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
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
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
BACKGROUND Remimazolam is a new benzodiazepine used for procedural sedation and general anesthesia.Several studies have used remimazolam for bendable bronchoscopy.AIM To assess the safety and efficacy of remimazolam f...BACKGROUND Remimazolam is a new benzodiazepine used for procedural sedation and general anesthesia.Several studies have used remimazolam for bendable bronchoscopy.AIM To assess the safety and efficacy of remimazolam for sedation in patients undergoing bendable bronchoscopy by performing a meta-analysis of randomized controlled trials(RCTs).METHODS We searched the EMBASE,PubMed,Cochrane Library,and Web of Science databases for RCTs on bendable bronchoscopic procedural sedation with remimazolam vs conventional sedatives(CS).RESULTS Five studies with 1080 cases were included.Remimazolam had the same sedation success rate compared with CS[relative risk(RR):1.35,95%CI:0.60-3.05,P=0.474,I2=99.6%].However,remimazolam was associated with a lower incidence of hypotension(RR:0.61;95%CI:0.40-0.95,P=0.027;I2=65.1%)and a lower incidence of respiratory depression(RR:0.50,95%CI:0.33-0.77,P=0.002,I2=42.3%).A subgroup analysis showed a higher success rate of sedation with remimazolam than midazolam(RR:2.45,95%CI:1.76-3.42,P<0.001).Compared with propofol,the incidence of hypotension(RR:0.45,95%CI:0.32-0.64,P<0.001,I2=0.0%),respiratory depression(RR:0.48,95%CI:0.30-0.76,P=0.002,I2=78.4%),hypoxemia(RR:0.36,95%CI:0.15-0.87,P=0.023),and injection pain(RR:0.04,95%CI:0.01-0.28,P=0.001)were lower.CONCLUSION Remimazolam is safe and effective during bronchoscopy.The sedation success rate was similar to that in the CS group.However,remimazolam has a higher safety profile,with fewer inhibitory effects on respiration and circulation.展开更多
BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings.A known risk of performing endoscopy under moderate sedation is the potential for over-sedation,requiring the use of reversa...BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings.A known risk of performing endoscopy under moderate sedation is the potential for over-sedation,requiring the use of reversal agents.More needs to be reported on rates of reversal across different outpatient settings.Our academic tertiary care center utilizes a triage tool that directs higher-risk patients to the in-hospital ambulatory procedure center(APC)for their procedure.Here,we report data on outpatient sedation reversal rates for endoscopy performed at an inhospital APC vs at a free-standing ambulatory endoscopy digestive health center(AEC-DHC)following risk stratification with a triage tool.AIM To observe the effect of risk stratification using a triage tool on patient outcomes,primarily sedation reversal events.METHODS We observed all outpatient endoscopy procedures performed at AEC-DHC and APC from April 2013 to September 2019.Procedures were stratified to their respective sites using a triage tool.We evaluated each procedure for which sedation reversal with flumazenil and naloxone was recorded.Demographics and characteristics recorded include patient age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,procedure type,and reason for sedation reversal.RESULTS There were 97366 endoscopic procedures performed at AEC-DHC and 22494 at the APC during the study period.Of these,17 patients at AEC-DHC and 9 at the APC underwent sedation reversals(0.017%vs 0.04%;P=0.06).Demographics recorded for those requiring reversal at AEC-DHC vs APC included mean age(53.5±21 vs 60.4±17.42 years;P=0.23),ASA class(1.66±0.48 vs 2.22±0.83;P=0.20),BMI(27.7±6.7 kg/m^(2) vs 23.7±4.03 kg/m^(2);P=0.06),and female gender(64.7%vs 22%;P=0.04).The mean doses of sedative agents and reversal drugs used at AEC-DHC vs APC were midazolam(5.9±1.7 mg vs 8.9±3.5 mg;P=0.01),fentanyl(147.1±49.9μg vs 188.9±74.1μg;P=0.10),flumazenil(0.3±0.18μg vs 0.17±0.17μg;P=0.13)and naloxone(0.32±0.10 mg vs 0.28±0.12 mg;P=0.35).Procedures at AEC-DHC requiring sedation reversal included colonoscopies(n=6),esophagogastroduodenoscopy(EGD)(n=9)and EGD/colonoscopies(n=2),whereas APC procedures included EGDs(n=2),EGD with gastrostomy tube placement(n=1),endoscopic retrograde cholangiopancreatography(n=2)and endoscopic ultrasound's(n=4).The indications for sedation reversal at AEC-DHC included hypoxia(n=13;76%),excessive somnolence(n=3;18%),and hypotension(n=1;6%),whereas,at APC,these included hypoxia(n=7;78%)and hypotension(n=2;22%).No sedation-related deaths or long-term post-sedation reversal adverse outcomes occurred at either site.CONCLUSION Our study highlights the effectiveness of a triage tool used at our tertiary care hospital for risk stratification in minimizing sedation reversal events during outpatient endoscopy procedures.Using a triage tool for risk stratification,low rates of sedation reversal can be achieved in the ambulatory settings for EGD and colonoscopy.展开更多
BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical venti...BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical ventilation.AIM To compare the neuroprotective effects of dexmedetomidine and propofol for sedation during prolonged mechanical ventilation in patients without brain injury.METHODS Patients who underwent mechanical ventilation for>72 h were randomly assigned to receive sedation with dexmedetomidine or propofol.The Richmond Agitation and Sedation Scale(RASS)was used to evaluate sedation effects,with a target range of-3 to 0.The primary outcomes were serum levels of S100-βand neuron-specific enolase(NSE)every 24 h.The secondary outcomes were remifentanil dosage,the proportion of patients requiring rescue sedation,and the time and frequency of RASS scores within the target range.RESULTS A total of 52 and 63 patients were allocated to the dexmedetomidine group and propofol group,respectively.Baseline data were comparable between groups.No significant differences were identified between groups within the median duration of study drug infusion[52.0(IQR:36.0-73.5)h vs 53.0(IQR:37.0-72.0)h,P=0.958],the median dose of remifentanil[4.5(IQR:4.0-5.0)μg/kg/h vs 4.6(IQR:4.0-5.0)μg/kg/h,P=0.395],the median percentage of time in the target RASS range without rescue sedation[85.6%(IQR:65.8%-96.6%)vs 86.7%(IQR:72.3%-95.3),P=0.592],and the median frequency within the target RASS range without rescue sedation[72.2%(60.8%-91.7%)vs 73.3%(60.0%-100.0%),P=0.880].The proportion of patients in the dexmedetomidine group who required rescue sedation was higher than in the propofol group with statistical significance(69.2%vs 50.8%,P=0.045).Serum S100-βand NSE levels in the propofol group were higher than in the dexmedetomidine group with statistical significance during the first six and five days of mechanical ventilation,respectively(all P<0.05).CONCLUSION Dexmedetomidine demonstrated stronger protective effects on the brain compared to propofol for long-term mechanical ventilation in patients without brain injury.展开更多
Worldwide,a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient comfort.Propofol,benzodiazepines and opioids continue to be widely used.However,in recent years,Remim...Worldwide,a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient comfort.Propofol,benzodiazepines and opioids continue to be widely used.However,in recent years,Remimazolam is gaining immense popularity for procedural sedation in gastrointestinal(GI)endoscopy.It is an ultra-short-acting benzodiazepine sedative which was approved by the Food and Drug Administration in July 2020 for use in procedural sedation.Remimazolam has shown a favorable pharmacokinetic and pharmacodynamic profile in terms of its non-specific metabolism by tissue esterase,volume of distribution,total body clearance,and negligible drug-drug interactions.It also has satisfactory efficacy and has achieved high rates of successful sedation in GI endoscopy.Furthermore,studies have demonstrated that the efficacy of Remimazolam is non-inferior to Propofol,which is currently a gold standard for procedural sedation in most parts of the world.However,the use of Propofol is associated with hemodynamic instability and respiratory depression.In contrast,Remimazolam has lower incidence of these adverse effects intra-procedurally and hence,may provide a safer alternative to Propofol in procedural sedation.In this comprehensive narrative review,highlight the pharmacologic characteristics,efficacy,and safety of Remimazolam for procedural sedation.We also discuss the potential of Remimazolam as a suitable alternative and how it can shape the future of procedural sedation in gastroenterology.展开更多
In this article we comment on the article by Walayat et al.Outpatient endoscopy has become vital in modern healthcare,providing efficient diagnostic and therapeutic interventions with minimal patient disruption.This s...In this article we comment on the article by Walayat et al.Outpatient endoscopy has become vital in modern healthcare,providing efficient diagnostic and therapeutic interventions with minimal patient disruption.This study highlighted the key developments in sedation management,focusing on risk stratification and procedural settings to enhance safety.The findings demonstrate that a rigorous triage tool effectively reduces adverse events related to sedation and reversals.By identifying patients at higher risk,this tool helps mitigate complications during procedures.Importantly,appropriate risk stratification allows complex procedures to be performed under conscious sedation,significantly improving patient outcomes and optimizing resource allocation,particularly in constrained healthcare environments.展开更多
Background: Deep sedation, euthanasia and therapeutic relentlessness lead us today to rethink the paradigm of life and the contingency of human existence. Between therapeutic relentlessness, the unreasonable care whic...Background: Deep sedation, euthanasia and therapeutic relentlessness lead us today to rethink the paradigm of life and the contingency of human existence. Between therapeutic relentlessness, the unreasonable care which uses heavy therapeutic means which are often disproportionate to the expected benefit, namely keeping alive a patient whose condition is considered medically hopeless;and euthanasia which would precipitate the process of death would be sedation in the terminal phase of the illness. Should doctors and families of comatose patients decide the “life” and “death” of their patients? For anti-euthanasia associations, doctors, relatives of terminally ill patients and the State itself, if they accept the principle of euthanasia, they are “murderers”, while for pro-euthanasists, the dignity of the human being would recommend that the days of patients in situations considered critical be shortened, to avoid unnecessary suffering and humiliation. Methods: A systematic review of the literature was carried out to identify relevant articles relating to euthanasia, dysthanasia and sedation in the terminal phase of illness. The search was conducted in French or English in three databases: PubMed, Google Scholar and Science Direct. Objectives: The objectives of this article are: 1) define the terminologies and concepts of palliative sedation, deep sedation, deep and continuous sedation until death, euthanasia and dysthanasia;2) present aspects of the meaning of life and the human person in African cultures;and 3) propose an ethical reflection on the value of life. Results: After precisely defining the concepts of euthanasia, dysthanasia and sedation, this research presented the African anthropological and ethical approach to the mysteries of life and death. Conclusion: With this in mind, the golden rule of medicine always remains as such “Primum non nocere”.展开更多
This paper examines sedation options in ICU postoperative care. It highlights the necessity of sedation for patients’ physical and mental comfort, safety, and reduction of delirium. The article advocates light sedati...This paper examines sedation options in ICU postoperative care. It highlights the necessity of sedation for patients’ physical and mental comfort, safety, and reduction of delirium. The article advocates light sedation, primarily with non-benzodiazepines like propofol or dexmedetomidine, to improve outcomes. It introduces novel sedatives like ciprofol and remimazolam, suggesting they may be future alternatives in ICU sedation, although more research is needed.展开更多
The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients,...The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.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
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
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.
基金Supported by the Fund of the Hunan Provincial Health Commission,No.D20230416797。
文摘BACKGROUND Remimazolam is a new benzodiazepine used for procedural sedation and general anesthesia.Several studies have used remimazolam for bendable bronchoscopy.AIM To assess the safety and efficacy of remimazolam for sedation in patients undergoing bendable bronchoscopy by performing a meta-analysis of randomized controlled trials(RCTs).METHODS We searched the EMBASE,PubMed,Cochrane Library,and Web of Science databases for RCTs on bendable bronchoscopic procedural sedation with remimazolam vs conventional sedatives(CS).RESULTS Five studies with 1080 cases were included.Remimazolam had the same sedation success rate compared with CS[relative risk(RR):1.35,95%CI:0.60-3.05,P=0.474,I2=99.6%].However,remimazolam was associated with a lower incidence of hypotension(RR:0.61;95%CI:0.40-0.95,P=0.027;I2=65.1%)and a lower incidence of respiratory depression(RR:0.50,95%CI:0.33-0.77,P=0.002,I2=42.3%).A subgroup analysis showed a higher success rate of sedation with remimazolam than midazolam(RR:2.45,95%CI:1.76-3.42,P<0.001).Compared with propofol,the incidence of hypotension(RR:0.45,95%CI:0.32-0.64,P<0.001,I2=0.0%),respiratory depression(RR:0.48,95%CI:0.30-0.76,P=0.002,I2=78.4%),hypoxemia(RR:0.36,95%CI:0.15-0.87,P=0.023),and injection pain(RR:0.04,95%CI:0.01-0.28,P=0.001)were lower.CONCLUSION Remimazolam is safe and effective during bronchoscopy.The sedation success rate was similar to that in the CS group.However,remimazolam has a higher safety profile,with fewer inhibitory effects on respiration and circulation.
文摘BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings.A known risk of performing endoscopy under moderate sedation is the potential for over-sedation,requiring the use of reversal agents.More needs to be reported on rates of reversal across different outpatient settings.Our academic tertiary care center utilizes a triage tool that directs higher-risk patients to the in-hospital ambulatory procedure center(APC)for their procedure.Here,we report data on outpatient sedation reversal rates for endoscopy performed at an inhospital APC vs at a free-standing ambulatory endoscopy digestive health center(AEC-DHC)following risk stratification with a triage tool.AIM To observe the effect of risk stratification using a triage tool on patient outcomes,primarily sedation reversal events.METHODS We observed all outpatient endoscopy procedures performed at AEC-DHC and APC from April 2013 to September 2019.Procedures were stratified to their respective sites using a triage tool.We evaluated each procedure for which sedation reversal with flumazenil and naloxone was recorded.Demographics and characteristics recorded include patient age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,procedure type,and reason for sedation reversal.RESULTS There were 97366 endoscopic procedures performed at AEC-DHC and 22494 at the APC during the study period.Of these,17 patients at AEC-DHC and 9 at the APC underwent sedation reversals(0.017%vs 0.04%;P=0.06).Demographics recorded for those requiring reversal at AEC-DHC vs APC included mean age(53.5±21 vs 60.4±17.42 years;P=0.23),ASA class(1.66±0.48 vs 2.22±0.83;P=0.20),BMI(27.7±6.7 kg/m^(2) vs 23.7±4.03 kg/m^(2);P=0.06),and female gender(64.7%vs 22%;P=0.04).The mean doses of sedative agents and reversal drugs used at AEC-DHC vs APC were midazolam(5.9±1.7 mg vs 8.9±3.5 mg;P=0.01),fentanyl(147.1±49.9μg vs 188.9±74.1μg;P=0.10),flumazenil(0.3±0.18μg vs 0.17±0.17μg;P=0.13)and naloxone(0.32±0.10 mg vs 0.28±0.12 mg;P=0.35).Procedures at AEC-DHC requiring sedation reversal included colonoscopies(n=6),esophagogastroduodenoscopy(EGD)(n=9)and EGD/colonoscopies(n=2),whereas APC procedures included EGDs(n=2),EGD with gastrostomy tube placement(n=1),endoscopic retrograde cholangiopancreatography(n=2)and endoscopic ultrasound's(n=4).The indications for sedation reversal at AEC-DHC included hypoxia(n=13;76%),excessive somnolence(n=3;18%),and hypotension(n=1;6%),whereas,at APC,these included hypoxia(n=7;78%)and hypotension(n=2;22%).No sedation-related deaths or long-term post-sedation reversal adverse outcomes occurred at either site.CONCLUSION Our study highlights the effectiveness of a triage tool used at our tertiary care hospital for risk stratification in minimizing sedation reversal events during outpatient endoscopy procedures.Using a triage tool for risk stratification,low rates of sedation reversal can be achieved in the ambulatory settings for EGD and colonoscopy.
文摘BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical ventilation.AIM To compare the neuroprotective effects of dexmedetomidine and propofol for sedation during prolonged mechanical ventilation in patients without brain injury.METHODS Patients who underwent mechanical ventilation for>72 h were randomly assigned to receive sedation with dexmedetomidine or propofol.The Richmond Agitation and Sedation Scale(RASS)was used to evaluate sedation effects,with a target range of-3 to 0.The primary outcomes were serum levels of S100-βand neuron-specific enolase(NSE)every 24 h.The secondary outcomes were remifentanil dosage,the proportion of patients requiring rescue sedation,and the time and frequency of RASS scores within the target range.RESULTS A total of 52 and 63 patients were allocated to the dexmedetomidine group and propofol group,respectively.Baseline data were comparable between groups.No significant differences were identified between groups within the median duration of study drug infusion[52.0(IQR:36.0-73.5)h vs 53.0(IQR:37.0-72.0)h,P=0.958],the median dose of remifentanil[4.5(IQR:4.0-5.0)μg/kg/h vs 4.6(IQR:4.0-5.0)μg/kg/h,P=0.395],the median percentage of time in the target RASS range without rescue sedation[85.6%(IQR:65.8%-96.6%)vs 86.7%(IQR:72.3%-95.3),P=0.592],and the median frequency within the target RASS range without rescue sedation[72.2%(60.8%-91.7%)vs 73.3%(60.0%-100.0%),P=0.880].The proportion of patients in the dexmedetomidine group who required rescue sedation was higher than in the propofol group with statistical significance(69.2%vs 50.8%,P=0.045).Serum S100-βand NSE levels in the propofol group were higher than in the dexmedetomidine group with statistical significance during the first six and five days of mechanical ventilation,respectively(all P<0.05).CONCLUSION Dexmedetomidine demonstrated stronger protective effects on the brain compared to propofol for long-term mechanical ventilation in patients without brain injury.
文摘Worldwide,a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient comfort.Propofol,benzodiazepines and opioids continue to be widely used.However,in recent years,Remimazolam is gaining immense popularity for procedural sedation in gastrointestinal(GI)endoscopy.It is an ultra-short-acting benzodiazepine sedative which was approved by the Food and Drug Administration in July 2020 for use in procedural sedation.Remimazolam has shown a favorable pharmacokinetic and pharmacodynamic profile in terms of its non-specific metabolism by tissue esterase,volume of distribution,total body clearance,and negligible drug-drug interactions.It also has satisfactory efficacy and has achieved high rates of successful sedation in GI endoscopy.Furthermore,studies have demonstrated that the efficacy of Remimazolam is non-inferior to Propofol,which is currently a gold standard for procedural sedation in most parts of the world.However,the use of Propofol is associated with hemodynamic instability and respiratory depression.In contrast,Remimazolam has lower incidence of these adverse effects intra-procedurally and hence,may provide a safer alternative to Propofol in procedural sedation.In this comprehensive narrative review,highlight the pharmacologic characteristics,efficacy,and safety of Remimazolam for procedural sedation.We also discuss the potential of Remimazolam as a suitable alternative and how it can shape the future of procedural sedation in gastroenterology.
文摘In this article we comment on the article by Walayat et al.Outpatient endoscopy has become vital in modern healthcare,providing efficient diagnostic and therapeutic interventions with minimal patient disruption.This study highlighted the key developments in sedation management,focusing on risk stratification and procedural settings to enhance safety.The findings demonstrate that a rigorous triage tool effectively reduces adverse events related to sedation and reversals.By identifying patients at higher risk,this tool helps mitigate complications during procedures.Importantly,appropriate risk stratification allows complex procedures to be performed under conscious sedation,significantly improving patient outcomes and optimizing resource allocation,particularly in constrained healthcare environments.
文摘Background: Deep sedation, euthanasia and therapeutic relentlessness lead us today to rethink the paradigm of life and the contingency of human existence. Between therapeutic relentlessness, the unreasonable care which uses heavy therapeutic means which are often disproportionate to the expected benefit, namely keeping alive a patient whose condition is considered medically hopeless;and euthanasia which would precipitate the process of death would be sedation in the terminal phase of the illness. Should doctors and families of comatose patients decide the “life” and “death” of their patients? For anti-euthanasia associations, doctors, relatives of terminally ill patients and the State itself, if they accept the principle of euthanasia, they are “murderers”, while for pro-euthanasists, the dignity of the human being would recommend that the days of patients in situations considered critical be shortened, to avoid unnecessary suffering and humiliation. Methods: A systematic review of the literature was carried out to identify relevant articles relating to euthanasia, dysthanasia and sedation in the terminal phase of illness. The search was conducted in French or English in three databases: PubMed, Google Scholar and Science Direct. Objectives: The objectives of this article are: 1) define the terminologies and concepts of palliative sedation, deep sedation, deep and continuous sedation until death, euthanasia and dysthanasia;2) present aspects of the meaning of life and the human person in African cultures;and 3) propose an ethical reflection on the value of life. Results: After precisely defining the concepts of euthanasia, dysthanasia and sedation, this research presented the African anthropological and ethical approach to the mysteries of life and death. Conclusion: With this in mind, the golden rule of medicine always remains as such “Primum non nocere”.
文摘This paper examines sedation options in ICU postoperative care. It highlights the necessity of sedation for patients’ physical and mental comfort, safety, and reduction of delirium. The article advocates light sedation, primarily with non-benzodiazepines like propofol or dexmedetomidine, to improve outcomes. It introduces novel sedatives like ciprofol and remimazolam, suggesting they may be future alternatives in ICU sedation, although more research is needed.
文摘The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.
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.
