National data show that in China mainland unsedated gastrointestinal （GI） endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The pu...National data show that in China mainland unsedated gastrointestinal （GI） endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The purpose of this study was to compare sedated versus unsedated GI endoscopy regarding cost, safety, degree of comfort, tolerance level and overall satisfaction of patients over a 6-month period investigation. From March to September 2011, a questionnaire survey was performed on 1800 patients and 30 physicians at Zhongnan Hospital of Wuhan University and Wuhan General Hospital of Guangzhou Military Command. The patients fell into two groups according to their own de- cisions： the unsedated group （n=1000） and the sedated group （n=800）. After examination, the patients and the physicians were required to fill in a questionnaire form. All the data were analyzed statistically. The results showed that the main factors the patients took for consideration between sedated and unse- dated procedures included economy, comfort and safety. The income levels between the sedated and unsedated groups showed significant difference （P〈0.01）. Most patients in the unsedated group had lower income and were covered by less medical insurance. The tolerance rate was 92.4% vs. 65.5% be- tween the sedated and unsedated group, respectively. 95.5% patients in the sedated group and 72.1% pa- tients in the unsedated group chose the same endoscopy procedure for repeat examination. The survey data from endoscopists suggested the sedated procedure was more comfortable but less safe than the unsedated procedure （P〈0.01 ）. In China, unsedated GI endoscopy is now widely accepted by the major- ity of patients due to low cost and safety. Compared to unsedated GI endoscopy, sedated GI endoscopy is less painful, but more expensive and less safe. With the rapid improvement of people＇s living stan- dard and the reliability of sedation technology, we expect sedated GI endoscopy will be gradually ac- cepted by more patients.展开更多
AIM:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the procedure.METHODS:Consecutive patients who underwent colonoscopies over a 2-year period were invit...AIM:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the procedure.METHODS:Consecutive patients who underwent colonoscopies over a 2-year period were invited to participate.All patients who were to undergo our endoscopy unit were offered sedation with standard intravenous sedatives and analgesics,or an unsedated colonoscopy was attempted.Demographic details were recorded.The patient anxiety level prior to the procedure,time to reach the cecum,total discharge time,patient and endoscopist pain assessments,satisfaction after the examination and the patient’s willingness to return for the same procedure in the future were recorded.RESULTS:Among the 403 observed patients,more males were observed in the unsedated group(66.2%vs 55.2%,P=0.04).Additionally,the unsedated group patients were less anxious prior to the procedure(5.1vs 6.0,P<0.01).The colonoscopy completion rates were comparable between the 2 groups(85.9%vs84.2%,P=0.66).The time to reach the cecum was also comparable(12.2 min vs 11.8 min);however,the total discharge times were shorter in the unsedated group(20.7 min vs 83.0 min,P<0.01).Moreover,the average patient pain score(3.4 vs 5.7,P<0.01)was lower in the sedated group,while the satisfaction score(8.8 vs 7.8,P<0.01)was significantly higher.There was no significant difference,however,between the groups in terms of willingness to repeat the procedure if another was required in the future(83.3%vs 77.3%,P=0.17).CONCLUSION:Unsedated colonoscopy is feasible in willing patients.The option saves the endoscopy units up to one hour per patient and does not affect the patient willingness to return to the same physician again for additional colonoscopies if a repeated procedure is needed.展开更多
BACKGROUND Propofol is a short-acting,rapid-recovering anesthetic widely used in sedated colonoscopy for the early detection,diagnosis and treatment of colon diseases.However,the use of propofol alone may require high...BACKGROUND Propofol is a short-acting,rapid-recovering anesthetic widely used in sedated colonoscopy for the early detection,diagnosis and treatment of colon diseases.However,the use of propofol alone may require high doses to achieve the induction of anesthesia in sedated colonoscopy,which has been associated with anesthesia-related adverse events(AEs),including hypoxemia,sinus bradycardia,and hypotension.Therefore,propofol co-administrated with other anesthetics has been proposed to reduce the required dose of propofol,enhance the efficacy,and improve the satisfaction of patients receiving colonoscopy under sedation.AIM To evaluate the efficacy and safety of propofol target-controlled infusion(TCI)in combination with butorphanol for sedation during colonoscopy.METHODS In this controlled clinical trial,a total of 106 patients,who were scheduled for sedated colonoscopy,were prospectively recruited and assigned into three groups to receive different doses of butorphanol before propofol TCI:Low-dose butorphanol group(5μg/kg,group B1),high-dose butorphanol group(10μg/kg,group B2),and control group(normal saline,group C).Anesthesia was achieved by propofol TCI.The primary outcome was the median effective concentration(EC50)of propofol TCI,which was measured using the up-and-down sequential method.The secondary outcomes included AEs in perianesthesia and recovery characteristics.RESULTS The EC50 of propofol for TCI was 3.03μg/mL[95%confidence interval(CI):2.83-3.23μg/mL]in group B2,3.41μg/mL(95%CI:3.20-3.62μg/mL)in group B1,and 4.05μg/mL(95%CI:3.78-4.34μg/mL)in group C.The amount of propofol necessary for anesthesia was 132 mg[interquartile range(IQR),125-144.75 mg]in group B2 and 142 mg(IQR,135-154 mg)in group B1.Furthermore,the awakening concentration was 1.1μg/mL(IQR,0.9-1.2μg/mL)in group B2 and 1.2μg/mL(IQR,1.025-1.5μg/mL)in group B1.Notably,the propofol TCI plus butorphanol groups(groups B1 and B2)had a lower incidence of anesthesia AEs,when compared to group C.Furthermore,no significant differences were observed in the rates of AEs in perianesthesia,including hypoxemia,sinus bradycardia,hypotension,nausea and vomiting,and vertigo,among group C,group B1 and group B2.CONCLUSION The combined use with butorphanol reduces the EC50 of propofol TCI for anesthesia.The decrease in propofol might contribute to the reduced anesthesia-related AEs in patients undergoing sedated colonoscopy.展开更多
Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in Western countries, unsedated colonoscopy is still routinely provided in Europe and the Far East. This variation in sedati...Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in Western countries, unsedated colonoscopy is still routinely provided in Europe and the Far East. This variation in sedation practice relies on the different cultural attitudes of both patients and endoscopists across these countries. Data from the literature consistently report that, in unsedated patients, the use of alternative techniques, such as warm water irrigation or carbon dioxide insufflation, can allow a high quality and well tolerated examination.展开更多
AIM To evaluate the efficacy and safety of nitrous oxidesedated endoscopic ultrasound-guided fine needle aspiration. METHODS Enrolled patients were divided randomly into an experimental group(inhalation of nitrous oxi...AIM To evaluate the efficacy and safety of nitrous oxidesedated endoscopic ultrasound-guided fine needle aspiration. METHODS Enrolled patients were divided randomly into an experimental group(inhalation of nitrous oxide) and a control group(inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram(ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale. RESULTS There was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients(P > 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group(P < 0.05).CONCLUSION Nitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration.展开更多
AIM: To characterize the profiles of alveolar hypoventilation during colonoscopies performed under sedoanalgesia with a combination of alfentanil and either midazolam or propofol. METHODS: Consecutive patients undergo...AIM: To characterize the profiles of alveolar hypoventilation during colonoscopies performed under sedoanalgesia with a combination of alfentanil and either midazolam or propofol. METHODS: Consecutive patients undergoing routine colonoscopy were randomly assigned to sedation with either propofol or midazolam in an open-labeled design using a titration scheme. All patients received 4 μg/kg per body weight alfentanil for analgesia and 3 L of supplemental oxygen. Oxygen saturation (SpO 2 ) was measured by pulse oximetry (POX), and capnography (PcCO 2 ) was continuously measured using a combined dedicated sensor at the ear lobe. Instances of apnea resulting in measures such as stimulation of the patient, a chin lift, a mask maneuver, or withholding of sedation were recorded. PcCO 2 values (as a parameter of sedation-induced hypoventilation) were compared between groups at the following distinct time points: baseline, maximal rise, termination of the procedure and 5 min after termination of the procedure. The number of patients in both study groups who regained baseline PcCO 2 values (± 1.5 mmHg) five minutes after the procedure was determined.RESULTS: A total of 97 patients entered this study. The data from 14 patients were subsequently excluded for clinical procedure-related reasons or for technical problems. Therefore, 83 patients (mean age 62 ± 13 years) were successfully randomized to receive propofol (n = 42) or midazolam (n = 41) for sedation. Most of the patients were classified as American Society of Anesthesiologists (ASA) Ⅱ [16 (38%) in the midazolam group and 15 (32%) in the propofol group] and ASA Ⅲ [14 (33%) and 13 (32%) in the midazolam and propofol groups, respectively]. A mean dose of 5 (4-7) mg of Ⅳ midazolam and 131 (70-260) mg of Ⅳ propofol was used during the procedure in the corresponding study arms. The mean SpO 2 at baseline (%) was 99 ± 1 for the midazolam group and 99 ± 1 for the propofol group. No cases of hypoxemia (SpO 2 < 85%) or apnea were recorded. However, an increase in PcCO 2 that indicated alveolar hypoventilation occurred in both groups after administration of the first drug and was not detected with pulse oximetry alone. The mean interval between the initiation of sedation and the time when the PcCO 2 value increased to more than 2 mmHg was 2.8 ± 1.3 min for midazolam and 2.8 ± 1.1 min for propofol. The mean maximal rise was similar for both drugs: 8.6 ± 3.7 mmHg for midazolam and 7.4 ± 3.2 mmHg for propofol. Five minutes after the end of the procedure, the mean difference from the baseline values was significantly lower for the propofol treatment compared with midazolam (0.9 ± 3.0 mmHg vs 4.3 ± 3.7 mmHg, P = 0.0000169), and significantly more patients in the propofol group had regained their baseline value ± 1.5 mmHg (32 of 41vs 12 of 42,P = 0.0004). CONCLUSION: A significantly higher number of patients sedated with propofol had normalized PcCO 2 values five minutes after sedation when compared with patients sedated with midazolam.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
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 provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This ...The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis,with reference to the best available evidence.Topics covered include the pharmacology of anaesthetic agents,the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness,and the fundamentals of dialysis access procedures.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 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
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 In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient ou...BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient outcomes remains crucial.Remimazolam,a short-acting benzodiazepine,shows potential for improving sedation and reducing patient anxiety.The effects of combining remimazolam with CSE anesthesia,compared to traditional CSE anesthesia alone,on patient anxiety,sedation depth,and hemodynamics during PPH surgery have not been fully elucidated.AIM To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale(STAI-S)scores,sedation,and hemodynamics in PPH surgery.METHODS This study is a single-center,prospective,randomized controlled trial.Between November 23,2022,and August 6,2024,60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group(30 patients each).STAI-S scores,Ramsay sedation scores,and hemodynamic parameters(systolic blood pressure,diastolic blood pressure,heart rate)were measured at multiple time points.Two-way mixed-effects ANOVA and posthoc analyses were performed.RESULTS The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room[mean:28.80 vs 54.03,mean difference(95%CI):25.23(21.24-29.23),P<0.001]and 24 hours post-operation[mean:45.07 vs 54.53,mean difference(95%CI):9.47(6.29-12.64),P<0.001]than the CSE group.Moreover,the Combined group achieved a deeper sedation level during intraoperative maintenance[median:5.00(IQR:5.00-5.00)vs 2.00(IQR:2.00-2.00);median difference(95%CI):3.00(3.00-3.00),P<0.001].Regarding hemodynamics,a significant intergroup difference in systolic blood pressure was observed at the start of the surgery[mean:128.8 vs 114.7 for the Combined and CSE groups,mean difference(95%CI):14.17(0.77-27.57),adjusted P=0.033].CONCLUSION Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores,enhancing intraoperative sedation,and stabilizing systolic blood pressure at a critical stage,indicating its superiority in perioperative management.展开更多
Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and conve...Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way,TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope.Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.展开更多
[Objective]The aim was to study the sedative and hypnotic effects of Tartary Buckwheat ethanol extract and lay a foundation for further expanding the application of Tartary Buckwheat. [Method]The effects of Tartary Bu...[Objective]The aim was to study the sedative and hypnotic effects of Tartary Buckwheat ethanol extract and lay a foundation for further expanding the application of Tartary Buckwheat. [Method]The effects of Tartary Buckwheat ethanol extract on pentobarbital sodium and mice spontaneous action times were recorded. [Result]Ethanol extract of Tartary Buckwheat could prolong mice sleep duration caused by pentobarbital sodium （suprathreshold dosage）,increase mice sleep number caused by pentobarbital sodium （subthreshold dosage）,and obviously inhibit mice spontaneous action times. [Conclusion]Ethanol extract of Tartary Buckwheat has a function of sedation.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
AIM To compare colonoscopy quality with nitrous oxide gas(Entonox?) against intravenous conscious sedation using midazolam plus opioid.METHODS A retrospective analysis was performed on a prospectively held database of...AIM To compare colonoscopy quality with nitrous oxide gas(Entonox?) against intravenous conscious sedation using midazolam plus opioid.METHODS A retrospective analysis was performed on a prospectively held database of 18608 colonoscopies carried out in Lothian health board hospitals between July 2013 and January 2016.The quality of colonoscopies performed with Entonox was compared to intravenous conscious sedation(abbreviated in this article as IVM).Furthermore,the quality of colonoscopies performed with an unmedicated group was compared to IVM.The study used the following key markers of colonoscopy quality:(1) patient comfort scores;(2) caecal intubation rates(CIRs); and (3) polyp detection rates (PDRs).We used binary logistic regression to model the data.RESULTS There was no difference in the rate of moderate-toextreme discomfort between the Entonox and IVM groups (17.9% vs 18.8%; OR = 1.06,95%CI: 0.95-1.18,P = 0.27).Patients in the unmedicated group were less likely to experience moderate-to-extreme discomfort than those in the IVM group(11.4% vs 18.8%; OR = 0.71,95%CI: 0.60-0.83,P < 0.001).There was no difference in caecal intubation between the Entonox and IVM groups(94.4% vs 93.7%; OR = 1.08,95%CI: 0.92-1.28,P = 0.34).There was no difference in caecal intubation between the unmedicated and IVM groups (94.2% vs 93.7%; OR = 0.98,95%CI: 0.79-1.22,P = 0.87).Polyp detection in the Entonox group was not different from IVM group (35.0% vs 33.1%; OR = 1.01,95%CI: 0.93-1.10,P = 0.79).Polyp detection in the unmedicated group was not significantly different from the IVM group (37.4% vs 33.1%; OR = 0.97,95%CI: 0.87-1.08,P = 0.60).CONCLUSION The use of Entonox was not associated with lower colonoscopy quality when compared to intravenous conscious sedation using midazolam plus opioid.展开更多
Eight new cyclopyrrolone compounds were synthesized according to the structure activity relationship and action mechanism of Zopiclone, a cyclopyrrolone hypnotic. Their preliminary pharmacodynamics are under investig...Eight new cyclopyrrolone compounds were synthesized according to the structure activity relationship and action mechanism of Zopiclone, a cyclopyrrolone hypnotic. Their preliminary pharmacodynamics are under investigation.展开更多
文摘National data show that in China mainland unsedated gastrointestinal （GI） endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The purpose of this study was to compare sedated versus unsedated GI endoscopy regarding cost, safety, degree of comfort, tolerance level and overall satisfaction of patients over a 6-month period investigation. From March to September 2011, a questionnaire survey was performed on 1800 patients and 30 physicians at Zhongnan Hospital of Wuhan University and Wuhan General Hospital of Guangzhou Military Command. The patients fell into two groups according to their own de- cisions： the unsedated group （n=1000） and the sedated group （n=800）. After examination, the patients and the physicians were required to fill in a questionnaire form. All the data were analyzed statistically. The results showed that the main factors the patients took for consideration between sedated and unse- dated procedures included economy, comfort and safety. The income levels between the sedated and unsedated groups showed significant difference （P〈0.01）. Most patients in the unsedated group had lower income and were covered by less medical insurance. The tolerance rate was 92.4% vs. 65.5% be- tween the sedated and unsedated group, respectively. 95.5% patients in the sedated group and 72.1% pa- tients in the unsedated group chose the same endoscopy procedure for repeat examination. The survey data from endoscopists suggested the sedated procedure was more comfortable but less safe than the unsedated procedure （P〈0.01 ）. In China, unsedated GI endoscopy is now widely accepted by the major- ity of patients due to low cost and safety. Compared to unsedated GI endoscopy, sedated GI endoscopy is less painful, but more expensive and less safe. With the rapid improvement of people＇s living stan- dard and the reliability of sedation technology, we expect sedated GI endoscopy will be gradually ac- cepted by more patients.
基金Supported by Partially by College of Medicine Research Center,Deanship of Scientific Research,King Saud University
文摘AIM:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the procedure.METHODS:Consecutive patients who underwent colonoscopies over a 2-year period were invited to participate.All patients who were to undergo our endoscopy unit were offered sedation with standard intravenous sedatives and analgesics,or an unsedated colonoscopy was attempted.Demographic details were recorded.The patient anxiety level prior to the procedure,time to reach the cecum,total discharge time,patient and endoscopist pain assessments,satisfaction after the examination and the patient’s willingness to return for the same procedure in the future were recorded.RESULTS:Among the 403 observed patients,more males were observed in the unsedated group(66.2%vs 55.2%,P=0.04).Additionally,the unsedated group patients were less anxious prior to the procedure(5.1vs 6.0,P<0.01).The colonoscopy completion rates were comparable between the 2 groups(85.9%vs84.2%,P=0.66).The time to reach the cecum was also comparable(12.2 min vs 11.8 min);however,the total discharge times were shorter in the unsedated group(20.7 min vs 83.0 min,P<0.01).Moreover,the average patient pain score(3.4 vs 5.7,P<0.01)was lower in the sedated group,while the satisfaction score(8.8 vs 7.8,P<0.01)was significantly higher.There was no significant difference,however,between the groups in terms of willingness to repeat the procedure if another was required in the future(83.3%vs 77.3%,P=0.17).CONCLUSION:Unsedated colonoscopy is feasible in willing patients.The option saves the endoscopy units up to one hour per patient and does not affect the patient willingness to return to the same physician again for additional colonoscopies if a repeated procedure is needed.
文摘BACKGROUND Propofol is a short-acting,rapid-recovering anesthetic widely used in sedated colonoscopy for the early detection,diagnosis and treatment of colon diseases.However,the use of propofol alone may require high doses to achieve the induction of anesthesia in sedated colonoscopy,which has been associated with anesthesia-related adverse events(AEs),including hypoxemia,sinus bradycardia,and hypotension.Therefore,propofol co-administrated with other anesthetics has been proposed to reduce the required dose of propofol,enhance the efficacy,and improve the satisfaction of patients receiving colonoscopy under sedation.AIM To evaluate the efficacy and safety of propofol target-controlled infusion(TCI)in combination with butorphanol for sedation during colonoscopy.METHODS In this controlled clinical trial,a total of 106 patients,who were scheduled for sedated colonoscopy,were prospectively recruited and assigned into three groups to receive different doses of butorphanol before propofol TCI:Low-dose butorphanol group(5μg/kg,group B1),high-dose butorphanol group(10μg/kg,group B2),and control group(normal saline,group C).Anesthesia was achieved by propofol TCI.The primary outcome was the median effective concentration(EC50)of propofol TCI,which was measured using the up-and-down sequential method.The secondary outcomes included AEs in perianesthesia and recovery characteristics.RESULTS The EC50 of propofol for TCI was 3.03μg/mL[95%confidence interval(CI):2.83-3.23μg/mL]in group B2,3.41μg/mL(95%CI:3.20-3.62μg/mL)in group B1,and 4.05μg/mL(95%CI:3.78-4.34μg/mL)in group C.The amount of propofol necessary for anesthesia was 132 mg[interquartile range(IQR),125-144.75 mg]in group B2 and 142 mg(IQR,135-154 mg)in group B1.Furthermore,the awakening concentration was 1.1μg/mL(IQR,0.9-1.2μg/mL)in group B2 and 1.2μg/mL(IQR,1.025-1.5μg/mL)in group B1.Notably,the propofol TCI plus butorphanol groups(groups B1 and B2)had a lower incidence of anesthesia AEs,when compared to group C.Furthermore,no significant differences were observed in the rates of AEs in perianesthesia,including hypoxemia,sinus bradycardia,hypotension,nausea and vomiting,and vertigo,among group C,group B1 and group B2.CONCLUSION The combined use with butorphanol reduces the EC50 of propofol TCI for anesthesia.The decrease in propofol might contribute to the reduced anesthesia-related AEs in patients undergoing sedated colonoscopy.
文摘Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in Western countries, unsedated colonoscopy is still routinely provided in Europe and the Far East. This variation in sedation practice relies on the different cultural attitudes of both patients and endoscopists across these countries. Data from the literature consistently report that, in unsedated patients, the use of alternative techniques, such as warm water irrigation or carbon dioxide insufflation, can allow a high quality and well tolerated examination.
文摘AIM To evaluate the efficacy and safety of nitrous oxidesedated endoscopic ultrasound-guided fine needle aspiration. METHODS Enrolled patients were divided randomly into an experimental group(inhalation of nitrous oxide) and a control group(inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram(ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale. RESULTS There was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients(P > 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group(P < 0.05).CONCLUSION Nitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration.
文摘AIM: To characterize the profiles of alveolar hypoventilation during colonoscopies performed under sedoanalgesia with a combination of alfentanil and either midazolam or propofol. METHODS: Consecutive patients undergoing routine colonoscopy were randomly assigned to sedation with either propofol or midazolam in an open-labeled design using a titration scheme. All patients received 4 μg/kg per body weight alfentanil for analgesia and 3 L of supplemental oxygen. Oxygen saturation (SpO 2 ) was measured by pulse oximetry (POX), and capnography (PcCO 2 ) was continuously measured using a combined dedicated sensor at the ear lobe. Instances of apnea resulting in measures such as stimulation of the patient, a chin lift, a mask maneuver, or withholding of sedation were recorded. PcCO 2 values (as a parameter of sedation-induced hypoventilation) were compared between groups at the following distinct time points: baseline, maximal rise, termination of the procedure and 5 min after termination of the procedure. The number of patients in both study groups who regained baseline PcCO 2 values (± 1.5 mmHg) five minutes after the procedure was determined.RESULTS: A total of 97 patients entered this study. The data from 14 patients were subsequently excluded for clinical procedure-related reasons or for technical problems. Therefore, 83 patients (mean age 62 ± 13 years) were successfully randomized to receive propofol (n = 42) or midazolam (n = 41) for sedation. Most of the patients were classified as American Society of Anesthesiologists (ASA) Ⅱ [16 (38%) in the midazolam group and 15 (32%) in the propofol group] and ASA Ⅲ [14 (33%) and 13 (32%) in the midazolam and propofol groups, respectively]. A mean dose of 5 (4-7) mg of Ⅳ midazolam and 131 (70-260) mg of Ⅳ propofol was used during the procedure in the corresponding study arms. The mean SpO 2 at baseline (%) was 99 ± 1 for the midazolam group and 99 ± 1 for the propofol group. No cases of hypoxemia (SpO 2 < 85%) or apnea were recorded. However, an increase in PcCO 2 that indicated alveolar hypoventilation occurred in both groups after administration of the first drug and was not detected with pulse oximetry alone. The mean interval between the initiation of sedation and the time when the PcCO 2 value increased to more than 2 mmHg was 2.8 ± 1.3 min for midazolam and 2.8 ± 1.1 min for propofol. The mean maximal rise was similar for both drugs: 8.6 ± 3.7 mmHg for midazolam and 7.4 ± 3.2 mmHg for propofol. Five minutes after the end of the procedure, the mean difference from the baseline values was significantly lower for the propofol treatment compared with midazolam (0.9 ± 3.0 mmHg vs 4.3 ± 3.7 mmHg, P = 0.0000169), and significantly more patients in the propofol group had regained their baseline value ± 1.5 mmHg (32 of 41vs 12 of 42,P = 0.0004). CONCLUSION: A significantly higher number of patients sedated with propofol had normalized PcCO 2 values five minutes after sedation when compared with patients sedated with midazolam.
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 provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis,with reference to the best available evidence.Topics covered include the pharmacology of anaesthetic agents,the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness,and the fundamentals of dialysis access procedures.
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.
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.
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.
基金Supported by the Health Commission of Hunan Province,No.202204115263the Fundamental Research Funds for the Central Universities of Central South University,No.2024XQLH027.
文摘BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient outcomes remains crucial.Remimazolam,a short-acting benzodiazepine,shows potential for improving sedation and reducing patient anxiety.The effects of combining remimazolam with CSE anesthesia,compared to traditional CSE anesthesia alone,on patient anxiety,sedation depth,and hemodynamics during PPH surgery have not been fully elucidated.AIM To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale(STAI-S)scores,sedation,and hemodynamics in PPH surgery.METHODS This study is a single-center,prospective,randomized controlled trial.Between November 23,2022,and August 6,2024,60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group(30 patients each).STAI-S scores,Ramsay sedation scores,and hemodynamic parameters(systolic blood pressure,diastolic blood pressure,heart rate)were measured at multiple time points.Two-way mixed-effects ANOVA and posthoc analyses were performed.RESULTS The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room[mean:28.80 vs 54.03,mean difference(95%CI):25.23(21.24-29.23),P<0.001]and 24 hours post-operation[mean:45.07 vs 54.53,mean difference(95%CI):9.47(6.29-12.64),P<0.001]than the CSE group.Moreover,the Combined group achieved a deeper sedation level during intraoperative maintenance[median:5.00(IQR:5.00-5.00)vs 2.00(IQR:2.00-2.00);median difference(95%CI):3.00(3.00-3.00),P<0.001].Regarding hemodynamics,a significant intergroup difference in systolic blood pressure was observed at the start of the surgery[mean:128.8 vs 114.7 for the Combined and CSE groups,mean difference(95%CI):14.17(0.77-27.57),adjusted P=0.033].CONCLUSION Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores,enhancing intraoperative sedation,and stabilizing systolic blood pressure at a critical stage,indicating its superiority in perioperative management.
文摘Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way,TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope.Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.
基金Supported by Key Projects in the National Science &Technology Pillar Program during the Eleventh Five-year Plan Period(2006BAD02B06)Projects in Sichuan Province Administration of Traditional Chinese Medicine (2006750)~~
文摘[Objective]The aim was to study the sedative and hypnotic effects of Tartary Buckwheat ethanol extract and lay a foundation for further expanding the application of Tartary Buckwheat. [Method]The effects of Tartary Buckwheat ethanol extract on pentobarbital sodium and mice spontaneous action times were recorded. [Result]Ethanol extract of Tartary Buckwheat could prolong mice sleep duration caused by pentobarbital sodium （suprathreshold dosage）,increase mice sleep number caused by pentobarbital sodium （subthreshold dosage）,and obviously inhibit mice spontaneous action times. [Conclusion]Ethanol extract of Tartary Buckwheat has a function of sedation.
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AIM To compare colonoscopy quality with nitrous oxide gas(Entonox?) against intravenous conscious sedation using midazolam plus opioid.METHODS A retrospective analysis was performed on a prospectively held database of 18608 colonoscopies carried out in Lothian health board hospitals between July 2013 and January 2016.The quality of colonoscopies performed with Entonox was compared to intravenous conscious sedation(abbreviated in this article as IVM).Furthermore,the quality of colonoscopies performed with an unmedicated group was compared to IVM.The study used the following key markers of colonoscopy quality:(1) patient comfort scores;(2) caecal intubation rates(CIRs); and (3) polyp detection rates (PDRs).We used binary logistic regression to model the data.RESULTS There was no difference in the rate of moderate-toextreme discomfort between the Entonox and IVM groups (17.9% vs 18.8%; OR = 1.06,95%CI: 0.95-1.18,P = 0.27).Patients in the unmedicated group were less likely to experience moderate-to-extreme discomfort than those in the IVM group(11.4% vs 18.8%; OR = 0.71,95%CI: 0.60-0.83,P < 0.001).There was no difference in caecal intubation between the Entonox and IVM groups(94.4% vs 93.7%; OR = 1.08,95%CI: 0.92-1.28,P = 0.34).There was no difference in caecal intubation between the unmedicated and IVM groups (94.2% vs 93.7%; OR = 0.98,95%CI: 0.79-1.22,P = 0.87).Polyp detection in the Entonox group was not different from IVM group (35.0% vs 33.1%; OR = 1.01,95%CI: 0.93-1.10,P = 0.79).Polyp detection in the unmedicated group was not significantly different from the IVM group (37.4% vs 33.1%; OR = 0.97,95%CI: 0.87-1.08,P = 0.60).CONCLUSION The use of Entonox was not associated with lower colonoscopy quality when compared to intravenous conscious sedation using midazolam plus opioid.
文摘Eight new cyclopyrrolone compounds were synthesized according to the structure activity relationship and action mechanism of Zopiclone, a cyclopyrrolone hypnotic. Their preliminary pharmacodynamics are under investigation.
