BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion...BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.展开更多
BACKGROUND Elderly patients often display age-related physiological decline,which increases their susceptibility to complications during medical procedures.Therefore,it is clinically imperative to refine anesthetic pr...BACKGROUND Elderly patients often display age-related physiological decline,which increases their susceptibility to complications during medical procedures.Therefore,it is clinically imperative to refine anesthetic protocols for painless gastroscopy in this vulnerable population.AIM To explore the effects of the etomidate-propofol combination on anesthesia quality,compliance,and adverse reactions in elderly patients undergoing painless gastrointestinal endoscopy.METHODS A total of 103 elderly patients scheduled for painless gastrointestinal endoscopy at the Hospital of Wuhan Economic and Technological Development Zone(Hannan District)between October 2022 and October 2024 were enrolled.The participants were divided into a control group(n=50)receiving propofol anesthesia and an observation group(n=53)that received a combination of etomidate and propofol anesthesia.The anesthesia quality(including induction time,recovery time,and orientation recovery time),compliance,hemodynamic parameters(heart rate,oxygen saturation,systolic/diastolic blood pressure),adverse reactions(muscle tremors,injection pain,respiratory depression,hypotension,and nausea/vomiting),and analgesic and sedative effects[evaluated using the visual analog scale(VAS)and Ramsay score]were comparatively analyzed.RESULTS The observation group had significantly shorter anesthesia induction,recovery,and orientation recovery times than the control group.Moreover,the observation group showed higher compliance;greater hemodynamic stability at preanesthesia(T0),during anesthesia(T1),and postrecovery(T2)time points;and a significantly lower incidence of adverse reactions.The VAS and Ramsay scores at 5,30,and 60 minutes after anesthesia recovery were also significantly lower in the observation group than in the control group.CONCLUSION The etomidate-propofol combination for painless gastrointestinal endoscopy in elderly patients may provide superior anesthesia quality and improved compliance and safety,making it a promising approach for clinical application.展开更多
BACKGROUND Treatment-resistant depression(TRD)has a poor response to clinical treatment.Patients with TRD do not respond adequately to standard antidepressants.Even after receiving a full dose and sufficient duration ...BACKGROUND Treatment-resistant depression(TRD)has a poor response to clinical treatment.Patients with TRD do not respond adequately to standard antidepressants.Even after receiving a full dose and sufficient duration of combined antidepressant therapy,significant improvement is still difficult to achieve.At present,electroconvulsive therapy(ECT)remains a clinically effective method for treating refractory depression.A good anesthesia regimen can enhance its clinical efficacy.Actively exploring high-quality anesthesia regimens has become a current research hotspot.AIM To explore the effect of esketamine and etomidate anesthesia on the clinical efficacy of ECT for TRD.METHODS A total of 120 patients with TRD,treated at the Department of Psychiatry,The Second Affiliated Hospital of Shandong First Medical University,China between April 2020 and April 2024,were selected for the study.The patients were allocated at random into two groups using a random number table:The combination and control groups,with 60 patients in each group.Both groups underwent ECT;the combination group received esketamine and etomidate anesthesia,while the control group received etomidate anesthesia.The following parameters were compared between the two groups:Heart rate(HR);mean arterial pressure(MAP);peripheral capillary oxygen saturation(SpO2);initial and final threshold charges;and serum brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),5-hydroxytryptamine(5-HT),and interleukin-4(IL-4)levels.Neurological functions,basic executive function scores,and adverse reactions were compared during the treatment process.RESULTS During treatment,the maximum and minimum HR and MAP values in the combination group were markedly lower than those in the control group(P<0.05),whereas there was no significant difference in SpO2 between the two groups(P>0.05).During the treatment,there were no significant differences in the initial threshold charge and average duration of seizures during ECT between the two groups(P>0.05).However,the final threshold charge and total charge in the combination group were considerably lower than those in the control group(P<0.05).After treatment,the BDNF,NGF,5-HT,and IL-4 levels were evidently higher in the combination group than in the control group(P<0.05).During treatment,as the number of ECT sessions increased,both BRNAS and Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery(MCCB)scores increased,whereas Hamilton Depression Rating Scale(HAMD)-24 scores decreased in both groups.Starting from the third treatment session,the BRNAS and MCCB scores in the combination group were higher than in the control group,whereas the Hamilton Depression Scale-24 score was lower in the combination group than in the control group(P<0.05).After treatment,the Wisconsin Card Sorting Test scores and Tower of Hanoi test results in the combination group were significantly better than those in the control group(P<0.05).The occurrence of adverse reactions was compared between the two groups(P>0.05).CONCLUSION Esketamine and etomidate anesthesia during ECT for patients with TRD helps maintain stable vital signs during the treatment process,improves depressive symptoms,and enhances neurological and basic executive functions.展开更多
文摘BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.
文摘BACKGROUND Elderly patients often display age-related physiological decline,which increases their susceptibility to complications during medical procedures.Therefore,it is clinically imperative to refine anesthetic protocols for painless gastroscopy in this vulnerable population.AIM To explore the effects of the etomidate-propofol combination on anesthesia quality,compliance,and adverse reactions in elderly patients undergoing painless gastrointestinal endoscopy.METHODS A total of 103 elderly patients scheduled for painless gastrointestinal endoscopy at the Hospital of Wuhan Economic and Technological Development Zone(Hannan District)between October 2022 and October 2024 were enrolled.The participants were divided into a control group(n=50)receiving propofol anesthesia and an observation group(n=53)that received a combination of etomidate and propofol anesthesia.The anesthesia quality(including induction time,recovery time,and orientation recovery time),compliance,hemodynamic parameters(heart rate,oxygen saturation,systolic/diastolic blood pressure),adverse reactions(muscle tremors,injection pain,respiratory depression,hypotension,and nausea/vomiting),and analgesic and sedative effects[evaluated using the visual analog scale(VAS)and Ramsay score]were comparatively analyzed.RESULTS The observation group had significantly shorter anesthesia induction,recovery,and orientation recovery times than the control group.Moreover,the observation group showed higher compliance;greater hemodynamic stability at preanesthesia(T0),during anesthesia(T1),and postrecovery(T2)time points;and a significantly lower incidence of adverse reactions.The VAS and Ramsay scores at 5,30,and 60 minutes after anesthesia recovery were also significantly lower in the observation group than in the control group.CONCLUSION The etomidate-propofol combination for painless gastrointestinal endoscopy in elderly patients may provide superior anesthesia quality and improved compliance and safety,making it a promising approach for clinical application.
文摘BACKGROUND Treatment-resistant depression(TRD)has a poor response to clinical treatment.Patients with TRD do not respond adequately to standard antidepressants.Even after receiving a full dose and sufficient duration of combined antidepressant therapy,significant improvement is still difficult to achieve.At present,electroconvulsive therapy(ECT)remains a clinically effective method for treating refractory depression.A good anesthesia regimen can enhance its clinical efficacy.Actively exploring high-quality anesthesia regimens has become a current research hotspot.AIM To explore the effect of esketamine and etomidate anesthesia on the clinical efficacy of ECT for TRD.METHODS A total of 120 patients with TRD,treated at the Department of Psychiatry,The Second Affiliated Hospital of Shandong First Medical University,China between April 2020 and April 2024,were selected for the study.The patients were allocated at random into two groups using a random number table:The combination and control groups,with 60 patients in each group.Both groups underwent ECT;the combination group received esketamine and etomidate anesthesia,while the control group received etomidate anesthesia.The following parameters were compared between the two groups:Heart rate(HR);mean arterial pressure(MAP);peripheral capillary oxygen saturation(SpO2);initial and final threshold charges;and serum brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),5-hydroxytryptamine(5-HT),and interleukin-4(IL-4)levels.Neurological functions,basic executive function scores,and adverse reactions were compared during the treatment process.RESULTS During treatment,the maximum and minimum HR and MAP values in the combination group were markedly lower than those in the control group(P<0.05),whereas there was no significant difference in SpO2 between the two groups(P>0.05).During the treatment,there were no significant differences in the initial threshold charge and average duration of seizures during ECT between the two groups(P>0.05).However,the final threshold charge and total charge in the combination group were considerably lower than those in the control group(P<0.05).After treatment,the BDNF,NGF,5-HT,and IL-4 levels were evidently higher in the combination group than in the control group(P<0.05).During treatment,as the number of ECT sessions increased,both BRNAS and Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery(MCCB)scores increased,whereas Hamilton Depression Rating Scale(HAMD)-24 scores decreased in both groups.Starting from the third treatment session,the BRNAS and MCCB scores in the combination group were higher than in the control group,whereas the Hamilton Depression Scale-24 score was lower in the combination group than in the control group(P<0.05).After treatment,the Wisconsin Card Sorting Test scores and Tower of Hanoi test results in the combination group were significantly better than those in the control group(P<0.05).The occurrence of adverse reactions was compared between the two groups(P>0.05).CONCLUSION Esketamine and etomidate anesthesia during ECT for patients with TRD helps maintain stable vital signs during the treatment process,improves depressive symptoms,and enhances neurological and basic executive functions.
