taddei S, Ghidoni G, Patricelli G, Facciolongo N. Efficacy and safety of EBUS-TBNA under conscious sedation with meperidine and midazolam. Thorac Cancer 2022; 13:533-538. [PMID: 34994092 PMCID: PMC8841700 DOI: 10.1111/1759-7714.14286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 01/23/2023] Open
Abstract
Background According to the guidelines, endobronchial ultrasound guided transbronchial needle aspiration (EBUS‐TBNA) is the technique of choice for the diagnosis of mediastinal involvement in lung cancer; it is also useful for other mediastinal malignancies and benign pathology. Nevertheless, there is still discussion about whether to perform it under general anesthesia or under conscious sedation. Methods We retrospectively analyzed the data of all patients who underwent EBUS‐TBNA under conscious sedation with up to 1 mg/kg of meperidine and up to 0.15 mg/kg of midazolam in the Interventional Pulmonology Unit of the Azienda USL‐IRCCS Santa Maria Nuova of Reggio Emilia during 2 consecutive years. Demographic data, indication for the procedure, duration, number of lymph node sampled, number of passes per station, diagnostic yield, drugs dosage, questionnaire score, and complications were collected. Results A total of 302 patients underwent EBUS‐TBNA, and 68% of the patients were males and the mean age was 65 ± 13 years old. The average duration of procedures was 24.4 minutes and the mean dosage of drugs was 4.32 ± 1.52 mg for midazolam and 50.86 ± 13.71 mg for meperidine. The mean number of lymph nodes sampled per patient was 1.75 ± 0.82, and each patient received an average of 4.71 ± 1.78 passes. A total of 90.7% of patients completed the procedures, 85% had adequate samples, and 94.4% of patients declared with Likert's questionnaire that they strongly agree to repeat the test if necessary. Conclusion EBUS‐TBNA performed under conscious sedation with meperidine and midazolam is feasible and well‐tolerated and has a similar diagnostic yield of that reported in literature.
Collapse
Affiliation(s)
- Roberto Piro
- Pulmonology Unit, Department of Medical Specialties, Azienda Unità Sanitaria Locale - IRCCS Tecnologie, Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
| | - Eleonora Casalini
- Pulmonology Unit, Department of Medical Specialties, Azienda Unità Sanitaria Locale - IRCCS Tecnologie, Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Fontana
- Pulmonology Unit, Department of Medical Specialties, Azienda Unità Sanitaria Locale - IRCCS Tecnologie, Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
| | - Carla Galeone
- Pulmonology Unit, Department of Medical Specialties, Azienda Unità Sanitaria Locale - IRCCS Tecnologie, Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ruggiero
- Pulmonology Unit, Department of Medical Specialties, Azienda Unità Sanitaria Locale - IRCCS Tecnologie, Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
| | - Sofia Taddei
- Pulmonology Unit, Department of Medical Specialties, Azienda Unità Sanitaria Locale - IRCCS Tecnologie, Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Ghidoni
- Pulmonology Unit, Department of Medical Specialties, Azienda Unità Sanitaria Locale - IRCCS Tecnologie, Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Patricelli
- Pulmonology Unit, Azienda Sanitaria Locale Brindisi, Brindisi, Italy
| | - Nicola Facciolongo
- Pulmonology Unit, Department of Medical Specialties, Azienda Unità Sanitaria Locale - IRCCS Tecnologie, Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
4
|
Nam JH, Jang DK, Lee JK, Kang HW, Kim BW, Jang BI. Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam. Clin Endosc 2021; 55:234-239. [PMID: 34634857 PMCID: PMC8995981 DOI: 10.5946/ce.2021.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background/Aims The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions. Methods This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction. Results A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups. Conclusions Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.
Collapse
Affiliation(s)
- Ji Hyung Nam
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Hyoun Woo Kang
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | | |
Collapse
|
5
|
Nishizawa T, Yoshida S, Toyoshima O, Matsuno T, Irokawa M, Arano T, Ebinuma H, Suzuki H, Kanai T, Koike K. Risk Factors for Prolonged Hospital Stay after Endoscopy. Clin Endosc 2021; 54:851-856. [PMID: 33721977 PMCID: PMC8652156 DOI: 10.5946/ce.2020.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/30/2020] [Indexed: 01/21/2023] Open
Abstract
Background/Aims The recovery room used after endoscopy has limited capacity, and an efficient flow of the endoscopy unit is desired. We investigated the duration of hospital stay after endoscopy and the risk factors for prolonged hospital stay among outpatients.
Methods We retrospectively studied consecutive patients who underwent esophagogastroduodenoscopy or colonoscopy at the Toyoshima Endoscopy Clinic. We collected data on age, sex, body weight, midazolam and pethidine dosage, respiratory depression during endoscopy, and duration of hospital stay after endoscopy (scope out to check out). Risk factors for prolonged hospital stay (>100 minutes) were identified using multiple logistic regression analysis.
Results We enrolled 3,898 patients, including 3,517 (90.2%) patients tested under sedation and 381 (9.8%) patients tested without sedation. Overall, 442 (11.3%) patients had prolonged stay (>100 min). The mean time difference between sedation group and non-sedation group was 44.2 minutes for esophagogastroduodenoscopy and 39.1 minutes for colonoscopy. Age (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.014−1.036), female sex (OR, 1.657; 95% CI, 1.220−2.249), and midazolam dose (OR, 1.019; 95% CI, 1.013−1.026) were independently associated with prolonged hospital stay after esophagogastroduodenoscopy, with similar results for colonoscopy.
Conclusions Old age, female sex, and midazolam dose were independent risk factors for prolonged hospital stay after endoscopy.
Collapse
Affiliation(s)
- Toshihiro Nishizawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Shuntaro Yoshida
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Toyoshima
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Matsuno
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masataka Irokawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Gastroenterology, Sanraku Hospital, Tokyo, Japan
| | - Toru Arano
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Gastroenterology, The Fraternity Memorial Hospital, Tokyo, Japan
| | - Hirotoshi Ebinuma
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|