Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation ...Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.展开更多
The effective delivery of healthcare in procedural settings,particularly during endoscopic sedation,requires seamless collaboration between medical and nursing professionals.This necessity has become increasingly sign...The effective delivery of healthcare in procedural settings,particularly during endoscopic sedation,requires seamless collaboration between medical and nursing professionals.This necessity has become increasingly significant as healthcare systems strive to improve patient safety and quality of care during minimally invasive procedures,which have gained traction due to their benefits in diagnosis and treatment.The findings indicate significant discrepancies in how roles are perceived by medical and nursing staff,with over 60%of participants reporting confusion about specific responsibilities during sedation processes.This uncertainty has been associated with inconsistent patient outcomes and potential safety issues.Additionally,the research highlights the need for interprofessional education and collaborative practice models to promote effective communication and mutual understanding between medical and nursing teams.展开更多
Sedation is the standard of care in gastrointestinal(GI)endoscopy in most institutions.Various protocols are employed to ensure a comfor patient experience and a high procedural success rate.Benzodiazepines combined w...Sedation is the standard of care in gastrointestinal(GI)endoscopy in most institutions.Various protocols are employed to ensure a comfor patient experience and a high procedural success rate.Benzodiazepines combined with opioids are the most commonly used methods.However,these drugs have been associated with numerous adverse effects,including respiratory depression,hypoxia,and hypotension.Cohen et al conducted a study in this issue demonstrating the ability to minimize or eliminate opioid use without compromising procedural success rate or patient comfort.In this editorial,we explore the diverse sedation methods employed in GI procedures,assess the efficacy and safety of the drugs used,and highlight best practices.展开更多
Background:Previous studies have demonstrated the underlying neurophysiologic mechanism during general anesthesia in adults.However,the mechanism of propofol-induced moderate-deep sedation(PMDS)in modulating pediatric...Background:Previous studies have demonstrated the underlying neurophysiologic mechanism during general anesthesia in adults.However,the mechanism of propofol-induced moderate-deep sedation(PMDS)in modulating pediatric neural activity remains unknown,which therefore was investigated in the present study based on functional magnetic resonance imaging(fMRI).Methods:A total of 41 children(5.10�1.14 years,male/female 21/20)with fMRI were employed to construct the functional connectivity network(FCN).The network communication,graph-theoretic properties,and network hub identification were statistically analyzed(t test and Bonferroni correction)between sedation(21 children)and awake(20 children)groups.All involved analyses were established on the whole-brain FCN and seven sub-networks,which included the default mode network(DMN),dorsal attentional network(DAN),salience network(SAN),auditory network(AUD),visual network(VIS),subcortical network(SUB),and other networks(Other).Results:Under PMDS,significant decreases in network communication were observed between SUB-VIS,SUB-DAN,and VIS-DAN,and between brain regions from the temporal lobe,limbic system,and subcortical tissues.However,no significant decrease in thalamus-related communication was observed.Most graph-theoretic properties were significantly decreased in the sedation group,and all graphical features of the DMN showed significant group differences.The superior parietal cortex with different neurological functions was identified as a network hub that was not greatly affected.Conclusions:Although the children had a depressed level of neural activity under PMDS,the crucial thalamus-related communication was maintained,and the network hub superior parietal cortex stayed active,which highlighted clinical prac-tices that the human body under PMDS is still perceptible to external stimuli and can be awakened by sound or touch.展开更多
BACKGROUND Although the majority of gastrointestinal(GI)endoscopies in the United States are now performed with propofol sedation,a substantial minority are performed with midazolam and fentanyl sedation.Despite the u...BACKGROUND Although the majority of gastrointestinal(GI)endoscopies in the United States are now performed with propofol sedation,a substantial minority are performed with midazolam and fentanyl sedation.Despite the ubiquity of conscious sedation with midazolam and fentanyl in the United States,there is scant evidence specifically supporting the superiority of midazolam plus fentanyl over single agent midazolam sedation in GI endoscopy.We hypothesize that single agent sedation with midazolam is noninferior to sedation with midazolam plus fentanyl in GI endoscopy.AIM To investigate whether sedation with midazolam alone is noninferior to sedation with midazolam plus fentanyl in GI endoscopy.METHODS We conducted a randomized,single-blind study to compare the safety and effectiveness of single agent midazolam vs.standard fentanyl/midazolam moderate sedation in 300 outpatients presenting for upper endoscopy and/or colonoscopy at a tertiary care hospital.Primary outcomes were patient satisfaction as measured by the previously validated Procedural Sedation Assessment Survey.Secondary outcomes were procedure quality measures and adverse events.Statistical analysis was performed by a biomedical statistician using theχ^(2) test,Fisher’s exact test,and Welch’s 2-sample t-test.RESULTS There was no difference in patient satisfaction between sedation groups,as measured by a less than 1 point difference between groups in Procedural Sedation Assessment Survey scores for discomfort during the procedure,and for preference for level of sedation with future procedures.There were no differences in adverse events or procedure quality measures.Cecal intubation time was 1 minute longer in the single agent midazolam group,and an average of 2.7 mg more midazolam was administered when fentanyl was not included in the sedation regimen.The recruitment goal of 772 patients was not reached.CONCLUSION It may be possible to minimize or avoid using fentanyl in endoscopist administered moderate sedation for GI endoscopy.We hope these findings spur further work in this under-researched area.展开更多
Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2...Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2005 to May 2011. Eight hundred thirty seven patients were excluded due to prior papillary intervention or attempted ERCP. A total of 1079 patients were included. The 981 patients who underwent gastroenterologist directed sedation (GDS) served as the control population, while the 98 patients who received anesthesiologist directed sedation (ADS) served as the case population. Medical records were analyzed for patient demographics, procedure indication, adverse events, case complexity, procedural failure and sedation failure. Case complexity was defined by the grading system proposed by the working party of the ASGE Quality Committee. Sedation failure was defined by agitation or airway compromise prompting termination of the ERCP. Reasons for procedural failure included surgically altered anatomy, luminal obstruction, and technical failure. Study endpoint was defined as successful deep cannulation of the intended target duct. Results: Demographic distribution did not differ between the GDS and the ADS groups. Cannulation success rates were similar between the two groups, with 89.85% in the GDS group, and 89.58% in the ADS group (P = 0.864). There were no statistical differences between sedation groups in procedural or respiratory adverse events. Technical failure was the predominant basis for deep cannulation failure in both groups. Agitation and airway compromise accounted for deep cannulation failure similarly in both groups. The need for reversal agents was low but similar in both groups. There was no statistical advantage in deep cannulation success rate by complexity grade in either sedation class. Conclusion: Excellent procedural outcomes and low adverse event rates were achieved using GDS, a more accessible and cost-effective method in a community-based setting.展开更多
[Objective] The experiment aimed to explore sedation of dried ginger.[Method] By compared the experimental results before and after intragastric administration,the influences of decoction of dried ginger at different ...[Objective] The experiment aimed to explore sedation of dried ginger.[Method] By compared the experimental results before and after intragastric administration,the influences of decoction of dried ginger at different concentrations(1,2,3 mg/ml)on locomotor activities of white mice.[Result]When the decoction of dried ginger was 1 g/ml,the time of free movements and the number of raising forelimbs of mice were obviously detained(2.5 h after intragastric administration).When the decoction of dried ginger was 2 g/ml,the time of free movements and the number of raising forelimbs of mice were obviously influenced however the inhibition time is short than that of 1 g/ml.When the decoction of dried ginger was 3 g/ml,the inhibition is not obvious.[Conclusion] Dried ginger had some sedation effect which was related to its dosage.展开更多
BACKGROUND With increasing volume and cost of gastrointestinal endoscopic procedures,the proper selection of patients for moderate sedation becomes increasingly relevant.The current literature lacks consistent finding...BACKGROUND With increasing volume and cost of gastrointestinal endoscopic procedures,the proper selection of patients for moderate sedation becomes increasingly relevant.The current literature lacks consistent findings that allow for appropriate selection of patients for moderate sedation.AIM To analyze a nationwide registry of patients to identify patient and procedural factors associated with lower sedation requirements for endoscopy.METHODS The Clinical Outcomes Research Initiative National Endoscopic Database was queried to assess adult patients undergoing moderate sedation for esophagogastroduodenoscopy(EGD)and colonoscopy from 2008 to 2014.Patients were stratified into two groups[low dose(LD)and high dose sedation]based on sedation requirements.Anthropometric,procedural,and anesthesia data were compared,and multivariable analysis was performed to identify factors associated with LD sedation.RESULTS Of the 371102 patients included in the study,63137 where stratified into the LD sedation group and 307965 were in the high dose group.Moderate sedation was managed primarily by endoscopists(50%)and anesthesia providers(47%).Patients undergoing EGDs and procedures performed in the inpatient setting,in ambulatory surgery centers,intensive care units or hospital wards,required less sedation than colonoscopies,outpatient procedures and procedures done in endoscopy suites,respectively(P<0.0001 for all).On multivariable analysis,factors predictive of tolerance with lower sedation requirements for EGDs and colonoscopies were female gender,age≥50,non-White race,Hispanic descent,body mass index≤25 kg/m^(2),and higher American Society of Anesthesia Class(P<0.0001 for all).CONCLUSION Clinicians should consider these patient profiles in determining which patients will better tolerate moderate sedation vs those better suited for alternative sedation methods.展开更多
Purpose:To evaluate the effectiveness of daily sedation interruption in patients with mechanical ventilation in intensive care unit(ICU).Methods:The randomized controlled trials(RCTs)on the application of daily interr...Purpose:To evaluate the effectiveness of daily sedation interruption in patients with mechanical ventilation in intensive care unit(ICU).Methods:The randomized controlled trials(RCTs)on the application of daily interruption of sedation in sedated patients with mechanical ventilation in ICU were collected through databases including Cochrane library,MEDLINE,Web of Knowledge,Embase,CNKI,CBM and VIP Data.Two reviewers independently assessed the quality of studies and extracted the data.Meta-analysis was conducted on the included studies.Results:Eight RCTs involving 757 patients were included.The daily sedation interruptions could shorten the duration of mechanical ventilation(Z=5.36,p<0.0001),length of stay(Z=2.93,p=0.003<0.05)and reduce the rate of tracheotomy(Z=3.97,p<0.00001)in these patients.Additionally,daily sedation interruption was not associated with increased rate of unplanned extubation by the patients(Z=0.53,p=0.6<0.05).Conclusion:The application of daily interruption of sedation in patients with mechanical ventilation in ICU is safe and effective.展开更多
BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedatio...BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedation regimen by avoiding under-or oversedation.AIM To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.METHODS Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS.Patients were matched for age and endoscopic procedure.We recorded time of sedation and endoscopy,dosage of medication and adverse events.RESULTS There was a significant reduction in dose per time of propofol administered in the TCI group,compared to the NAPS group(8.2±2.7 mg/min vs 9.3±3.4 mg/min;P=0.046).The time needed to provide adequate sedation levels was slightly but significantly lower in the control group(5.3±2.7 min vs 7.7±3.3 min;P<0.001),nonetheless the total endoscopy time was similar in both groups.No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.CONCLUSION This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy.This may translate into less adverse events.However,further and randomized trials need to confirm this trend.展开更多
Objective: to explore the application effect of programmed sedation nursing in ICU patients with mechanical ventilation. Methods: 128 mechanical ventilation patients in ICU of our hospital from May 2018 to May 2020 we...Objective: to explore the application effect of programmed sedation nursing in ICU patients with mechanical ventilation. Methods: 128 mechanical ventilation patients in ICU of our hospital from May 2018 to May 2020 were randomly divided into control group (routine sedation nursing) and program group (programmed sedation nursing). The sedation effect and sedation adverse reactions of the two groups were observed. Results: after the programmed sedation nursing, the sedative dosage of the program group was significantly less than that of the control group, and the mechanical ventilation time and ICU treatment time of the program group were significantly shorter than those of the control group, P < 0.05. The incidence of sedation adverse reactions in the program group was significantly lower than that in the control group, P < 0.05. Conclusion: programmed sedation nursing for ICU patients with mechanical ventilation can effectively improve the sedation effect and reduce the occurrence of sedation adverse reactions, which is worthy of promotion.展开更多
Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate(conscious) sedation.Moderate sedation,using midazolam and an opioid,is the standard method of sedation,although propofol is incre...Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate(conscious) sedation.Moderate sedation,using midazolam and an opioid,is the standard method of sedation,although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation.Moreover,the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and,consequently,its low risk of inducing hepatic encephalopathy.In the future,propofol could become the preferred sedation agent,especially for routine colonoscopy.Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam.Among opioids,pethidine and fentanyl are the most popular.A number of other substances have been tested in several clinical trials with promising results.Among them,newer opioids,such as remifentanil,enable a faster recovery.The controversy regarding the administration of sedation by an endoscopist or an experienced nurse,as well as the optimal staffing of en-doscopy units,continues to be a matter of discussion.Safe sedation in special clinical circumstances,such as in the cases of obese,pregnant,and elderly individuals,as well as patients with chronic lung,renal or liver disease,requires modification of the dose of the drugs used for sedation.In the great majority of patients,sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide.In this review,an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.展开更多
AIM： To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS： In this prospective study, conducted over a period of three years, 1,104 patients refe...AIM： To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS： In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus （0.5-1.5 mg/kg）. Arterial blood pressure （BP） was monitored at 3 rain intervals and heart rate and oxygen saturation （SpO2） were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS： A statistically significant reduction in mean arterial pressure was demonstrated （P〈0.001） when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60mmHg, was noted in only 5 patients （0.5%）. Oxygen saturation decreased from 96.5% to 94.4 % （P〈0.001）. A critical decrease in oxygen saturation （〈90%） was documented in 27 patients （2.4%）. CONCLUSION： Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effelts if carefully titrated. All the patients （and especially ASA Ⅲ group） require monitoring and care of an anesthesiologist.展开更多
AIM: To compare deep sedation with propofol-fentanyl and midazolam-fentanyl regimens during upper gastrointestinal endoscopy. METHODS: After obtaining approval of the research ethics committee and informed consent, 20...AIM: To compare deep sedation with propofol-fentanyl and midazolam-fentanyl regimens during upper gastrointestinal endoscopy. METHODS: After obtaining approval of the research ethics committee and informed consent, 200 patients were evaluated and referred for upper gastrointestinal endoscopy. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group).We assessed the level of sedation using the observer's assessment of alertness/sedation (OAA/S) score and bispectral index (BIS). We evaluated patient and physician satisfaction, as well as the recovery time and complication rates. The statistical analysis was performed using SPSS statistical software and included the MannWhitney test, χ 2 test, measurement of analysis of variance, and the κ statistic. RESULTS: The times to induction of sedation, recovery, and discharge were shorter in the propofolfentanyl group than the midazolam-fentanyl group. According to the OAA/S score, deep sedation events occurred in 25% of the propofol-fentanyl group and 11% of the midazolam-fentanyl group (P = 0.014). Additionally, deep sedation events occurred in 19% of the propofol-fentanyl group and 7% of the midazolamfentanyl group according to the BIS scale (P = 0.039). There was good concordance between the OAA/S score and BIS for both groups (κ = 0.71 and κ = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group and 26% of the midazolam-fentanyl group (P = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofolfentanyl and midazolam-fentanyl groups, respectively (P < 0.001). There were no severe complications in either group. Although patients were equally satisfied with both drug combinations, physicians were more satisfied with the propofol-fentanyl combination. CONCLUSION: Deep sedation occurred with propofolfentanyl and midazolam-fentanyl, but was more frequent in the former. Recovery was faster in the propofol-fentanyl group.展开更多
Endoscopic submucosal dissection(ESD)has been proposed as the gold standard in the treatment of early gastric cancer because it facilitates a more accurate histological assessment and reduces the risk of tumor recurre...Endoscopic submucosal dissection(ESD)has been proposed as the gold standard in the treatment of early gastric cancer because it facilitates a more accurate histological assessment and reduces the risk of tumor recurrence.However,the time course of ESD for large gastric tumors is frequently prolonged because of the tumor size and technical difficulties and typically requires higher doses of sedative and pain-controlling drugs.Sedative or anesthetic drugs such as midazolam or propofol are used during the procedure.Therapeutic endoscopy of early gastric cancers can often be performed with only moderate sedation.Compared with midazolam,propofol has a very fast onset of action,short plasma half-life and time to achieve sedation,faster time to recovery and discharge,and results in higher patient satisfaction.For overall success,maintaining safety and stability not only during the procedure but also subsequently in the recovery room and ward is necessary.In obese patients,it is recommended that the injected dose be based on a calculated standard weight.Cooperation between gastroenterologists,surgeons,and anesthesiologists is imperative for a successful ESD procedure.展开更多
AIM: To assess the usefulness of bispectral index (BIS) monitoring in order to carry out endoscopic submucosal dissection (ESD) safely and with patients' satisfaction. METHODS: Three hundred sixty-six patients wit...AIM: To assess the usefulness of bispectral index (BIS) monitoring in order to carry out endoscopic submucosal dissection (ESD) safely and with patients' satisfaction. METHODS: Three hundred sixty-six patients with an early-stage neoplasm of the digestive tract were enrolled. The BIS monitor (A-1050: Aspect medical systems/NIHON KOHDEN, Tokyo, Japan) was used. The appropriate sedative condition was set at 55 to 75 BIS levels (BIS value) during the endoscopic procedures. RESULTS: Among 366 cases, 13 were accompanied by adverse events during and/or after ESD. All episodes occurred in cases with BIS value between 56 and 65. Hypotension was observed in four cases, and bradycardia in six. Respiratory distress was observed in two cases with chronic pulmonary obstructive disease. All patients with adverse events were able to leave the hospital without extension of the hospitalization. CONCLUSION: BIS monitoring is useful to safely perform ESD. A BIS value of 70 to 75 is suitable for ESD.展开更多
AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B....AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A (n = 40) received a split dose of midazolam in combination with meperidine. Group B (n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. RESULTS: Group A had a lower frequency of significant hypoxemia (P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B (P = 0.043). Group B recovered from sedation slightly sooner than group A (P < 0.002). Scores for pain and memory, except insertion-related memory, were lower in group A one week after colonoscopic examination (P = 0.018 and P < 0.030, respectively). Poor patient controllability was noted by the endoscopist and nurse in group B (P = 0.038 and P = 0.032, respectively). CONCLUSION: Split dose midazolam in combination with meperidine resulted in a safer, more equable sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.展开更多
Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing a...Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endoscopy would include rapid onset and offset of action,analgesic and anxiolytic effects,ease of titration to desired level of sedation,rapid recovery and an excellent safety prof ile.Therefore there is an impulse for development of new approaches to endoscopic sedation.This article provides an update on the methods of sedation today available and future directions in endoscopic sedation.展开更多
AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) ...AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.展开更多
Endoscopic retrograde cholangiopancrea tography(ERCP) is the most complex gastrointestinal procedure,which needs patients' cooperation. The aim of this study was to observe the quality and safey of sedation with p...Endoscopic retrograde cholangiopancrea tography(ERCP) is the most complex gastrointestinal procedure,which needs patients' cooperation. The aim of this study was to observe the quality and safey of sedation with propofol in patients undergoing therapeutic ERCP. METHODS:Seventy patients who had undergone therapeutic ERCP were randomly divided into two groups.One group, given intravenously propofol, and the other sedated with routine method, served as the control. Blood pressure, heart rate,oxygen saturation were monitored and cardiorespiratory event was observed. Patient cooperation,performance, recovery time and amnesia served as variables postoperation. RESULTS:Blood pressure elevated in four patients in the propofol group, less than in the control group(P<0.01). Seven patients showed decreased blood pressure after administration of propofol,but none in the control group (P<0.01). Twelve patients in the control group showed mild or significant resistance, but none in the propofol group (P<0.01). The time for performance in the propofol group(P<0.05) was shorter than in the control group. Patient recovery was quicker in the propofol group than in the control group (P<0.01). The degree of amnesia better in the propofol group than in the control group ( P<0.01). The degree of amnesia was also better in the propofol group than in the control group (P<0.01). CONCLUSIONS:Propofol proves to be an excellent sedative for therapeutic ERCP. Being effective and safe, it shows a shorter ERCP duration but quick recovery and better amnesia. It is better than other routine sedatives.展开更多
文摘Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.
文摘The effective delivery of healthcare in procedural settings,particularly during endoscopic sedation,requires seamless collaboration between medical and nursing professionals.This necessity has become increasingly significant as healthcare systems strive to improve patient safety and quality of care during minimally invasive procedures,which have gained traction due to their benefits in diagnosis and treatment.The findings indicate significant discrepancies in how roles are perceived by medical and nursing staff,with over 60%of participants reporting confusion about specific responsibilities during sedation processes.This uncertainty has been associated with inconsistent patient outcomes and potential safety issues.Additionally,the research highlights the need for interprofessional education and collaborative practice models to promote effective communication and mutual understanding between medical and nursing teams.
文摘Sedation is the standard of care in gastrointestinal(GI)endoscopy in most institutions.Various protocols are employed to ensure a comfor patient experience and a high procedural success rate.Benzodiazepines combined with opioids are the most commonly used methods.However,these drugs have been associated with numerous adverse effects,including respiratory depression,hypoxia,and hypotension.Cohen et al conducted a study in this issue demonstrating the ability to minimize or eliminate opioid use without compromising procedural success rate or patient comfort.In this editorial,we explore the diverse sedation methods employed in GI procedures,assess the efficacy and safety of the drugs used,and highlight best practices.
基金supported by the Natural Science Foundation of Shandong Province,ZR2024MH072Open Project of Key Laboratory of Medical Imaging and Artificial Intelligence of Hunan Province,Xiangnan University,YXZN2022002+2 种基金Projects of Xiamen Scientific and Technological Plan,3502Z20199096 and 3502Z20209220the National Natural Science Foundation of China,61802330the Yantai City Science and Technology Innovation Development Plan,2023XDRH006.
文摘Background:Previous studies have demonstrated the underlying neurophysiologic mechanism during general anesthesia in adults.However,the mechanism of propofol-induced moderate-deep sedation(PMDS)in modulating pediatric neural activity remains unknown,which therefore was investigated in the present study based on functional magnetic resonance imaging(fMRI).Methods:A total of 41 children(5.10�1.14 years,male/female 21/20)with fMRI were employed to construct the functional connectivity network(FCN).The network communication,graph-theoretic properties,and network hub identification were statistically analyzed(t test and Bonferroni correction)between sedation(21 children)and awake(20 children)groups.All involved analyses were established on the whole-brain FCN and seven sub-networks,which included the default mode network(DMN),dorsal attentional network(DAN),salience network(SAN),auditory network(AUD),visual network(VIS),subcortical network(SUB),and other networks(Other).Results:Under PMDS,significant decreases in network communication were observed between SUB-VIS,SUB-DAN,and VIS-DAN,and between brain regions from the temporal lobe,limbic system,and subcortical tissues.However,no significant decrease in thalamus-related communication was observed.Most graph-theoretic properties were significantly decreased in the sedation group,and all graphical features of the DMN showed significant group differences.The superior parietal cortex with different neurological functions was identified as a network hub that was not greatly affected.Conclusions:Although the children had a depressed level of neural activity under PMDS,the crucial thalamus-related communication was maintained,and the network hub superior parietal cortex stayed active,which highlighted clinical prac-tices that the human body under PMDS is still perceptible to external stimuli and can be awakened by sound or touch.
文摘BACKGROUND Although the majority of gastrointestinal(GI)endoscopies in the United States are now performed with propofol sedation,a substantial minority are performed with midazolam and fentanyl sedation.Despite the ubiquity of conscious sedation with midazolam and fentanyl in the United States,there is scant evidence specifically supporting the superiority of midazolam plus fentanyl over single agent midazolam sedation in GI endoscopy.We hypothesize that single agent sedation with midazolam is noninferior to sedation with midazolam plus fentanyl in GI endoscopy.AIM To investigate whether sedation with midazolam alone is noninferior to sedation with midazolam plus fentanyl in GI endoscopy.METHODS We conducted a randomized,single-blind study to compare the safety and effectiveness of single agent midazolam vs.standard fentanyl/midazolam moderate sedation in 300 outpatients presenting for upper endoscopy and/or colonoscopy at a tertiary care hospital.Primary outcomes were patient satisfaction as measured by the previously validated Procedural Sedation Assessment Survey.Secondary outcomes were procedure quality measures and adverse events.Statistical analysis was performed by a biomedical statistician using theχ^(2) test,Fisher’s exact test,and Welch’s 2-sample t-test.RESULTS There was no difference in patient satisfaction between sedation groups,as measured by a less than 1 point difference between groups in Procedural Sedation Assessment Survey scores for discomfort during the procedure,and for preference for level of sedation with future procedures.There were no differences in adverse events or procedure quality measures.Cecal intubation time was 1 minute longer in the single agent midazolam group,and an average of 2.7 mg more midazolam was administered when fentanyl was not included in the sedation regimen.The recruitment goal of 772 patients was not reached.CONCLUSION It may be possible to minimize or avoid using fentanyl in endoscopist administered moderate sedation for GI endoscopy.We hope these findings spur further work in this under-researched area.
文摘Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2005 to May 2011. Eight hundred thirty seven patients were excluded due to prior papillary intervention or attempted ERCP. A total of 1079 patients were included. The 981 patients who underwent gastroenterologist directed sedation (GDS) served as the control population, while the 98 patients who received anesthesiologist directed sedation (ADS) served as the case population. Medical records were analyzed for patient demographics, procedure indication, adverse events, case complexity, procedural failure and sedation failure. Case complexity was defined by the grading system proposed by the working party of the ASGE Quality Committee. Sedation failure was defined by agitation or airway compromise prompting termination of the ERCP. Reasons for procedural failure included surgically altered anatomy, luminal obstruction, and technical failure. Study endpoint was defined as successful deep cannulation of the intended target duct. Results: Demographic distribution did not differ between the GDS and the ADS groups. Cannulation success rates were similar between the two groups, with 89.85% in the GDS group, and 89.58% in the ADS group (P = 0.864). There were no statistical differences between sedation groups in procedural or respiratory adverse events. Technical failure was the predominant basis for deep cannulation failure in both groups. Agitation and airway compromise accounted for deep cannulation failure similarly in both groups. The need for reversal agents was low but similar in both groups. There was no statistical advantage in deep cannulation success rate by complexity grade in either sedation class. Conclusion: Excellent procedural outcomes and low adverse event rates were achieved using GDS, a more accessible and cost-effective method in a community-based setting.
文摘[Objective] The experiment aimed to explore sedation of dried ginger.[Method] By compared the experimental results before and after intragastric administration,the influences of decoction of dried ginger at different concentrations(1,2,3 mg/ml)on locomotor activities of white mice.[Result]When the decoction of dried ginger was 1 g/ml,the time of free movements and the number of raising forelimbs of mice were obviously detained(2.5 h after intragastric administration).When the decoction of dried ginger was 2 g/ml,the time of free movements and the number of raising forelimbs of mice were obviously influenced however the inhibition time is short than that of 1 g/ml.When the decoction of dried ginger was 3 g/ml,the inhibition is not obvious.[Conclusion] Dried ginger had some sedation effect which was related to its dosage.
文摘BACKGROUND With increasing volume and cost of gastrointestinal endoscopic procedures,the proper selection of patients for moderate sedation becomes increasingly relevant.The current literature lacks consistent findings that allow for appropriate selection of patients for moderate sedation.AIM To analyze a nationwide registry of patients to identify patient and procedural factors associated with lower sedation requirements for endoscopy.METHODS The Clinical Outcomes Research Initiative National Endoscopic Database was queried to assess adult patients undergoing moderate sedation for esophagogastroduodenoscopy(EGD)and colonoscopy from 2008 to 2014.Patients were stratified into two groups[low dose(LD)and high dose sedation]based on sedation requirements.Anthropometric,procedural,and anesthesia data were compared,and multivariable analysis was performed to identify factors associated with LD sedation.RESULTS Of the 371102 patients included in the study,63137 where stratified into the LD sedation group and 307965 were in the high dose group.Moderate sedation was managed primarily by endoscopists(50%)and anesthesia providers(47%).Patients undergoing EGDs and procedures performed in the inpatient setting,in ambulatory surgery centers,intensive care units or hospital wards,required less sedation than colonoscopies,outpatient procedures and procedures done in endoscopy suites,respectively(P<0.0001 for all).On multivariable analysis,factors predictive of tolerance with lower sedation requirements for EGDs and colonoscopies were female gender,age≥50,non-White race,Hispanic descent,body mass index≤25 kg/m^(2),and higher American Society of Anesthesia Class(P<0.0001 for all).CONCLUSION Clinicians should consider these patient profiles in determining which patients will better tolerate moderate sedation vs those better suited for alternative sedation methods.
文摘Purpose:To evaluate the effectiveness of daily sedation interruption in patients with mechanical ventilation in intensive care unit(ICU).Methods:The randomized controlled trials(RCTs)on the application of daily interruption of sedation in sedated patients with mechanical ventilation in ICU were collected through databases including Cochrane library,MEDLINE,Web of Knowledge,Embase,CNKI,CBM and VIP Data.Two reviewers independently assessed the quality of studies and extracted the data.Meta-analysis was conducted on the included studies.Results:Eight RCTs involving 757 patients were included.The daily sedation interruptions could shorten the duration of mechanical ventilation(Z=5.36,p<0.0001),length of stay(Z=2.93,p=0.003<0.05)and reduce the rate of tracheotomy(Z=3.97,p<0.00001)in these patients.Additionally,daily sedation interruption was not associated with increased rate of unplanned extubation by the patients(Z=0.53,p=0.6<0.05).Conclusion:The application of daily interruption of sedation in patients with mechanical ventilation in ICU is safe and effective.
文摘BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedation regimen by avoiding under-or oversedation.AIM To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.METHODS Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS.Patients were matched for age and endoscopic procedure.We recorded time of sedation and endoscopy,dosage of medication and adverse events.RESULTS There was a significant reduction in dose per time of propofol administered in the TCI group,compared to the NAPS group(8.2±2.7 mg/min vs 9.3±3.4 mg/min;P=0.046).The time needed to provide adequate sedation levels was slightly but significantly lower in the control group(5.3±2.7 min vs 7.7±3.3 min;P<0.001),nonetheless the total endoscopy time was similar in both groups.No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.CONCLUSION This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy.This may translate into less adverse events.However,further and randomized trials need to confirm this trend.
文摘Objective: to explore the application effect of programmed sedation nursing in ICU patients with mechanical ventilation. Methods: 128 mechanical ventilation patients in ICU of our hospital from May 2018 to May 2020 were randomly divided into control group (routine sedation nursing) and program group (programmed sedation nursing). The sedation effect and sedation adverse reactions of the two groups were observed. Results: after the programmed sedation nursing, the sedative dosage of the program group was significantly less than that of the control group, and the mechanical ventilation time and ICU treatment time of the program group were significantly shorter than those of the control group, P < 0.05. The incidence of sedation adverse reactions in the program group was significantly lower than that in the control group, P < 0.05. Conclusion: programmed sedation nursing for ICU patients with mechanical ventilation can effectively improve the sedation effect and reduce the occurrence of sedation adverse reactions, which is worthy of promotion.
文摘Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate(conscious) sedation.Moderate sedation,using midazolam and an opioid,is the standard method of sedation,although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation.Moreover,the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and,consequently,its low risk of inducing hepatic encephalopathy.In the future,propofol could become the preferred sedation agent,especially for routine colonoscopy.Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam.Among opioids,pethidine and fentanyl are the most popular.A number of other substances have been tested in several clinical trials with promising results.Among them,newer opioids,such as remifentanil,enable a faster recovery.The controversy regarding the administration of sedation by an endoscopist or an experienced nurse,as well as the optimal staffing of en-doscopy units,continues to be a matter of discussion.Safe sedation in special clinical circumstances,such as in the cases of obese,pregnant,and elderly individuals,as well as patients with chronic lung,renal or liver disease,requires modification of the dose of the drugs used for sedation.In the great majority of patients,sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide.In this review,an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.
基金Supported by "Bates" Clinic, Svetice 15, Zagreb, Croatia, in the form of grant, equipment and drugs
文摘AIM： To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS： In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus （0.5-1.5 mg/kg）. Arterial blood pressure （BP） was monitored at 3 rain intervals and heart rate and oxygen saturation （SpO2） were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS： A statistically significant reduction in mean arterial pressure was demonstrated （P〈0.001） when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60mmHg, was noted in only 5 patients （0.5%）. Oxygen saturation decreased from 96.5% to 94.4 % （P〈0.001）. A critical decrease in oxygen saturation （〈90%） was documented in 27 patients （2.4%）. CONCLUSION： Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effelts if carefully titrated. All the patients （and especially ASA Ⅲ group） require monitoring and care of an anesthesiologist.
文摘AIM: To compare deep sedation with propofol-fentanyl and midazolam-fentanyl regimens during upper gastrointestinal endoscopy. METHODS: After obtaining approval of the research ethics committee and informed consent, 200 patients were evaluated and referred for upper gastrointestinal endoscopy. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group).We assessed the level of sedation using the observer's assessment of alertness/sedation (OAA/S) score and bispectral index (BIS). We evaluated patient and physician satisfaction, as well as the recovery time and complication rates. The statistical analysis was performed using SPSS statistical software and included the MannWhitney test, χ 2 test, measurement of analysis of variance, and the κ statistic. RESULTS: The times to induction of sedation, recovery, and discharge were shorter in the propofolfentanyl group than the midazolam-fentanyl group. According to the OAA/S score, deep sedation events occurred in 25% of the propofol-fentanyl group and 11% of the midazolam-fentanyl group (P = 0.014). Additionally, deep sedation events occurred in 19% of the propofol-fentanyl group and 7% of the midazolamfentanyl group according to the BIS scale (P = 0.039). There was good concordance between the OAA/S score and BIS for both groups (κ = 0.71 and κ = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group and 26% of the midazolam-fentanyl group (P = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofolfentanyl and midazolam-fentanyl groups, respectively (P < 0.001). There were no severe complications in either group. Although patients were equally satisfied with both drug combinations, physicians were more satisfied with the propofol-fentanyl combination. CONCLUSION: Deep sedation occurred with propofolfentanyl and midazolam-fentanyl, but was more frequent in the former. Recovery was faster in the propofol-fentanyl group.
文摘Endoscopic submucosal dissection(ESD)has been proposed as the gold standard in the treatment of early gastric cancer because it facilitates a more accurate histological assessment and reduces the risk of tumor recurrence.However,the time course of ESD for large gastric tumors is frequently prolonged because of the tumor size and technical difficulties and typically requires higher doses of sedative and pain-controlling drugs.Sedative or anesthetic drugs such as midazolam or propofol are used during the procedure.Therapeutic endoscopy of early gastric cancers can often be performed with only moderate sedation.Compared with midazolam,propofol has a very fast onset of action,short plasma half-life and time to achieve sedation,faster time to recovery and discharge,and results in higher patient satisfaction.For overall success,maintaining safety and stability not only during the procedure but also subsequently in the recovery room and ward is necessary.In obese patients,it is recommended that the injected dose be based on a calculated standard weight.Cooperation between gastroenterologists,surgeons,and anesthesiologists is imperative for a successful ESD procedure.
文摘AIM: To assess the usefulness of bispectral index (BIS) monitoring in order to carry out endoscopic submucosal dissection (ESD) safely and with patients' satisfaction. METHODS: Three hundred sixty-six patients with an early-stage neoplasm of the digestive tract were enrolled. The BIS monitor (A-1050: Aspect medical systems/NIHON KOHDEN, Tokyo, Japan) was used. The appropriate sedative condition was set at 55 to 75 BIS levels (BIS value) during the endoscopic procedures. RESULTS: Among 366 cases, 13 were accompanied by adverse events during and/or after ESD. All episodes occurred in cases with BIS value between 56 and 65. Hypotension was observed in four cases, and bradycardia in six. Respiratory distress was observed in two cases with chronic pulmonary obstructive disease. All patients with adverse events were able to leave the hospital without extension of the hospitalization. CONCLUSION: BIS monitoring is useful to safely perform ESD. A BIS value of 70 to 75 is suitable for ESD.
文摘AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A (n = 40) received a split dose of midazolam in combination with meperidine. Group B (n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. RESULTS: Group A had a lower frequency of significant hypoxemia (P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B (P = 0.043). Group B recovered from sedation slightly sooner than group A (P < 0.002). Scores for pain and memory, except insertion-related memory, were lower in group A one week after colonoscopic examination (P = 0.018 and P < 0.030, respectively). Poor patient controllability was noted by the endoscopist and nurse in group B (P = 0.038 and P = 0.032, respectively). CONCLUSION: Split dose midazolam in combination with meperidine resulted in a safer, more equable sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.
文摘Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endoscopy would include rapid onset and offset of action,analgesic and anxiolytic effects,ease of titration to desired level of sedation,rapid recovery and an excellent safety prof ile.Therefore there is an impulse for development of new approaches to endoscopic sedation.This article provides an update on the methods of sedation today available and future directions in endoscopic sedation.
基金Supported by The Department of Anesthesiology and Perioperative Medicine,Tufts Medical Center,Boston,United States
文摘AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.
文摘Endoscopic retrograde cholangiopancrea tography(ERCP) is the most complex gastrointestinal procedure,which needs patients' cooperation. The aim of this study was to observe the quality and safey of sedation with propofol in patients undergoing therapeutic ERCP. METHODS:Seventy patients who had undergone therapeutic ERCP were randomly divided into two groups.One group, given intravenously propofol, and the other sedated with routine method, served as the control. Blood pressure, heart rate,oxygen saturation were monitored and cardiorespiratory event was observed. Patient cooperation,performance, recovery time and amnesia served as variables postoperation. RESULTS:Blood pressure elevated in four patients in the propofol group, less than in the control group(P<0.01). Seven patients showed decreased blood pressure after administration of propofol,but none in the control group (P<0.01). Twelve patients in the control group showed mild or significant resistance, but none in the propofol group (P<0.01). The time for performance in the propofol group(P<0.05) was shorter than in the control group. Patient recovery was quicker in the propofol group than in the control group (P<0.01). The degree of amnesia better in the propofol group than in the control group ( P<0.01). The degree of amnesia was also better in the propofol group than in the control group (P<0.01). CONCLUSIONS:Propofol proves to be an excellent sedative for therapeutic ERCP. Being effective and safe, it shows a shorter ERCP duration but quick recovery and better amnesia. It is better than other routine sedatives.
