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Bruni A, Barbara G, Vitello A, Marasco G, Maida M. Sedation in endoscopy: Current practices and future innovations. World J Gastrointest Endosc 2025; 17:106604. [DOI: 10.4253/wjge.v17.i6.106604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2025] [Revised: 04/17/2025] [Accepted: 05/24/2025] [Indexed: 06/11/2025] Open
Abstract
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 advocating 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, particularly in high-risk populations, although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited. Further investigations into these sedation strategies in higher-risk cohorts, as well as complex therapeutic endoscopy, will likely inform more nuanced, patient-specific protocols aimed at maximizing both safety and procedural efficiency.
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Affiliation(s)
- Angelo Bruni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Emilia-Romagna, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Emilia-Romagna, Italy
| | - Alessandro Vitello
- Department of Medicine and Surgery, University of Enna ‘Kore’, Enna 94100, Sicilia, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Emilia-Romagna, Italy
| | - Marcello Maida
- Department of Medicine and Surgery, University of Enna ‘Kore’, Enna 94100, Sicilia, Italy
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Zheng L, Wu X, Gu W, Wang R, Wang J, He H, Wang Z, Yi B, Zhang Y. Development and validation of a hypoxemia prediction model in middle-aged and elderly outpatients undergoing painless gastroscopy. Sci Rep 2025; 15:17965. [PMID: 40410303 PMCID: PMC12102271 DOI: 10.1038/s41598-025-02540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 05/14/2025] [Indexed: 05/25/2025] Open
Abstract
Hypoxemia is a common complication associated with anesthesia in painless gastroscopy. With the aging of the social population, the number of cases of hypoxemia among middle-aged and elderly patients is increasing. However, tools for predicting hypoxemia in middle-aged and elderly patients are lacking. In this study, we investigated the risk factors for hypoxemia in middle-aged and elderly outpatients undergoing painless gastroscopy based on machine learning and constructed a risk prediction model. In this retrospective study, we included the data on 1,348 outpatients undergoing painless gastroscopy. In total, 26 characteristic variables, including demographic information, past medical history, and clinical data of the patients were included, and BorutaShap was used for feature selection. Five machine learning algorithm models, including logistic regression (LR), support vector machine (SVM), random forest (RF), extreme gradient boosting (XGB), and light gradient boosting machine (LightGBM), were selected. The best models were selected based on the area under the receiver operating characteristic curve (AUROC). Model feature importance was explained and analyzed using Shapley Additive Explanations (SHAP). The endpoint event of this study was considered to be hypoxemia during the procedure, defined as at least one occurrence of pulse oxygen saturation below 90% without probe misalignment or interference from the beginning of anesthesia induction to the end of painless gastroscopy. In the final cohort of 984 patients, 11% of patients (108/984) experienced hypoxemia during the painless gastroscopy procedure. The AUROCs of the five models were as follows: Logistic Regression (AUROC = 0.893, 95CI: 0.881-0.899), SVM (AUROC = 0.855, 95CI: 0.812-0.884), Random Forest (AUROC = 0.914, 95CI: 0.889-0.924), XGB (AUROC = 0.902, 95CI: 0.865-0.919), and LightGBM (AUROC = 0.891, 95CI: 0.847-0.917). Regarding the explanation of the importance of SHAP features, preoperative variables (baseline SpO2, body mass index, and micrognathia) and intraoperative variables (operating time of gastroscopy, induction dose of etomidate and propofol mixture, append anesthetic, cough, and repeated pharyngeal irritation) significantly contributed to the model. We identified eight potential risk factors related to the occurrence of hypoxemia in middle-aged and elderly patients undergoing painless gastroscopy, based on machine learning feature engineering. Among the five machine learning algorithms, RF exhibited the best predictive performance in the internal test set and had a certain degree of generalization ability in the external validation set, which indicated that the RF model was more suitable for the data framework of this study. This model was more likely to enhance the accuracy of hypoxemia prediction in middle-aged and elderly patients undergoing painless gastroscopy, and thus, it is suitable for assisting anesthesiologists in clinical decision-making.
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Affiliation(s)
- Leilei Zheng
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Xinyan Wu
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Wei Gu
- Department of Anesthesiology, Minhang Hospital of Fudan University, Shanghai, 201199, China
| | - Rui Wang
- Department of Anesthesiology, Third Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Jing Wang
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Hongying He
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Zhao Wang
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Bin Yi
- Department of Anesthesiology, First Affiliated Hospital of Army Medical University, Chongqing, 400038, China.
| | - Yi Zhang
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.
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Pigò F, Gottin M, Conigliaro R. The Incidence of Adverse Events in Adults Undergoing Procedural Sedation with Propofol Administered by Non-Anesthetists: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2025; 15:1234. [PMID: 40428226 PMCID: PMC12110594 DOI: 10.3390/diagnostics15101234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Revised: 04/15/2025] [Accepted: 05/08/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: The administration of propofol without an anesthesiologist (NAAP) during endoscopic procedures is generally considered safe. However, the available data remain limited and fragmented due to legal constraints. This systematic review and meta-analysis aimed to evaluate the incidence of adverse events in adults undergoing procedural sedation with NAAP. Methods: A comprehensive search was conducted in three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) for studies published between 2010 and 2023. Eligible studies included randomized controlled trials and observational studies that reported predefined adverse events in adult patients receiving NAAP for procedural sedation. The analysis encompassed various types of endoscopic procedures and sedation protocols, including both balanced sedation and propofol monotherapy. Clinical heterogeneity was assessed by comparing patient characteristics, sedation methods, and outcome measures across studies. A random effects model was used for the meta-analysis, with results presented as estimated incidence rates. Subgroup analyses were conducted based on the hypoxia severity, sedation approach, and procedure type. Results: The search yielded 2963 records, of which 73 studies met the inclusion criteria, covering a total of 967,238 procedural sedations. Hypoxia was the most frequently reported adverse event, occurring in 40‱ of cases, followed by hypotension (38‱) and bradycardia (9‱). Severe adverse events requiring emergency intervention were rare, with an incidence of 0.12‱. The subgroup analysis indicated a low occurrence (6‱) of severe desaturation (SpO2 < 80%) and no significant differences in adverse event rates between balanced propofol sedation and propofol-only sedation. However, advanced endoscopic procedures (EUS, ERCP, PEG, enteroscopy, EMR/ESD) were associated with a higher risk of hypoxia (10% vs. 26‱; p < 0.00001) and major complications (3.1‱ vs. 0.1‱; p = 0.015) compared to diagnostic procedures. Conclusions: NAAP-based procedural sedation appears to be generally safe. While the minor adverse event rates vary depending on the sedation regimen and procedure type, major complications remain exceptionally rare.
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Affiliation(s)
- Flavia Pigò
- Digestive Endoscopy, Azienda Ospedaliero Universitaria of Modena, 41125 Modena, Italy
| | - Matteo Gottin
- Gastroenterology Unit, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy;
| | - Rita Conigliaro
- Digestive Endoscopy, Azienda Ospedaliero Universitaria of Modena, 41125 Modena, Italy
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Ehlken H, Foerster J, Barten MJ, Issleib M, Rösch T, Reichenspurner H, Schachschal G. Poor risk-benefit ratio of gastrointestinal endoscopy for screening prior to heart or lung transplantation. Surg Endosc 2025; 39:3106-3112. [PMID: 40164836 PMCID: PMC12041142 DOI: 10.1007/s00464-025-11678-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 03/14/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND Routine pre-transplant evaluations for heart or lung recipients often include upper and lower gastrointestinal endoscopies. However, given that these patients frequently have significant and multiple comorbidities, the risk-benefit ratio of endoscopy with sedation remains uncertain. METHODS We conducted a retrospective chart review of all patients who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy as part of the pre-transplant evaluation for heart (HTX) or lung transplantation (LuTX) at our center over a 10-year period. All procedures were performed with either anesthesiologist-assisted sedation or general anesthesia (72%) or physician-assisted sedation (28%). The primary outcomes included the prevalence of pre/neoplastic lesions and the rate of adverse events, classified according to the American Society of Gastrointestinal Endoscopy. RESULTS A total of 315 patients (70% male, median age 55 years) were included, with ASA grades 3 (31%) and 4 (69%). Of these, 90% underwent both EGD and colonoscopy. While no neoplasia or findings relevant to transplantation were detected on EGD, a single rectal malignant pedunculated polyp was identified and curatively removed via colonoscopy (G2 pT1 L0 V0 R0). The adenoma detection rate during colonoscopy was 25%, including a 7% rate of advanced adenomas, with six additional lesions (< 10 mm) exhibiting high-grade dysplasia. Conversely, severe adverse events occurred in 2.5% of cases, involving both cardiovascular and colonoscopy-related complications. These included two cases of severe hypotension and bradyarrhythmia requiring cardiovascular resuscitation, with one resulting in death (0.3% mortality). Additionally, one splenic rupture, two colonic perforations, and two cases of severe post-polypectomy bleeding were observed. CONCLUSION The routine requirement for upper and lower gastrointestinal endoscopy as a screening measure before heart or lung transplantation should be reconsidered due to its unfavorable risk-benefit profile. An individualized approach should be taken.
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Affiliation(s)
- Hanno Ehlken
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jana Foerster
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Markus Johannes Barten
- Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Malte Issleib
- Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Guido Schachschal
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Kato H, Kawasaki Y, Sumi K, Shibata Y, Nomura N, Ushio J, Eguchi J, Ito T, Inoue H. Propofol-alone sedative efficacy in observational biliopancreatic endoscopic ultrasound. DEN OPEN 2025; 5:e70025. [PMID: 39420874 PMCID: PMC11483557 DOI: 10.1002/deo2.70025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 09/19/2024] [Accepted: 09/30/2024] [Indexed: 10/19/2024]
Abstract
Objectives Appropriate sedative and analgesic selection is essential to reduce patient discomfort and body movement to safely conduct endoscopic ultrasonography (EUS). However, few cases have examined sedation with propofol in EUS, and few studies the need for combined analgesia. In this study, we retrospectively evaluated the usefulness and safety of propofol without analgesics for sedation in biliopancreatic observational EUS. Methods This single-center retrospective study included 516 observational biliopancreatic EUS procedures using propofol alone performed between April 2021 and March 2023. The primary and secondary endpoints were the observational biliopancreatic EUS results obtained with propofol alone and adverse event occurrence, respectively. Results The median examination time and total propofol dose were 22 (range: 10-67) min and 186.5 (range: 50-501) mg, respectively. The median starting Richmond Agitation-Sedation Scale and Visual Analog Scale scores were -5 (range: -5-1) and 0 (range: 0-10), respectively. The median recovery time was 22 (range: 5-80) min. Adverse events occurred in 60 (11.6%) patients. Trainee-performed examination (odds ratio [OR] 3.52, 95% confidence interval [CI]: 1.63-7.60, p = 0.0014) and examination length (>22 min; OR 1.67, 95% CI: 0.95-2.92, p = 0.07) were risk factors for adverse events.High body mass index (OR 1.87, 95% CI: 1.10-3.16, p = 0.02) and extended examination time (OR 4.23, 95% CI: 2.08-8. 57, p < 0.001) were risk factors for delayed recovery. Conclusions During observational biliopancreatic EUS, propofol is useful as a single sedative and offers high patient satisfaction and relative safety.
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Affiliation(s)
- Hisaki Kato
- Department of Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Yuki Kawasaki
- Department of Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Kazuya Sumi
- Department of Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Yuki Shibata
- Department of Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Norihiro Nomura
- Department of Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Jun Ushio
- Department of Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Junichi Eguchi
- Department of Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Takayoshi Ito
- Department of Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Haruhiro Inoue
- Department of Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
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Lee K, Jung DH, Lee SJ, Yoo YC, Shin SK. Effect of remimazolam on oxygen reserve compared with propofol during upper gastrointestinal endoscopy: Randomized controlled study. Dig Endosc 2025; 37:391-399. [PMID: 39511827 PMCID: PMC11986890 DOI: 10.1111/den.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 10/02/2024] [Indexed: 11/15/2024]
Abstract
OBJECTIVES Propofol is commonly used for endoscopic sedation. However, it can induce adverse hemodynamic effects. Remimazolam is known to have a fast onset and short duration comparable to that of propofol, but with fewer effects on hemodynamics. We assessed the Oxygen Reserve Index to verify whether a sedative dose of remimazolam would better preserve oxygenation in the mild hyperoxic range than propofol in sedated patients undergoing diagnostic upper gastrointestinal endoscopy. METHODS Patients scheduled for diagnostic upper gastrointestinal endoscopy were enrolled. Patients were randomly assigned to either the remimazolam or propofol groups and received 0.1 mg/kg remimazolam or 0.5 mg/kg propofol, respectively. Bolus injections of either 0.05 mg/kg remimazolam or 0.25 mg/kg propofol were added if required. The primary outcome was the prevalence of oxygen reserve depletion, defined as the Oxygen Reserve Index decreasing to 0.00, and hypoxia defined as peripheral oxygen saturation falling to <94%. RESULTS Among 69 patients, the incidence of oxygen reserve depletion was significantly higher in the propofol group (65.7% vs. 38.2%, P = 0.022). Hypoxia was frequently observed in the propofol group, whereas none was observed in the remimazolam group (11.4% vs. 0%, P = 0.042). Additional sedative injections were frequently required to complete endoscopy in the propofol group. None of the patients in the remimazolam group required airway interventions. Nausea was frequent in the propofol group in the recovery room. CONCLUSION Our results indicate that remimazolam is a safe and useful sedative for upper gastrointestinal endoscopy.
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Affiliation(s)
- Kyuho Lee
- Department of Anesthesiology and Pain MedicineSeverance Hospital, Yonsei University College of MedicineSeoulKorea
| | - Da Hyun Jung
- Department of Gastroenterology and Internal MedicineSeverance Hospital, Yonsei University College of MedicineSeoulKorea
| | - Sung Jin Lee
- Department of Anesthesiology and Pain MedicineSeverance Hospital, Yonsei University College of MedicineSeoulKorea
| | - Young Chul Yoo
- Department of Anesthesiology and Pain MedicineSeverance Hospital, Yonsei University College of MedicineSeoulKorea
| | - Sung Kwan Shin
- Department of Gastroenterology and Internal MedicineSeverance Hospital, Yonsei University College of MedicineSeoulKorea
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Chen YS, Feng GH, Yue QQ, Wang YF, Liu M, Zhao KH, Tang T, Huang MT, Yi WT, Yan HL, Yan JH, Zeng Y. Effects of non-pharmacological interventions on anxiety in patients undergoing colonoscopy: A network meta-analysis of randomized controlled trials. J Psychosom Res 2025; 191:112065. [PMID: 40043571 DOI: 10.1016/j.jpsychores.2025.112065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 01/07/2025] [Accepted: 02/17/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Anxiety is a common and significant problem in patients who need to undergo colonoscopy. However, the question of which non-pharmacological intervention is the best strategy to reduce anxiety in patients undergoing colonoscopy remains unanswered. OBJECTIVES To evaluate and rank the effectiveness of various non-pharmacological interventions for reducing anxiety in patients undergoing colonoscopy in order to identify the most effective strategies. METHODS We searched PubMed, Cochrane Library, Embase, Web of Science, and Medline for randomized controlled trials published from the database construction to March 2024. The primary outcome was the difference between pre- and post-intervention anxiety means. A network meta-analysis was conducted utilizing the "gemtc" package based on R4.3.0. RESULTS The analysis encompassed 24 randomized controlled trials, incorporating 2525 participants and evaluating 9 non-pharmacological interventions. All non-pharmacological interventions reduced anxiety in patients undergoing colonoscopy compared to standard care, with music intervention (SMD = -0.52, 95 %CI (-0.84,-0.20)), audiovisual distraction (SMD = -0.54, 95 %CI(-0.96,-0.12)), video information (SMD = -1.47, 95 %CI(-2.03,-0.90)), individual education (SMD = -1.72, 95 %CI(-2.76,-0.70)), and electroacupuncture (SMD = -1.12, 95 %CI(-2.10,-0.13)) having statistically significant effects. SUCRA ranking identified the priority of individual education (SUCRA: 92.5 %) and video information (SUCRA: 87.7 %). Meta-regression and sensitivity analysis further demonstrated the stability of the evidence. The certainty of the evidence was mostly rated as medium to low. CONCLUSION This review highlights the superior effects of individual education and video information in reducing anxiety in patients undergoing colonoscopy. The findings of our review could provide clinical decision-makers and healthcare practitioners, such as doctors and nurses, with evidence-based practices for selecting interventions to reduce anxiety in patients undergoing colonoscopy.
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Affiliation(s)
- Yun-Shan Chen
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Ge-Hui Feng
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Qian-Qian Yue
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Yi-Fei Wang
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Min Liu
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Ke-Hao Zhao
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Tian Tang
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Mao-Ting Huang
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Wen-Ting Yi
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Hui-Ling Yan
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Jia-Hui Yan
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Ying Zeng
- Department of International and Humanistic Nursing, Hunan Science Popularization Education Base, School of Nursing, Hengyang Medical School, University of South China, Hengyang, China.; Hunan Engineering Research Center for Early Diagnosis and Treatment of Liver Cancer, Cancer Research Institute, Hengyang Medical School, University of South China; Hunan Province Key Laboratory of Tumor Cellular & Molecular Pathology, Cancer Research Institute, Hengyang Medical School, University of South China, Hengyang, China..
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Yamaguchi D, Esaki M. Remimazolam: Promising sedative for upper gastrointestinal endoscopy. Dig Endosc 2025; 37:400-401. [PMID: 39810700 PMCID: PMC11986888 DOI: 10.1111/den.14995] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 12/23/2024] [Indexed: 01/16/2025]
Affiliation(s)
- Daisuke Yamaguchi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of MedicineSaga UniversitySagaJapan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of MedicineSaga UniversitySagaJapan
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Li H, Wang J, Cheng D, Li Y, Li P, Ma Q, Yao Y, Chen J, Zhang Q, Guo J, Wang S, Xing N. Bilevel positive airway pressure ventilation to prevent hypoxaemia during gastroscopy under sedation in patients at risk of hypoxaemia: study protocol for a prospective randomised controlled trial. BMJ Open 2025; 15:e096800. [PMID: 40074253 PMCID: PMC11904358 DOI: 10.1136/bmjopen-2024-096800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 02/14/2025] [Indexed: 03/14/2025] Open
Abstract
INTRODUCTION During sedation for gastroscopy, hypoxaemia represents the most common adverse event. The objective of this trial is to assess the efficacy and safety of bilevel positive airway pressure (BPAP) for the prevention of hypoxaemia, in comparison with nasal cannula oxygen therapy, among patients predisposed to hypoxaemia during sedation for gastroscopy. METHODS AND ANALYSIS This randomised controlled trial (RCT) will include 616 patients at risk of hypoxaemia when undergoing gastroscopy, including those with advanced age, frailty, American Society of Anesthesiologists grades III-IV, obesity, obstructive sleep apnoea-hypopnoea syndrome, cardiac disease, respiratory disease and diabetes. The patients will be randomly assigned to either the BPAP or nasal cannula group in a 1:1 ratio. The primary analysis for this study will use the modified intention-to-treat analysis set. The primary outcome is defined as the incidence of hypoxaemia (SpO275%-90%, duration 5-60 s). Outcomes data will be compared using the χ2 or Fisher's exact tests. Effect sizes will be used to assess the clinical effects of the intervention using absolute risk differences and 95% CIs. To assess the efficacy of BPAP in different patient subgroups, analyses will be performed based on clinical characteristics and risk factors associated with hypoxaemia. ETHICS AND DISSEMINATION The Ethics Committee of the First Affiliated Hospital of Zhengzhou University reviewed and approved this RCT (Scientific Research Ethics Review: 2023-KY-0815-003). Subsequently, the outcome will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2400084596.
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Affiliation(s)
- Huixin Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Jinguang Wang
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dan Cheng
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Yanna Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Pingle Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiaoling Ma
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongchao Yao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiaqi Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qingli Zhang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junping Guo
- Zhengzhou University College of Medicine, Zhengzhou, Henan, China
| | - Shuailei Wang
- Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Na Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
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Leroy PL, Krauss BS, Costa LR, Barbi E, Irwin MG, Carlson DW, Absalom A, Andolfatto G, Roback MG, Babl FE, Mason KP, Roelofse J, Costa PS, Green SM. Procedural sedation competencies: a review and multidisciplinary international consensus statement on knowledge, skills, training, and credentialing. Br J Anaesth 2025; 134:817-829. [PMID: 39327154 PMCID: PMC11867087 DOI: 10.1016/j.bja.2024.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 09/28/2024] Open
Abstract
Procedural sedation is practised by a heterogeneous group of practitioners working in a wide array of settings. However, there are currently no accepted standards for the competencies a sedation practitioner should have, the content of sedation training programmes, and guidelines for credentialing. The multidisciplinary International Committee for the Advancement of Procedural Sedation sought to develop a consensus statement on the following: which competencies should medical or dental practitioners have for procedural sedation and how are they obtained, assessed, maintained, and privileged. Using the framework of Competency-Based Medical Education, the practice of procedural sedation was defined as a complex professional task requiring demonstrable integration of different competencies. For each question, the results of a literature review were synthetised into preliminary statements. Following an iterative Delphi review method, final consensus was reached. Using multispeciality consensus, we defined procedural sedation competence by identifying a set of core competencies in the domains of knowledge, skills, and attitudes across physical safety, effectiveness, psychological safety, and deliberate practice. In addition, we present a standardised framework for competency-based training and credentialing of procedural sedation practitioners.
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Affiliation(s)
- Piet L Leroy
- Department of Pediatrics, Maastricht University Medical Centre and School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
| | - Baruch S Krauss
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Luciane R Costa
- Department of Pediatric Dentistry, Federal University of Goias, Goiania, Goias, Brazil
| | - Egidio Barbi
- Department of Pediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Michael G Irwin
- Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Douglas W Carlson
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Anthony Absalom
- Department of Anaesthesia, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gary Andolfatto
- University of British Columbia Department of Emergency Medicine, Lions Gate Hospital, North Vancouver, British Columbia, Canada
| | - Mark G Roback
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Franz E Babl
- Departments of Paediatrics and Critical Care, University of Melbourne, Emergency Department, Royal Children's Hospital, Emergency Research, Murdoch Children's Research Institute, Parkville, WA, Australia
| | - Keira P Mason
- Department of Anesthesia, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - James Roelofse
- Departments of Anaesthesia, University of the Western Cape, Stellenbosch University, Tygerberg, Republic of South Africa
| | - Paulo S Costa
- Department of Pediatrics, Federal University of Goias, Goiania, Goias, Brazil
| | - Steven M Green
- Department of Emergency Medicine, Loma Linda University, Loma Linda, CA, USA
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11
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Takimoto Y, Iwasaki E, Horibe M, Fukuhara S, Minami K, Kawasaki S, Masaoka T, Ogata H, Bazerbachi F, Kanai T. Capnographic monitoring using a novel mainstream system during endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: A prospective randomized controlled trial. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2025; 32:254-263. [PMID: 39835495 PMCID: PMC11926942 DOI: 10.1002/jhbp.12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
BACKGROUND/PURPOSE Insufficient studies exist on capnography efficacy during endoscopic ultrasound or endoscopic retrograde cholangiopancreatography, and no definitive conclusions have been drawn. To evaluate the feasibility and efficacy of a novel mainstream capnography using an over-the-biteblock end-tidal CO2 (EtCO2) detector in decreasing the risk of hypoxemia during endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). METHODS Patients undergoing EUS or ERCP with conscious sedation at a single Japanese center were randomized to a control or a novel capnography monitored (intervention) group in a 1:1 ratio. Hypoxemia correction maneuvers were pursued if the oxygen saturation decreased to <92% in the control or intervention group and if a 15-s suspension of EtCO2 wave occurred in the intervention group. The primary outcome was the incidence of hypoxemic events, defined as oxygen saturation <90%, during the procedures. Secondary outcomes included technical feasibility of EUS and ERCP with the use of this novel over-the-biteblock monitor. RESULTS In total, 250 patients were enrolled without dropouts or missing data (control group: 125; capnography group: 125). There was no significant difference in the incidence of hypoxemia between the control and capnography groups (29.6% [37/125] vs. 26.4% [33/125]; p = .573). The estimated odds ratio was 0.925 (95% confidence interval: 0.708-1.208). The EtCO2 concentration was successfully captured without impeding endoscopic maneuvers from the beginning to the end of the procedure in all patients. CONCLUSIONS Although the novel mainstream capnography with an over-the-biteblock EtCO2 detector captures the EtCO2 concentration in EUS or ERCP under conscious sedation, it does not lead to the prevention of hypoxemia.
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Affiliation(s)
- Yoichi Takimoto
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic EndoscopyKeio University School of MedicineTokyoJapan
| | - Kazuhiro Minami
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
| | - Shintaro Kawasaki
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
| | - Tatsuhiro Masaoka
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic EndoscopyKeio University School of MedicineTokyoJapan
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy ProgramSt. Cloud HospitalSt. CloudMinnesotaUSA
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
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12
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Thurm T, Zmora N, Bruck R, Bar N, Philips A, Shibolet O, Deutsch L. Pre-endoscopy Anesthesiology Clinic Evaluation Does Not Reduce Adverse Event Rates for High-risk for Sedation Patients. J Patient Saf 2025:01209203-990000000-00313. [PMID: 39976441 DOI: 10.1097/pts.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 01/22/2025] [Indexed: 02/21/2025]
Abstract
OBJECTIVES Preoperative or preanesthesia evaluation is an established practice in patients undergoing surgery. The efficacy of a similar practice before endoscopic procedures has not yet been determined. At our medical center, patients with severe comorbidities, deemed at high risk for sedation, were assigned to an anesthesiologist-supervised endoscopic procedure (ASEP). Since late 2016 they are assessed at anesthesiology clinic pre-endoscopy. Our objective was to compare adverse events (AEs) between these 2 strategies. METHODS A retrospective review of all ambulatory upper and lower endoscopies between 2016 and 2017 was performed. Data on postprocedural (14 d) emergency department (ED) admissions, hospitalizations, operations, and mortality before and after policy change (BPC and APC) were compared. RESULTS During the study period 18,240 ambulatory upper and lower endoscopic procedures were performed in 14,906 patients, 7447 (49.96%) BPC, and 7459 (50.04%) APC; 580 were ASEP. The proportions of ASEP were comparable between the 2 time periods (BPC 295 versus APC 285; P=0.721); however, APC there was a 25-fold increase in pre-endoscopy anesthesiology clinic assessments [BPC-6 patients (2.03%) versus APC-146 patients (51.22%), P<0.001]. Postprocedural sedation-related AEs were comparable between the groups [0.07%-BPC (head injury, stroke, myocardial infarction, and aspiration) versus 0.03%-APC (aspiration and dyspnea), P=0.256]. None of these patients were sedated by an anesthesiologist. CONCLUSIONS Policy change of pre-endoscopy evaluation for high-risk for sedation patients was not associated with a change in AE rates. Policy adherence was limited. The lack of AE rate reduction may indicate a marginal impact on an already low event rate with ASEP for high-risk patients.
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Affiliation(s)
- Tamar Thurm
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center Affiliated With Faculty of Health and Medical Sciences, Tel Aviv University, Tel Aviv
| | - Niv Zmora
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center Affiliated With Faculty of Health and Medical Sciences, Tel Aviv University, Tel Aviv
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Rafael Bruck
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center Affiliated With Faculty of Health and Medical Sciences, Tel Aviv University, Tel Aviv
| | - Nir Bar
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center Affiliated With Faculty of Health and Medical Sciences, Tel Aviv University, Tel Aviv
| | - Adam Philips
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center Affiliated With Faculty of Health and Medical Sciences, Tel Aviv University, Tel Aviv
| | - Oren Shibolet
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center Affiliated With Faculty of Health and Medical Sciences, Tel Aviv University, Tel Aviv
| | - Liat Deutsch
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center Affiliated With Faculty of Health and Medical Sciences, Tel Aviv University, Tel Aviv
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13
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Conigliaro R, Pigò F, Gottin M, Grande G, Russo S, Cocca S, Marocchi M, Lupo M, Marsico M, Sculli S, Bertani H. Safety of endoscopist-directed nurse-administered sedation in an Italian referral hospital: An audit of 2 years and 19,407 procedures. Dig Liver Dis 2025; 57:630-635. [PMID: 39462711 DOI: 10.1016/j.dld.2024.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/23/2024] [Accepted: 10/03/2024] [Indexed: 10/29/2024]
Abstract
BACKGROUND AND STUDY AIMS Balanced propofol sedation (BPS) administered by adequately trained non-anaesthesiologist personnel has gained popularity in GI endoscopy because of its shorter procedure and recovery time, high patient satisfaction, and low rate of adverse events (AEs), despite being considered controversial. We report data from an audit of endoscopist-directed (ED) nurse-administered sedation in an Italian referral hospital. PATIENTS AND METHODS Consecutive endoscopic procedures performed between 2020 and 2022 were considered. Under the guidance of the endoscopist, the nurse administered midazolam/fentanyl, followed by a progressive top-up dosage of a 10-20 mg bolus of propofol to achieve moderate to deep sedation. The endoscopists and nurses were all certified in our hospital with a continuous and scheduled training from 2006. RESULTS During the study period, a total of 19,407 examinations (7,803 EGDS, 10,439 colonoscopies, 77 PEG, 697 EUS, and 365 ERCP) and 14,415 patients were included. Of these, 29.4 % of patients were classified as ASA I, 66.5 % as ASA II, and 5.1 % as ASA III. Hypotension was recorded in 1,293 (6 %) examinations and bradycardia in 176 (0.9 %) patients. Eleven patients (0.06 %) had minor respiratory adverse events. Two patients (0.01 %) had major AEs requiring orotracheal intubation. CONCLUSIONS ED-BPS is safe in low-risk patients. Major AEs occurred in 0.01 % of procedures.
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Affiliation(s)
- R Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - F Pigò
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy.
| | - M Gottin
- Gastroenterology Unit Ospedale San Bassiano, Bassano del Grappa, Italy
| | - G Grande
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - S Russo
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - S Cocca
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - M Marocchi
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - M Lupo
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - M Marsico
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - S Sculli
- Anaesthesiology Department, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - H Bertani
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
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14
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Manno M, Bonura GF, Soriani P, Pileggi R, Aragona G, Cennamo V, Colecchia A, Conigliaro R, DI Marco M, Fabbri C, Fuccio L, LA Fortezza RF, Merighi A, Mussetto A, Nervi G, Orsi P, Sassatelli R, Zagari RM, Biancheri P. Anesthesiologist-directed care for elective gastrointestinal endoscopy: results of an Italian multicentric prospective observational study. Minerva Gastroenterol (Torino) 2024; 70:405-412. [PMID: 38842039 DOI: 10.23736/s2724-5985.24.03656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Sedation, ranging from minimal, moderate and deep sedation to general anesthesia, improves patient comfort and procedure quality in gastrointestinal endoscopy (GIE). There are currently no comprehensive recommendations on sedation practice in diagnostic and therapeutic GIE. We aimed to investigate real-life sedation practice in elective GIE. METHODS We performed a multicentric observational study across 14 Endoscopy Units in Italy. We recorded consecutive data on all diagnostic procedures performed with Anesthesiologist-directed care (ADC) and all therapeutic procedures performed with ADC or non-Anesthesiologist sedation (NAS) over a three-month period. RESULTS Dedicated ADC is available five days/week in 28.6% (4/14), four days/week in 21.5% (3/14), three days/week in 35.7% (5/14), two days/week in 7.1% (1/14) and one day/week in 7.1% (1/14) of participating Centers. ADC use for elective diagnostic GIE varied from 15.4% to 75.1% of the total number of procedures performed with ADC among different Centers. ADC use for elective therapeutic GIE varied from 10.8% to 98.9% of the total number of elective therapeutic procedures performed among different Centers. CONCLUSIONS Our study highlights the lack of standardization and consequent great variability in sedation practice for elective GIE, with ADC being potentially overused for diagnostic procedures and underused for complex therapeutic procedures. A collaborative effort involving Endoscopists, Anesthesiologist and Institutions is needed to optimize sedation practice in GIE.
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Affiliation(s)
- Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, Carpi, Modena, Italy -
| | - Giuliano F Bonura
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, Carpi, Modena, Italy
| | - Paola Soriani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, Carpi, Modena, Italy
| | - Roberta Pileggi
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, Carpi, Modena, Italy
| | - Giovanni Aragona
- Gastroenterology and Hepatology Unit, Civil Hospital, Azienda USL di Piacenza, Piacenza, Italy
| | | | | | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, A.O.U. di Modena, Modena, Italy
| | - Marco DI Marco
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL della Romagna, Rimini, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Rosa F LA Fortezza
- Gastrointestinal Unit, Department of Internal Medicine, Hospital of Imola, University of Bologna, Imola, Bologna, Italy
| | - Alberto Merighi
- Gastroenterology and Digestive Endoscopy Unit, A.O.U. di Ferrara, Ferrara, Italy
| | | | - Giorgio Nervi
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paolo Orsi
- Gastroenterology Unit, Azienda USL di Parma, Parma, Italy
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Rocco M Zagari
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Esophagus and Stomach Organic Diseases Unit, IRCCS A.O.U. di Bologna, Bologna, Italy
| | - Paolo Biancheri
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, Carpi, Modena, Italy
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15
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Arnaert S, Persyn D, Cool M, Lambrecht G, Deboever G. Unsedated or On-Demand Minimally Sedated Water-Aided Outpatient Colonoscopy in Colorectal Cancer Screening and Surveillance: A Step Forward or Backward? Experience from Daily Practice in a Regional (Nonacademic) Hospital. Diagnostics (Basel) 2024; 14:2596. [PMID: 39594262 PMCID: PMC11592770 DOI: 10.3390/diagnostics14222596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 11/04/2024] [Accepted: 11/07/2024] [Indexed: 11/28/2024] Open
Abstract
Background: By using optimal insertion techniques with water infusion and dynamic position changes, pain during colonoscopy is greatly reduced and the procedures can usually be performed without sedation. We investigated whether the excellent results with water-aided colonoscopy reported by experts are reproducible in daily practice in a regional hospital. Methods: During the year 2023, 500 consecutive outpatients 50-75 years old presenting for colorectal cancer screening and surveillance could choose between unsedated or on-demand minimally sedated colonoscopy, moderate sedation with midazolam, or deep sedation with propofol. A total of 57% opted for unsedated colonoscopy, and of those patients, 250 consecutive patients were included. The primary outcome was the feasibility of the procedure. Cecal intubation rate (CIR), pain scores, use of midazolam, and willingness to repeat future procedures in the same way were registered periprocedural. Additional outcomes were cecal intubation time (CIT), detection rate of lesions, polyp resection rate, rate of adequate bowel preparation, and volume of water aspirated during insertion. Results: 250 consecutive sedation-free or on-demand minimally sedated water-based colonoscopies were analyzed. The CIR was 98%. A total of 96.5% completed without sedation and 5% of the procedures were perceived as moderately painful, but none had severe pain. The willingness to repeat was 97%. The mean CIT was 8.2 min. Conclusions: Using water-aided insertion techniques, comfortable sedation-free, or on-demand minimally sedated colonoscopy in daily practice in a regional hospital is feasible in the vast majority of patients presenting for colorectal cancer screening and surveillance, and the willingness to repeat is very high.
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Affiliation(s)
| | | | | | - Guy Lambrecht
- Department of Gastroenterology, AZ Damiaan, 8400 Oostende, Belgium; (S.A.); (D.P.); (M.C.)
| | - Guido Deboever
- Department of Gastroenterology, AZ Damiaan, 8400 Oostende, Belgium; (S.A.); (D.P.); (M.C.)
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Wang S, Ji J, Xiong C, Zhong W, Li L, Gong S, Lu J, Hei Z, Yao W, Chen C. Comparing oxygen therapies for hypoxemia prevention during gastrointestinal endoscopy under procedural sedation: A systematic review and network meta-analysis. J Clin Anesth 2024; 98:111586. [PMID: 39154630 DOI: 10.1016/j.jclinane.2024.111586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
STUDY OBJECTIVE Hypoxemia is the most frequent adverse event observed during gastrointestinal endoscopy under procedural sedation. An optimum oxygen therapy has still not been conclusively determined. DESIGN A systematic review and network meta-analysis of randomized clinical trials. SETTING Digestive Endoscopy Center. PATIENTS Adults (≥18 years old and of both sexes) during gastrointestinal endoscopy under procedural sedation. INTERVENTIONS Pubmed, MEDLINE, Web of Science, Embase, and Clinicaltrials.gov. were searched until June 30, 2023. Randomized clinical trials (RCTs) comparing any oxygen therapy with another oxygen therapy or with placebo (nasal cannula, NC) were included. MEASUREMENT The primary outcome was the incidence of hypoxemia, defined as the pulse oxygen saturation (SpO2). Random-effects network meta-analyses were performed. Data are reported as odds ratios (OR), prediction intervals (PrI) and 95% CI. Bias risk was evaluated following the guidelines outlined by the Cochrane Collaboration. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. MAIN RESULTS We included 27 RCTs with a total of 7552 patients. Compared to the use of NC, non-invasive positive pressure ventilation (NIPPV) demonstrated superior efficacy in mitigating hypoxemia (NIPPV vs. NC, OR = 0.16, 95% CI: 0.08-0.31, 95% PrI: 0.06-0.41), followed by Wei nasal jet tube (WNJT) (WNJT vs. NC, OR = 0.17, 95% CI: 0.10-0.30, 95% PrI: 0.07-0.42). The efficacy for preventing hypoxemia was ranked as follows: NIPPV > WNJT > oropharynx/nasopharyngeal catheter > high-flow nasal oxygenation > nasal mask > NC. CONCLUSIONS During gastrointestinal endoscopy under procedural sedation, all other advanced oxygen therapies were found to be more efficacious than nasal cannula. NIPPV and WNJT appear to be the most efficacious oxygen therapy for preventing hypoxemia. Additionally, clinicians should make a choice regarding the most suitable oxygen therapy based on the risk population, type of endoscopy and adverse events.
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Affiliation(s)
- Shuailei Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Jiaming Ji
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chang Xiong
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Weilong Zhong
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liping Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shengyuan Gong
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiamei Lu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Weifeng Yao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Chaojin Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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17
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Kimura S, Sone M, Sugawara S, Itou C, Ozawa M, Sato T, Matsui Y, Arai Y, Kusumoto M. Safety of propofol sedation administered by interventional radiologists for radiofrequency ablation in patients with hepatocellular carcinoma. Jpn J Radiol 2024; 42:1290-1297. [PMID: 38922567 PMCID: PMC11522072 DOI: 10.1007/s11604-024-01615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/16/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To evaluate the safety of propofol sedation administered by interventional radiologists during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS Propofol sedation was administered by interventional radiologists in 72 patients (85 procedures, 93 tumors) during RFA for HCC between August 2018 and December 2020. Interventional radiologists equipped with adequate knowledge and skills in sedation and respiratory management were responsible for sedation. Sedation was carefully assessed based on vital signs, including end-tidal carbon dioxide, consciousness status, and bispectral index. The primary endpoint was the incidence of sedation-related complications, which were evaluated separately as respiratory and cardiovascular complications. Secondary endpoints were technical success rate, ablation-related complications, and local tumor control rate. Technical success was defined as completion of ablation in the planned area. Complications were evaluated using the Clavien-Dindo classification. Sedation-related complications, technical success rate, and ablation-related complications were evaluated on a procedure basis, and local tumor control was evaluated on a tumor basis. RESULTS Respiratory and cardiovascular complications were observed in eight (8/85, 9.4%) and two (2/85, 2.4%) patients, respectively. Four patients required the jaw thrust maneuver due to glossoptosis, whereas a decrease in oxygen saturation to < 90% was recorded in the other four patients. However, these were temporary, and none required manual ventilation or endotracheal intubation. Bradycardia (< 50 bpm) was detected in two patients; one recovered immediately without treatment, whereas the other rapidly improved after atropine sulfate administration. No severe hypotension (< 80 mmHg) was observed. The technical success rate was 100% (85/85). Grade 3 ablation-related complications were identified in three patients (3/85, 3.5%). The local tumor control rate was 95.7% (89/93). CONCLUSION Propofol sedation can be safely administered by interventional radiologists during RFA for HCC. Although it requires special safety considerations, it may be a sedation option during hepatic RFA.
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Affiliation(s)
- Shintaro Kimura
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
- Cancer Medicine, The Jikei University Graduate School of Medicine, Tokyo, Japan.
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Chihiro Itou
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mizuki Ozawa
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Cancer Medicine, The Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Tetsufumi Sato
- Department of Anesthesia and Intensive Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiyuki Matsui
- Cancer Medicine, The Jikei University Graduate School of Medicine, Tokyo, Japan
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Lim JW, Kim MJ, Lee GH, Kim DS, Jung SH, Kim YY, Kim JW, Lee Y, Kim HS, Park SY, Kim DH. Comparison of Synergistic Sedation with Midazolam and Propofol Versus Midazolam and Pethidine in Colonoscopies: A Prospective, Randomized Controlled Study. Chonnam Med J 2024; 60:192-197. [PMID: 39381126 PMCID: PMC11458312 DOI: 10.4068/cmj.2024.60.3.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 10/10/2024] Open
Abstract
Colonoscopy is a key procedure for the early detection of colorectal cancer. Despite its importance, the discomfort associated with colonoscopy often requires sedation, and the ideal sedation regimen remains to be determined. In this prospective randomized controlled trial, patients scheduled for colonoscopy were randomly assigned to two different sedation protocols. Group A received a combination of midazolam and propofol, while group B was given midazolam and pethidine. The study analyzed data from 51 patients, with 23 in group A and 28 in group B. The incidence of adverse events was similar across both groups. Additionally, no significant differences were observed in cecal intubation times or total procedure durations. Notably, group A had a lower frequency of required postural changes (1.0±.7 vs. 1.5±0.7, p=0.02) and a reduced rate of manual compression (52.2% vs. 82.1%, p=0.02). There were no significant differences between the groups regarding subjective pain or overall satisfaction. Both sedation regimens were found to be safe and effective. The midazolam and propofol combination was associated with a smoother procedure, evidenced by fewer postural adjustments and less manual compression needed during colonoscopy.
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Affiliation(s)
- Jae Woong Lim
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Min Jae Kim
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Gang Han Lee
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Dae Sol Kim
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Sang Hyuk Jung
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Yu Yeon Kim
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Jin Won Kim
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Yohan Lee
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Hyun Soo Kim
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Seon Young Park
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Dong Hyun Kim
- Division of gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
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19
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Zheng L, Ye M, Ma J, Jin C, Yang Y, Li H, Zheng R, Wang Y. Effects of adding adjuvants to propofol on the post-anesthesia cognitive function in patients undergoing gastroscopy/colonoscopy: a systematic review and meta-analysis. Expert Opin Drug Saf 2024; 23:995-1005. [PMID: 38217432 DOI: 10.1080/14740338.2024.2305705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES This study aimed to elucidate the effects of propofol plus adjuvants on postoperative cognitive dysfunction (POCD) and patient satisfaction. METHODS Studies published up to September 2023 on the Chinese National Knowledge Infrastructure (CNKI), Wanfang Data, Sinomed, PubMed, Embase, Cochrane Library, Web of Science, and Clinictrials.gov websites were searched. Binary summary of results was used for meta-analyses. RESULTS We included 18 studies (2691 patients). The combined sedation did not affect the processing speed (ES = 0.02, 95%CI: -0.01, 0.04; I2 = 79.3%, p < 0.001), attention (ES = 0.02, 95%CI: -0.02, 0.05; I2 = 95.0%, p < 0.001), nor working memory (ES = 0.02, 95%CI: -0.03, 0.06; I2 = 94.4%, p < 0.001) in CogState brief battery tool. A significant effect of combined sedation was observed in the domain of visual learning in CogState tool (ES = -0.03, 95%CI: -0.04, -0.02; I2 = 15.8%, p = 0.306). The TDT (ES = 4.96, 95%CI: 2.92, 7.00) indicates that combined sedation would increase error rates in the tests of cognitive function. The DSST (ES = 0.16, 95% CI: -0.44, 0.75) shown that combined sedation does not affect cognitive function. In addition, an insignificant difference in patient satisfaction between combined sedation and propofol alone was observed (ES = -0.03, 95%CI: -0.09, 0.02). CONCLUSION The available evidence suggests that propofol combined with adjuvants may affect POCD but not patient satisfaction. REGISTRATION NUMBER INPLASY2023110092.
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Affiliation(s)
- Liupu Zheng
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengqian Ye
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jun Ma
- Division of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chen Jin
- Division of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Yang
- Division of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haoqi Li
- Division of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rongyuan Zheng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Division of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
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20
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Paramitha MP, Waloejo CS, Hamzah. Propofol target-controlled infusion for gastrointestinal endoscopy. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2024; 13:82-85. [DOI: 10.18528/ijgii240023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 01/03/2025] Open
Affiliation(s)
- Maharani Pradnya Paramitha
- Department of Anaesthesiology and Reanimation, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Jawa Timur, Indonesia
| | - Christrijogo Sumartono Waloejo
- Department of Anaesthesiology and Reanimation, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Jawa Timur, Indonesia
| | - Hamzah
- Department of Anaesthesiology and Reanimation, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Jawa Timur, Indonesia
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21
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Choe JW, Hyun JJ, Son SJ, Lee SH. Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea. Clin Endosc 2024; 57:476-485. [PMID: 38605689 PMCID: PMC11294856 DOI: 10.5946/ce.2023.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND/AIMS Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation. METHODS This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm. RESULTS Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79-0.86) and displayed a moderate discriminatory power. CONCLUSIONS High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.
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Affiliation(s)
- Jung Wan Choe
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jong Jin Hyun
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Seong-Jin Son
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Seung-Hak Lee
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Korea
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22
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Cavus Z, Moralar DG, Gok AK, Gunaydin AS. The Effects of Ketamine-Propofol and Remifentanil-Propofol Combinations on Integrated Pulmonary Index During Sedation in Gastrointestinal System Endoscopy. SISLI ETFAL HASTANESI TIP BULTENI 2024; 58:189-196. [PMID: 39021693 PMCID: PMC11249984 DOI: 10.14744/semb.2024.37043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/13/2023] [Accepted: 06/03/2024] [Indexed: 07/20/2024]
Abstract
Objectives Different sedo-analgesia and monitoring methods are used during endoscopic procedures. And yet, there is no consensus on optimal sedating agents. In this study, the main aim is to compare ketamine-propofol and remifentanil propofol sedo-analgesia protocols by monitoring integrated pulmonary index (IPI). Methods The study population is divided into two groups: Group ketamine received 0.25 mg/kg ketamine and 0.75 mg/kg propofol at the beginning of anesthesia. 1 mcg/kg of remifentanil and 0.75 mg/kg propofol were administered to group remifentanil patients at the induction of anesthesia. Anesthesia maintenance was provided by titration of drug doses according to the Ramsey sedation scale. Measurements were taken at four different points in time: just before anesthesia was induced, five minutes after sedation was induced, ten minutes later, and five minutes after the treatment was finished. Results There was no significant difference in respiratory parameters such as respiratory rate, SPO2, and EtCO2 measured in the T1 time period between the groups. In the T2 time period, a significant difference was found between the groups in the integrated pulmonary index (IPI), sPO2, respiratory rate, and systolic pressure parameters were found to be significantly higher in group ketamine. T3 time period results were higher in these three parameters: IPI, sPO2, and respiration rate. In the T2, T3, T4 time periods, there was a difference between the groups in the respiration count parameter and it was found to be higher in group ketamine. Conclusion Although it causes slight prolongation in recovery, ketamine is a safe and effective drug that can be used during endoscopic procedures.
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Affiliation(s)
- Zuhal Cavus
- Department of Anaesthesiology and Reanimation, University of Health Sciences Türkiye, Gaziosmanpasa Training and Research Hospital, Istanbul, Türkiye
| | - Dondu Genc Moralar
- Department of Anaesthesiology and Reanimation, University of Health Sciences Türkiye, Gaziosmanpasa Training and Research Hospital, Istanbul, Türkiye
| | - Ayfer Kaya Gok
- Department of Anaesthesiology and Reanimation, University of Health Sciences Türkiye, Gaziosmanpasa Training and Research Hospital, Istanbul, Türkiye
| | - Ali Selman Gunaydin
- Department of Anaesthesiology and Reanimation, University of Health Sciences Türkiye, Gaziosmanpasa Training and Research Hospital, Istanbul, Türkiye
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23
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Colquhoun DA, Somsouk M, Chen CL. Does Propofol Improve Polyp Detection during Colonoscopy? The Promise and Peril of Clinical Registry Data. Anesthesiology 2024; 140:1062-1064. [PMID: 38629962 PMCID: PMC11104318 DOI: 10.1097/aln.0000000000004987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Douglas A Colquhoun
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ma Somsouk
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Catherine L Chen
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
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24
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Michael FA, Hessz D, Graf C, Zimmer C, Nour S, Jung M, Kloka J, Knabe M, Welsch C, Blumenstein I, Dultz G, Finkelmeier F, Walter D, Mihm U, Lingwal N, Zeuzem S, Bojunga J, Friedrich-Rust M. Thoracic impedance pneumography in propofol-sedated patients undergoing percutaneous endoscopic gastrostomy (PEG) placement in gastrointestinal endoscopy: A prospective, randomized trial. J Clin Anesth 2024; 94:111403. [PMID: 38368798 DOI: 10.1016/j.jclinane.2024.111403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/25/2023] [Accepted: 01/23/2024] [Indexed: 02/20/2024]
Abstract
STUDY OBJECTIVE To assess the efficacy of an ECG-based method called thoracic impedance pneumography to reduce hypoxic events in endoscopy. DESIGN This was a single center, 1:1 randomized controlled trial. SETTING The trial was conducted during the placement of percutaneous endoscopic gastrostomy (PEG). PATIENTS 173 patients who underwent PEG placement were enrolled in the present trial. Indication was oncological in most patients (89%). 58% of patients were ASA class II and 42% of patients ASA class III. INTERVENTIONS Patients were randomized in the standard monitoring group (SM) with pulse oximetry and automatic blood pressure measurement or in the intervention group with additional thoracic impedance pneumography (TIM). Sedation was performed with propofol by gastroenterologists or trained nurses. MEASUREMENTS Hypoxic episodes defined as SpO2 < 90% for >15 s were the primary endpoint. Secondary endpoints were minimal SpO2, apnea >10s/>30s and incurred costs. MAIN RESULTS Additional use of thoracic impedance pneumography reduced hypoxic episodes (TIM: 31% vs SM: 49%; p = 0.016; OR 0.47; NNT 5.6) and elevated minimal SpO2 per procedure (TIM: 90.0% ± 8.9; SM: 84.0% ± 17.6; p = 0.007) significantly. Apnea events >10s and > 30s were significantly more often detected in TIM (43%; 7%) compared to SM (1%; 0%; p < 0.001; p = 0.014) resulting in a time advantage of 17 s before the occurrence of hypoxic events. As a result, adjustments of oxygen flow were significantly more often necessary in SM than in TIM (p = 0.034) and assisted ventilation was less often needed in TIM (2%) compared with SM (9%; p = 0.053). Calculated costs for the additional use of thoracic impedance pneumography were 0.13$ (0.12 €/0.11 £) per procedure. CONCLUSIONS Additional thoracic impedance pneumography reduced the quantity and extent of hypoxic events with less need of assisted ventilation. Supplemental costs per procedure were negligible. KEY WORDS thoracic impedance pneumography, capnography, sedation, monitoring, gastrointestinal endoscopy, percutaneous endoscopic gastrostomy.
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Affiliation(s)
- F A Michael
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany.
| | - D Hessz
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - C Graf
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - C Zimmer
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - S Nour
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - M Jung
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - J Kloka
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt am Main, Germany
| | - M Knabe
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - C Welsch
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - I Blumenstein
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - G Dultz
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - F Finkelmeier
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - D Walter
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - U Mihm
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - N Lingwal
- Goethe University Frankfurt, University Hospital, Institute of Biostatistics and Mathematical Modeling, Frankfurt am Main, Germany
| | - S Zeuzem
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - J Bojunga
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
| | - M Friedrich-Rust
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany
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25
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Mandarino FV, Fanti L, Barchi A, Sinagra E, Massimino L, Azzolini F, Viale E, Napolitano M, Salmeri N, Agostoni M, Danese S. Safety and tolerability outcomes of nonanesthesiologist-administered propofol using target-controlled infusion in routine GI endoscopy. Gastrointest Endosc 2024; 99:914-923. [PMID: 38128787 DOI: 10.1016/j.gie.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/18/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND AIMS Nonanesthesiologist-administered propofol (NAAP) is increasingly accepted, but data are limited on drug administration using target-controlled infusion (TCI) in clinical practice. TCI adjusts the drug infusion based on patient-specific parameters, maintaining a constant drug dose to reduce the risk of adverse events (AEs) because of drug overdosing and to enhance patient comfort. The aims of this study were to assess the rate of AEs and to evaluate patient satisfaction with NAAP using TCI in a retrospective cohort of 18,302 procedures. METHODS Low-risk patients (American Society of Anesthesiologists score I and II) undergoing outpatient GI endoscopic procedures, including EGDs and colonoscopies, were sequentially enrolled at IRCCS San Raffaele Hospital (Milan, Italy) between May 2019 and November 2021. RESULTS Data from 7162 EGDs and 11,140 colonoscopies were analyzed. Mean patient age was 59.1 ± 14.8 years, and mean body mass index was 24.9 ± 3.7 kg/m2. The male-to-female ratio was equal at 8798 (48.1%):9486 (51.9%). AEs occurred in 240 procedures (1.3%) out of the total cohort, with no differences between EGDs and colonoscopies (100 [1.4%] and 140 [1.2%], respectively; P = .418). Most patients (15,875 [98.9%]) indicated they would likely repeat the procedure with the same sedation protocol. Age (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P < .008) was the only independent factor associated with overall AEs. CONCLUSIONS NAAP using TCI is an effective and safe sedation method for routine endoscopy. The proper propofol dosage based on individual patients and the presence of trained operators are crucial for NAAP sedation management.
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Affiliation(s)
- Francesco Vito Mandarino
- Department of Gastroenterology and Gastrointestinal Endosco, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
| | - Lorella Fanti
- Department of Gastroenterology and Gastrointestinal Endosco, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
| | - Alberto Barchi
- Department of Gastroenterology and Gastrointestinal Endosco, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Cefalù, Italy
| | - Luca Massimino
- Department of Gastroenterology and Gastrointestinal Endosco, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
| | - Francesco Azzolini
- Department of Gastroenterology and Gastrointestinal Endosco, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
| | - Edi Viale
- Department of Gastroenterology and Gastrointestinal Endosco, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
| | - Maria Napolitano
- Department of Gastroenterology and Gastrointestinal Endosco, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
| | - Noemi Salmeri
- Gynecology and Obstetrics Unit, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
| | - Massimo Agostoni
- Department of Anesthesiology, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Gastrointestinal Endosco, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
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26
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Drews J, Harder J, Kaiser H, Soenarjo M, Spahlinger D, Wohlmuth P, Wirtz S, Eberhardt R, Bornitz F, Bunde T, von Hahn T. Impact of a simple non-invasive nasal mask device on intraprocedural hypoxemia in overweight individuals undergoing upper gastrointestinal endoscopy with sedation provided by a non-anesthesiologist provider. Clin Endosc 2024; 57:196-202. [PMID: 37430405 PMCID: PMC10984753 DOI: 10.5946/ce.2023.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND/AIMS Hypoxemia is a common side effect of propofol sedation during endoscopy. Applying mild positive airway pressure (PAP) using a nasal mask may offer a simple way to reduce such events and optimize the conditions for diagnostic and therapeutic upper gastrointestinal endoscopies. METHODS We compared overweight patients (body mass index >25 kg/m2) with a nasal PAP mask or standard nasal cannula undergoing upper gastrointestinal endoscopies by non-anesthesiologists who provided propofol sedation. Outcome parameters included the frequency and severity of hypoxemic episodes. RESULTS We analyzed 102 procedures in 51 patients with nasal PAP masks and 51 controls. Episodes of hypoxemia (oxygen saturation [SpO2] <90% at any time during sedation) occurred in 25 (49.0%) controls compared to 8 (15.7%) patients with nasal PAP masks (p<0.001). Severe hypoxemia (SpO2 <80%) occurred in three individuals (5.9%) in both groups. The mean delta between baseline SpO2 and the lowest SpO2 recorded was significantly decreased among patients with nasal PAP mask compared to controls (3.7 and 8.2 percentage points difference, respectively). There were significantly fewer airway interventions performed in the nasal PAP mask group (15.7% vs. 41.2%, p=0.008). CONCLUSION Using a nasal PAP mask may be a simple means of increasing patient safety and ease of examination.
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Affiliation(s)
- Jan Drews
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Jonas Harder
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Hannah Kaiser
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Miriam Soenarjo
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Dorothee Spahlinger
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Peter Wohlmuth
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Proresearch Research Institute, Hamburg, Germany
| | - Sebastian Wirtz
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Department of Anesthesiology and Surgical Critical Care, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Ralf Eberhardt
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Department of Pneumology and Medical Critical Care, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Florian Bornitz
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Department of Pneumology and Medical Critical Care, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Torsten Bunde
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
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27
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Sarraj R, Theiler L, Vakilzadeh N, Krupka N, Wiest R. Propofol sedation in routine endoscopy: A case series comparing target controlled infusion vs manually controlled bolus concept. World J Gastrointest Endosc 2024; 16:11-17. [PMID: 38313457 PMCID: PMC10835478 DOI: 10.4253/wjge.v16.i1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/27/2023] [Accepted: 12/06/2023] [Indexed: 01/15/2024] Open
Abstract
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.
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Affiliation(s)
- Riad Sarraj
- Department of Visceral Surgery and Medicine, Inselspital University Hospital, Bern 3010, Switzerland
| | - Lorenz Theiler
- Clinic for Anesthesia, Perioperative, Emergency & Intensive Care Medicine, Kantonsspital Aarau, Aarau 5001, Switzerland
| | - Nima Vakilzadeh
- Department of Nephrology and Hypertension, University Hospital Lausanne, Lausanne 1011, Switzerland
| | - Niklas Krupka
- Department of Visceral Surgery and Medicine, Inselspital University Hospital, Bern 3010, Switzerland
| | - Reiner Wiest
- Department of Visceral Surgery and Medicine, Inselspital University Hospital, Bern 3010, Switzerland
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Gupta S, Kurup R, Shahidi N, Vosko S, McKay O, Zahid S, Whitfield A, Lee EY, Williams SJ, Burgess NG, Bourke MJ. Safety and efficacy of physician-administered balanced-sedation for the endoscopic mucosal resection of large non-pedunculated colorectal polyps. Endosc Int Open 2024; 12:E1-E10. [PMID: 38188923 PMCID: PMC10769574 DOI: 10.1055/a-2180-8880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 08/17/2023] [Indexed: 01/09/2024] Open
Abstract
Background and study aims Because of concerns about peri-procedural adverse events (AEs), guidelines recommend anesthetist-managed sedation (AMS) for long and complex endoscopic procedures. The safety and efficacy of physician-administered balanced sedation (PA-BS) for endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs) ≥20 mm is unknown. Patients and methods We compared PA-BS with AMS in a retrospective study of prospectively collected data from consecutive patients referred for management of LNPCPs (NCT01368289; NCT02000141). A per-patient propensity analysis was performed following a 1:2 nearest-neighbor (Greedy-type) match, based on age, gender, Charlson comorbidity index, and lesion size. The primary outcome was any peri-procedural AE, which included hypotension, hypertension, tachycardia, bradycardia, hypoxia, and new arrhythmia. Secondary outcomes were unplanned admissions, 28-day re-presentation, technical success, and recurrence. Results Between January 2016 and June 2020, 700 patients underwent EMR for LNPCPs, of whom 638 received PA-BS. Among them, the median age was 70 years (interquartile range [IQR] 62-76 years), size 35 mm (IQR 25-45 mm), and duration 35 minutes (IQR 25-60 minutes). Peri-procedural AEs occurred in 149 (23.4%), most commonly bradycardia (116; 18.2%). Only five (0.8%) required an unplanned sedation-related admission due to AEs (2 hypotension, 1 arrhythmia, 1 bradycardia, 1 hypoxia), with a median inpatient stay of 1 day (IQR 1-3 days). After propensity-score matching, there were no differences between PA-BS and AMS in peri-procedural AEs, unplanned admissions, 28-day re-presentation rates, technical success or recurrence. Conclusions Physician-administered balanced sedation for the EMR of LNPCPs is safe. Peri-procedural AEs are infrequent, transient, rarely require admission (<1%), and are experienced in similar frequencies to those receiving anesthetist-managed sedation.
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Affiliation(s)
- Sunil Gupta
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia
| | - Rajiv Kurup
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
| | - Neal Shahidi
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia
- Gastroenterology and Hepatology, The University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Sergei Vosko
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
| | - Owen McKay
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
| | - Simmi Zahid
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
| | - Anthony Whitfield
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia
| | - Eric Y. Lee
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia
| | | | - Nicholas Graeme Burgess
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia
| | - Michael J. Bourke
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia
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Meeusen V, Barach P, van Zundert A. Designing safe procedural sedation: adopting a resilient culture. HANDBOOK OF PERIOPERATIVE AND PROCEDURAL PATIENT SAFETY 2024:115-163. [DOI: 10.1016/b978-0-323-66179-9.00012-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Behrens A, Ell C. Safety of endoscopist-guided sedation in a low-risk collective. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1593-1602. [PMID: 36630976 DOI: 10.1055/a-1957-7788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Worldwide, gastrointestinal endoscopies are predominantly performed under sedation. National and international guidelines and recommendations contain very different specifications for the use of sedation in gastrointestinal endoscopy. These differences come from specific requirements for staffing during endoscopy. AIM The aim of the study is to evaluate whether endoscopist-guided sedation without additional sedation assistance is not inferior to endoscopist-guided sedation with additional sedation assistance with respect to the rate of sedation-associated complications in a defined low-risk population (low-risk procedure and low-risk patient). METHODS Prospective, multicenter, randomized study. RESULTS 27 German study centers participated in the study. A total of 30 569 endoscopies were recorded during the study period from 1.8.2015 to 10.3.2020. The final data analysis included 28 673 examinations (64.1 % esophagosgastroduodenoscopies and 35.9 % colonoscopies). In 307 (1.1 %) examinations, 322 sedation-associated complications occurred. Of these, 321 (1.1 %) were minor complications and one (0.003 %) was a major complication. There was no statistically significant difference in the frequency of sedation-associated complications between endoscopist-guided sedation with versus without additional sedation assistance. Within the legal framework, a "shadow" sedation assistant was present in the study group without sedation assistance. This assistant intervened because of sedation-associated complications in 101 (0.7 %) of the endoscopies. CONCLUSION The study documents the safety of propofol-based endoscopist-guided sedation in a low-risk population. In 98.9 % of all endoscopies, no sedation-associated complication occurred or it was so minimal that no intervention (e. g., increase of oxygen supply) was necessary. The study cannot answer to what extent a serious complication was avoided by the active intervention of the "shadow" sedation assistance in the group without sedation assistance.The study proves in a randomized, prospective design that sedation in low-risk endoscopy (low-risk patient, low-risk procedure) can be performed as endoscopist-guided sedation without additional sedation assistance, without demonstrably accepting a reduction in safety.
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Affiliation(s)
- Angelika Behrens
- Klinik für Innere Medizin mit den Schwerpunkten Gastroenterologie und Pneumologie, Evangelische Elisabeth Klinik Krankenhausbetriebs gGmbH, Berlin, Germany
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Wehrmann T, Riphaus A, Eckardt AJ, Klare P, Kopp I, von Delius S, Rosien U, Tonner PH. Updated S3 Guideline "Sedation for Gastrointestinal Endoscopy" of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) - June 2023 - AWMF-Register-No. 021/014. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e654-e705. [PMID: 37813354 DOI: 10.1055/a-2165-6388] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Till Wehrmann
- Clinic for Gastroenterology, DKD Helios Clinic Wiesbaden, Wiesbaden, Germany
| | - Andrea Riphaus
- Internal Medicine, St. Elisabethen Hospital Frankfurt Artemed SE, Frankfurt, Germany
| | - Alexander J Eckardt
- Clinic for Gastroenterology, DKD Helios Clinic Wiesbaden, Wiesbaden, Germany
| | - Peter Klare
- Department Internal Medicine - Gastroenterology, Diabetology, and Hematology/Oncology, Hospital Agatharied, Hausham, Germany
| | - Ina Kopp
- Association of the Scientific Medical Societies in Germany e.V. (AWMF), Berlin, Germany
| | - Stefan von Delius
- Medical Clinic II - Internal Medicine - Gastroenterology, Hepatology, Endocrinology, Hematology, and Oncology, RoMed Clinic Rosenheim, Rosenheim, Germany
| | - Ulrich Rosien
- Medical Clinic, Israelite Hospital, Hamburg, Germany
| | - Peter H Tonner
- Anesthesia and Intensive Care, Clinic Leer, Leer, Germany
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Everett SM, Triantafyllou K, Hassan C, Mergener K, Tham TC, Almeida N, Antonelli G, Axon A, Bisschops R, Bretthauer M, Costil V, Foroutan F, Gauci J, Hritz I, Messmann H, Pellisé M, Roelandt P, Seicean A, Tziatzios G, Voiosu A, Gralnek IM. Informed consent for endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023; 55:952-966. [PMID: 37557899 DOI: 10.1055/a-2133-3365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
All endoscopic procedures are invasive and carry risk. Accordingly, all endoscopists should involve the patient in the decision-making process about the most appropriate endoscopic procedure for that individual, in keeping with a patient's right to self-determination and autonomy. Recognition of this has led to detailed guidelines on informed consent for endoscopy in some countries, but in many no such guidance exists; this may lead to variations in care and exposure to risk of litigation. In this document, the European Society of Gastrointestinal Endoscopy (ESGE) sets out a series of statements that cover best practice in informed consent for endoscopy. These statements should be seen as a minimum standard of practice, but practitioners must be aware of and adhere to the law in their own country. 1: Patients should give informed consent for all gastrointestinal endoscopic procedures for which they have capacity to do so. 2: The healthcare professional seeking consent for an endoscopic procedure should ensure that the patient has the capacity to consent to that procedure. 3: For patients who lack capacity, healthcare personnel should at all times try to engage with people close to the patient, such as family, friends, or caregivers, to achieve consensus on the appropriateness of performing the procedure. 4: Where a patient lacks capacity to provide informed consent, the best interest decision should be clearly documented in the medical record. This should include information about the capacity assessment, reason(s) that the decision cannot be delayed for capacity recovery (or if recovery is not expected), who has been consulted, and where relevant the form of authority for the decision. 5: There should be a systematic and transparent disclosure of the expected benefits and harms that may reasonably affect patient choice on whether or not to undergo any diagnostic or interventional endoscopic procedure. Information about possible alternatives, as well as the consequences of doing nothing, should also be provided when relevant. 6: The information provided on the benefit and harms of an endoscopic procedure should be adapted to the procedure and patient-specific risk factors, and the preferences of the patient should be central to the consent process. 7: The consent discussion should be undertaken by an individual who is familiar with the procedure and its risks, and is able to discuss these in the context of the individual patient. 8: Patients should confirm consent to an endoscopic procedure in a private, unrushed, and non-coercive environment. 9: If a patient requests that an endoscopic procedure be discontinued, the procedure should be paused and the patient's capacity for decision making assessed. If a competent patient continues to object to the procedure, or if a conclusive determination of capacity is not feasible, the examination should be terminated as soon as it is safe to do so. 10: Informed consent should be sufficiently detailed to cover all findings that can be reasonably anticipated during an endoscopic examination. The scope of this consent should not be expanded, nor a patient's implicit consent for additional interventions assumed, unless failure to proceed with such interventions would result in immediate and predictable harm to the patient.
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Affiliation(s)
- Simon M Everett
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland
| | - Nuno Almeida
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | | | - Raf Bisschops
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Michael Bretthauer
- Clinical Effectiveness Group, Department of Transplantation Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation
| | - James Gauci
- Department of Gastroenterology, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Istvan Hritz
- Department of Surgery, Transplantation and Gastroenterology, Center for Therapeutic Endoscopy, Semmelweis University, Budapest, Hungary
| | - Helmut Messmann
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Philip Roelandt
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - Georgios Tziatzios
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, Athens, Greece
| | - Andrei Voiosu
- Gastroenterology and Hepatology Department, Colentina Clinical Hospital and Internal Medicine and Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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Gravina AG, Pellegrino R, De Micco R, Dellavalle M, Grasso A, Palladino G, Satolli S, Ciaravola M, Federico A, Tessitore A, Romano M, Ferraro F. Effectiveness and safety of an atropine/midazolam and target controlled infusion propofol-based moderate sedation protocol during percutaneous endoscopic transgastric jejunostomy procedures in Parkinson's disease: a real-life retrospective observational study. Front Med (Lausanne) 2023; 10:1233575. [PMID: 37771983 PMCID: PMC10523572 DOI: 10.3389/fmed.2023.1233575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Patients with Parkinson's disease (PD), often elderly with various comorbidities, may require a continuous intestinal infusion of carbidopa/levodopa gel by the placement of a percutaneous endoscopic gastrostomy (PEG) with a jejunal tube (PEG-J) to improve their motor outcome and quality of life. However, it is unclear what is the best procedural sedation protocol for PEG-J procedures. Fifty patients with PD and indication for PEG-J procedure (implantation, replacement, removal) underwent, from 2017 to 2022, a sedation protocol characterized by premedication with atropine (0.01 mg/Kg i.v.), midazolam (0.015-0.03 mg/Kg i.v.) and induction with bolus propofol (0.5-1 mg/Kg i.v.) as well as, finally, sedation with continuous infusion propofol (2-5 mg/Kg/h i.v.) by Target Controlled Infusion (TCI) technique. Ninety-eight per cent of patients experienced no intraprocedural or peri-procedural adverse events. All the procedures were technically successful. A good discharge time was recorded. The vital parameters recorded during the procedure did not vary significantly. A PEG-J procedure conducted within 30 min showed a significant advantage over end-tidal carbon dioxide (EtCO2). Indeed, the latter showed some predictive behavior (OR: 1.318, 95% CI 1.075-1.615, p = 0.008). In the real world, this sedation protocol showed a good safety and effectiveness profile, even with reduced doses of midazolam and a TCI propofol technique in moderate sedation.
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Affiliation(s)
- Antonietta Gerarda Gravina
- Department of Precision Medicine, Hepatogastroenterology and Digestive Endoscopy Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Raffaele Pellegrino
- Department of Precision Medicine, Hepatogastroenterology and Digestive Endoscopy Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, Neurology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mirco Dellavalle
- Department of Woman, Child, General and Specialized Surgery, Anaesthesia and Intensive Care Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anna Grasso
- Department of Woman, Child, General and Specialized Surgery, Anaesthesia and Intensive Care Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanna Palladino
- Department of Precision Medicine, Hepatogastroenterology and Digestive Endoscopy Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Sara Satolli
- Department of Advanced Medical and Surgical Sciences, Neurology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Massimo Ciaravola
- Department of Woman, Child, General and Specialized Surgery, Anaesthesia and Intensive Care Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alessandro Federico
- Department of Precision Medicine, Hepatogastroenterology and Digestive Endoscopy Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, Neurology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marco Romano
- Department of Precision Medicine, Hepatogastroenterology and Digestive Endoscopy Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fausto Ferraro
- Department of Woman, Child, General and Specialized Surgery, Anaesthesia and Intensive Care Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Miyamoto K, Matsumoto K, Obata T, Sato R, Matsumi A, Morimoto K, Ogawa T, Terasawa H, Fujii Y, Yamazaki T, Uchida D, Horiguchi S, Tsutsumi K, Kato H, Otsuka M. The efficacy of non-anesthesiologist-administered propofol sedation with a target-controlled infusion system during double-balloon endoscopic retrograde cholangiopancreatography. BMC Gastroenterol 2023; 23:296. [PMID: 37667224 PMCID: PMC10478296 DOI: 10.1186/s12876-023-02936-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The sedation method used during double-balloon endoscopic retrograde cholangiopancreatography (DB-ERCP) differs among countries and/or facilities, and there is no established method. This study aimed to evaluate the efficacy of non-anesthesiologist-administered propofol (NAAP) sedation using a target-controlled infusion (TCI) system during DB-ERCP. METHODS This retrospective study was conducted between May 2017 and December 2020 at an academic center. One hundred and fifty-six consecutive patients who underwent DB-ERCP were sedated by gastroenterologists using diazepam (n = 77) or propofol with a TCI system (n = 79), depending on the period. The primary endpoint was a comparison of poor sedation rates between the two groups. Poor sedation was defined as a condition requiring the use of other sedative agents or discontinuation of the procedure. Secondary endpoints were sedation-related adverse events and risk factors for poor sedation. RESULTS Poor sedation occurred significantly more often in the diazepam sedation group (diazepam sedation, n = 12 [16%] vs. propofol sedation, n = 1 [1%]; P = 0.001). Vigorous body movements (3 or 4) (diazepam sedation, n = 40 [52%] vs. propofol sedation, n = 28 [35%]; P = 0.038) and hypoxemia (< 85%) (diazepam sedation, n = 7 [9%] vs. propofol sedation, n = 1 [1%]; P = 0.027) occurred significantly more often in the diazepam sedation group. In the multivariate analysis, age < 70 years old (OR, 10.26; 95% CI, 1.57-66.98; P = 0.015), BMI ≥ 25 kg/m2 (OR, 11.96; 95% CI, 1.67-85.69; P = 0.014), and propofol sedation (OR, 0.06; 95% CI, 0.01-0.58; P = 0.015) were associated factors for poor sedation. CONCLUSIONS NAAP sedation with the TCI system during DB-ERCP was safer and more effective than diazepam sedation.
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Affiliation(s)
- Kazuya Miyamoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Kazuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan.
| | - Taisuke Obata
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Ryosuke Sato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Akihiro Matsumi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Kosaku Morimoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Taiji Ogawa
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Hiroyuki Terasawa
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Yuki Fujii
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Tatsuhiro Yamazaki
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Daisuke Uchida
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Koichiro Tsutsumi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-Cho, Okayama, 700-8558, Japan
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Lorenz P, Wehrmann T, Riphaus A, Eckardt AJ, Klare P, Koop I, Fischer N, Jansen PL. Leitlinienreport der aktualisierten S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e628-e653. [PMID: 37678314 DOI: 10.1055/a-2124-5746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Pia Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Till Wehrmann
- Klinik für Gastroenterologie, DKD Helios Klinik Wiesbaden, Wiesbaden, Deutschland
| | - Andrea Riphaus
- Innere Medizin, St. Elisabethen Krankenhaus Frankfurt Artemed SE, Frankfurt, Deutschland
| | - Alexander J Eckardt
- Klinik für Gastroenterologie, DKD Helios Klinik Wiesbaden, Wiesbaden, Deutschland
| | - Peter Klare
- Abteilung Innere Medizin Gastroenterologie, Diabetologie und Hämato-/Onkologie, Krankenhaus Agatharied, Hausham, Deutschland
| | - Ina Koop
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Deutschland
| | - Nadine Fischer
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
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Wehrmann T, Riphaus A, Eckardt AJ, Klare P, Kopp I, von Delius S, Rosien U, Tonner PH. Aktualisierte S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1246-1301. [PMID: 37678315 DOI: 10.1055/a-2124-5333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Till Wehrmann
- Klinik für Gastroenterologie, DKD Helios Klinik Wiesbaden, Wiesbaden, Deutschland
| | - Andrea Riphaus
- Innere Medizin, St. Elisabethen Krankenhaus Frankfurt Artemed SE, Frankfurt, Deutschland
| | - Alexander J Eckardt
- Klinik für Gastroenterologie, DKD Helios Klinik Wiesbaden, Wiesbaden, Deutschland
| | - Peter Klare
- Abteilung Innere Medizin - Gastroenterologie, Diabetologie und Hämato-/Onkologie, Krankenhaus Agatharied, Hausham, Deutschland
| | - Ina Kopp
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF), Berlin, Deutschland
| | - Stefan von Delius
- Medizinische Klinik II - Innere Medizin - Gastroenterologie, Hepatologie, Endokrinologie, Hämatologie und Onkologie, RoMed Klinikum Rosenheim, Rosenheim, Deutschland
| | - Ulrich Rosien
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - Peter H Tonner
- Anästhesie- und Intensivmedizin, Klinikum Leer, Leer, Deutschland
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Lee S, Choi JW, Chung IS, Kim DK, Sim WS, Kim TJ. Comparison of high-flow nasal cannula and conventional nasal cannula during sedation for endoscopic submucosal dissection: a retrospective study. Therap Adv Gastroenterol 2023; 16:17562848231189957. [PMID: 37655054 PMCID: PMC10467296 DOI: 10.1177/17562848231189957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/27/2023] [Indexed: 09/02/2023] Open
Abstract
Background The high-flow nasal cannula (HFNC) is a relatively recent method that provides high-flow, heated, humidified gas delivery. Objectives We compared HFNC (group HF) and conventional nasal cannula (NC) (group CO) during deep sedation with propofol and remifentanil for endoscopic submucosal dissection (ESD). Design Single-center, retrospective observational cohort study. Methods In this study, a total of 159 cases were analyzed (group CO, 71 and group HF, 88). We collected the data from electronic medical records from September 2020 to June 2021. The lowest oxygen saturation (SpO2), incidence of hypoxia (SpO2 < 90%), rescue interventions, and adverse events between the two groups were investigated. Results There were significant differences between the two groups in lowest SpO2 and incidence of hypoxia [group CO versus group HF; 90.3 ± 9.7% versus 95.7 ± 9.0%, 25 (35.2%) versus 10 (11.4%); p < 0.001, p < 0.001; respectively]. Among the rescue interventions, the number of jaw thrust, patient stimulation, O2 flow increase, and nasal airway insertion were significantly higher in the CO group than in the HF group. However, postprocedural chest X-ray showed higher rates of abnormal findings (atelectasis, aspiration, and pneumoperitoneum) in group HF than in group CO [group CO: 8 (11.3%) versus group HF: 26 (29.5%), p = 0.005]. In multivariable analysis, besides group CO, difficult type of lesion was the risk factor for hypoxia. Conclusions Compared to the conventional NC, HFNC provided adequate oxygenation and a stable procedure without significant adverse events during sedation for ESD. However, caution is needed to avoid complications associated with deep sedation and difficult type of lesions.
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Affiliation(s)
- Seungwon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - In Sun Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Jun Kim
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Chen Y, Lu Y, Xiang X, Fu L, Liu Y, Li C, Sun J. Efficacy and safety analysis of midazolam combined with dezocine sedation and analgesia colonoscopy in patients with inflammatory bowel disease: a prospective single-center open study. Front Pharmacol 2023; 14:1150045. [PMID: 37492093 PMCID: PMC10364117 DOI: 10.3389/fphar.2023.1150045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
Objective: Colonoscopy plays an important role in the diagnosis, prognosis prediction, assessment of disease activity and severity, and treatment of inflammatory bowel disease (IBD)-related complications. However, some patients refuse to undergo colonoscopy due to perceived pain and other discomfort, their diagnosis and treatment are affected. Therefore, we conducted a prospective study to explore the efficacy and safety of midazolam combined with dezocine for sedation in IBD patients undergoing colonoscopy. Methods: 224 patients were divided into sedative-colonoscopy-group (SCG, n = 93), anesthesia-colonoscopy-group (ACG, n = 90) and ordinary-colonoscopy-group (OCG, n = 41). The vital signs (blood pressure, pulse, respiration and blood oxygen saturation), pain degree during colonoscopy, satisfaction and complication rates of the three groups were compared. Results: Before colonoscopy, there was no significant difference among the vital signs of the three groups. The vital signs of the ACG were significantly lower than those of the SEG and the OCG (p < 0.05), and the difference was not significant between the SCG and OCG during colonoscopy. The colonoscopy pain score in the SCG was lower than that in the OCG (0.79 ± 1.09 vs. 2.98 ± 1.27, p < 0.001). The satisfaction score of the SCG (9.26 ± 1.16) was not significantly different from that of the ACG (9.42 ± 1.41) but was higher than that of the OCG (6.63 ± 1.13) (p < 0.001). The total complication rate of the ACG was 45.56% (41/90), which was significantly higher than that of the SCG [20.43% (19/93)] and the OCG [19.51% (8/41)]. Colon perforation, abnormal blood pressure fluctuation and hypoxemia were significantly more common in the ACG than in the SCG and the OCG (p < 0.05). However, there was no significant difference in the incidence of complications between the SCG and OCG. Conclusion: Compared with ordinary-colonoscopy, colonoscopy performed under midazolam and dezocine sedation is more comfortable for patients, thereby increasing satisfaction and compliance. Colonoscopy that is performed under midazolam and dezocine is similar to colonoscopy that is anesthesia with propofol in terms of comfort, satisfaction and compliance and similar to ordinary-colonoscopy in terms of safety. Considering the shortage of anesthesiologists, the application of midazolam combined with dezocine for digestive endoscopy is worthy of clinical promotion.
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Affiliation(s)
- Yongpeng Chen
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Lu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xueyuan Xiang
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liping Fu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanan Liu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chujun Li
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiachen Sun
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Prosenz J, Stättermayer MS, Riedl F, Maieron A. Adherence to guidelines in patients with non-variceal upper gastrointestinal bleeding (UGIB) - results from a retrospective single tertiary center registry. Scand J Gastroenterol 2023; 58:856-862. [PMID: 36855301 DOI: 10.1080/00365521.2023.2183734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/12/2023] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Guidelines for the management of upper gastrointestinal bleeding (UGIB) are regularly published, yet little is known concerning adherence to recommendations in practice. OBJECTIVES We aimed to assess adherence to European Society of Gastrointestinal Endoscopy (ESGE) recommendations in patients with non-variceal UGIB. MATERIALS AND METHODS All hospitalized patients with an esophagogastroduodenoscopy (EGD) performed due to suspected non-variceal UGIB at our department were included in a prospective registry. Data between 2018-2020 from this registry were retrospectively analyzed. Adherence to the 2015 ESGE bleeding and propofol sedation guidelines was assessed. Adherence to recommendations concerning preendoscopic (risk) evaluation, preendoscopic PPI, transfusion management, and endoscopic management of peptic ulcers was analyzed. RESULTS Among 1005 patients (mean age 70.4 years, 42.1% women) the most common bleeding etiologies were gastric or duodenal ulcers (16.8%), esophagitis/GERD (11.1%), and angiodysplasia (9.9%); mortality was 7.6%. Adherence to preendosopic risk evaluation was low, in 0% a Mallampati classification and in 37.5% an ASA scoring was documented. Preendoscopic PPI was started at 58.6%, and adherence to recommended transfusion management was >98%. Peptic ulcers were Forrest-graded in 72.8%. High-risk ulcers were treated appropriately in 77.9% and low-risk ulcers were not treated in 73.6%. Especially Forrest Ib ulcers were undertreated, with an adherence of 59.6%. Only 22/179 (12.3%) patients with peptic ulcers and early endoscopy were consistently managed according to ESGE recommendations. CONCLUSIONS Adherence to ESGE guidelines in patients with non-variceal UGIB is moderate to low, even at a tertiary university hospital. Strategies must be devised for guidelines to reach patients in everyday practice.
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Affiliation(s)
- Julian Prosenz
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
- Research Programme for Medical Science, Paracelsus Medical University, Salzburg, Austria
| | - Marie-Sophie Stättermayer
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
| | - Florian Riedl
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
| | - Andreas Maieron
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
- Research Programme for Medical Science, Paracelsus Medical University, Salzburg, Austria
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40
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Kim DH, Chun MK, Lee JY, Lee JS, Ryu JM, Choi SJ, Park JS. Safety and efficacy of pediatric sedation protocol for diagnostic examination in a pediatric emergency room: A retrospective study. Medicine (Baltimore) 2023; 102:e34176. [PMID: 37352029 PMCID: PMC10289638 DOI: 10.1097/md.0000000000034176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023] Open
Abstract
Pediatric patients undergoing diagnostic tests in the pediatric emergency room are frequently sedated. Although efforts are made to prevent adverse events, no sedation protocol has specified the optimal regimen, dosage, and interval of medication to prevent adverse events. This study analyzed the safety and efficacy of sequential pediatric sedation protocols for pediatric patients undergoing diagnostic tests in the pediatric emergency room of a single tertiary medical center. The medical records of patients aged < 18 years who visited the pediatric emergency room of Seoul Asan Medical Center between January and December 2019 for diagnostic testing were retrospectively reviewed. Sedation protocols consisted of 50 mg/kg and 25 mg/kg chloral hydrate, 0.1 mg/kg and 0.1 mg/kg midazolam, and 1 mg/kg and 0.5 to 1 mg/kg ketamine, administered sequentially at intervals of 30, 20, 10, 10, and 10 minutes, respectively. Patients were assessed prior to sedation, and adverse events were investigated. Of the 289 included patients, 20 (6.9%) experienced adverse events, none serious, and nine (3.1%) failed to reach the depth of sedation required to complete the test. The regimen (P = .622) and dosage (P = .777) of the sedatives were unrelated to the occurrence of adverse events when sedation was performed according to protocol. The sedation protocol used in these patients, consisting of sequential administration of minimum dosages, achieved a sufficient depth of sedation with relatively few adverse events, indicating that this protocol can be used safely and effectively for painless sedation in pediatric patients undergoing diagnostic testing.
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Affiliation(s)
- Da Hyun Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Kyo Chun
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Yong Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Seung Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Min Ryu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Jun Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Sung Park
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Dhir A, Jain K. Sedation for endoscopic procedures: Treading a tightrope. Indian J Gastroenterol 2023; 42:153-155. [PMID: 37166699 DOI: 10.1007/s12664-023-01375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Ankita Dhir
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160 012, India
- Department of Anaesthesia, Max Super Speciality Hospital, Phase6, Mohali, 160 055, India
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160 012, India.
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Nagashima H, Mikata R, Isono S, Ogasawara S, Sugiyama H, Ohno I, Yasui S, Matsumura T, Koroki K, Kusakabe Y, Miura Y, Kan M, Maruta S, Yamada T, Takemura R, Sato Y, Kato J, Kato N. Phase II study comparing nasal pressure monitoring with capnography during invasive endoscopic procedures: a single-center, single-arm trial. Sci Rep 2023; 13:1265. [PMID: 36690708 PMCID: PMC9871023 DOI: 10.1038/s41598-023-28213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
Nasal pressure signal is commonly used to evaluate obstructive sleep apnea. This study aimed to assess its safety for respiratory monitoring during sedation. A total of 45 adult patients undergoing sedation with propofol and fentanyl for invasive endoscopic procedures were enrolled. While both nasal pressure and capnograph signals were continuously recorded, only the nasal pressure signal was displayed. The primary outcome was the incidence of oxygen desaturation below 90%. The secondary outcomes were the ability to predict the desaturation and incidence of harmful events and false alarms, defined as an apnea waveform lasting more than 3 min without desaturation. Of the 45 participants, 43 completed the study. At least one desaturation event occurred in 12 patients (27.9%; 95% confidence interval 15.3-43.7%). In these 12 patients, more than half of the desaturation events were predictable in 9 patients by capnography and 11 patients by nasal pressure monitoring (p = 0.59). In the 43 patients, false alarms were detected in 7 patients with capnography and 11 patients with nasal pressure monitoring (p = 0.427). Harmful events unrelated to nasal pressure monitoring occurred in 2 patients. Nasal pressure monitoring is safe and possibly useful for respiratory monitoring despite false alarms during sedation.
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Affiliation(s)
- Hiroki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Rintaro Mikata
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan.
| | - Shiroh Isono
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
- Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Harutoshi Sugiyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Izumi Ohno
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Shin Yasui
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Yuko Kusakabe
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Yoshifumi Miura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Motoyasu Kan
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Shikiko Maruta
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Toshihito Yamada
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Ryo Takemura
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
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Liu F, Cheng X, Wang Y, Li K, Peng T, Fang N, Pasunooti KK, Jun S, Yang X, Wu J. Effect of remimazolam tosilate on the incidence of hypoxemia in elderly patients undergoing gastrointestinal endoscopy: A bi-center, prospective, randomized controlled study. Front Pharmacol 2023; 14:1131391. [PMID: 37144222 PMCID: PMC10151819 DOI: 10.3389/fphar.2023.1131391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
Background: Remimazolam tosilate is a new ultra-short-acting benzodiazepine sedative medicine. In this study, we evaluated the effect of remimazolam tosilate on the incidence of hypoxemia during sedation in elderly patients undergoing gastrointestinal endoscopy. Methods: Patients in the remimazolam group received an initial dose of 0.1 mg/kg and a bolus dose of 2.5 mg of remimazolam tosilate, whereas patients in the propofol group received an initial dose of 1.5 mg/kg and a bolus dose of 0.5 mg/kg of propofol. Patients received ASA standard monitoring (heart-rate, non-invasive blood pressure, and pulse oxygen saturation) during the entire examination process. The primary outcome was the incidence of moderate hypoxemia (defined as 85%≤ SpO2< 90%, >15s) during the gastrointestinal endoscopy. The secondary outcomes included the incidence of mild hypoxemia (defined as SpO2 90%-94%) and severe hypoxemia (defined as SpO2< 85%, >15s), the lowest pulse oxygen saturation, airway maneuvers used to correct hypoxemia, patient's hemodynamic as well as other adverse events. Results: 107 elderly patients (67.6 ± 5.7 years old) in the remimazolam group and 109 elderly patients (67.5 ± 4.9 years old) in the propofol group were analyzed. The incidence of moderate hypoxemia was 2.8% in the remimazolam group and 17.4% in the propofol group (relative risk [RR] = 0.161; 95% confidence interval [CI], 0.049 to 0.528; p < 0.001). The frequency of mild hypoxemia was less in the remimazolam group, but not statistically significant (9.3% vs. 14.7%; RR = 0.637; 95% CI, 0.303 to 1.339; p = 0.228). There was no significant difference in the incidence of severe hypoxemia between the two groups (4.7% vs. 5.5%; RR = 0.849; 95% CI, 0.267 to 2.698; p = 0.781). The median lowest SpO2 during the examination was 98% (IQR, 96.0%-99.0%) in patients in the remimazolam group, which was significantly higher than in patients in the propofol group (96%, IQR, 92.0%-99.0%, p < 0.001). Patients in the remimazolam group received more drug supplementation during endoscopy than patients in the propofol group (p = 0.014). There was a statistically significant difference in the incidence of hypotension between the two groups (2.8% vs. 12.8%; RR = 0.218; 95% CI, 0.065 to 0.738; p = 0.006). No significant differences were found in the incidence of adverse events such as nausea and vomiting, dizziness, and prolonged sedation. Conclusion: This study explored the safety of remimazolam compared with propofol during gastrointestinal endoscopy in elderly patients. Despite the increased supplemental doses during sedation, remimazolam improved risk of moderate hypoxemia (i.e., 85%≤ SpO2 < 90%) and hypotension in elderly patients.
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Affiliation(s)
- Fang Liu
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyan Cheng
- Department of Anaesthesiology, Weifang People’s Hospital (The First Affiliated Hospital of Weifang Medical University), Weifang, China
| | - Yingjie Wang
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kai Li
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
| | - Tianliang Peng
- Department of Anaesthesiology, Weifang People’s Hospital (The First Affiliated Hospital of Weifang Medical University), Weifang, China
| | - Ningning Fang
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
| | - Kalyan K. Pasunooti
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
- Department of Pharmacology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Seungho Jun
- Division of Cardiology, Johns Hopkins University Medical Institutions, Baltimore, MD, United States
| | - Xiaomei Yang
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Xiaomei Yang, ; Jianbo Wu,
| | - Jianbo Wu
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
- Department of Anaesthesiology and Perioperative Medicine, Qilu Hospital Dezhou Hospital, Shandong University, Dezhou, China
- *Correspondence: Xiaomei Yang, ; Jianbo Wu,
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Sun DJ, You YX, He XJ, Li HT, Zeng XP, Li DZ, Wang W. Effects of light music played by piano intervention on satisfaction, anxiety, and pain in patients undergoing colonoscopy: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e32339. [PMID: 36595974 PMCID: PMC9803447 DOI: 10.1097/md.0000000000032339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Colonoscopy is the main kind of way to detect and treat diseases about large intestine, but during the examination and preparation, these 2 processes are able to lead abdominal pain, abdominal distention and other discomfort feel, which will cause patients to refuse the examination and become anxious. Painless and sedative endoscopy may reduce discomfort of patients, but there is a risk of adverse effects. Many studies have shown that playing music during colonoscopy can reduce discomfort and increase acceptance of colonoscopy, but the conclusion remains controversial. The 3 approaches of random, single-blind, controlled method were used to investigate the interventions effects of piano light music on satisfaction, anxiety and pain in patients undergoing colonoscopy. METHODS A total of 216 patients were randomly divided into piano music group (n = 112, piano music played during colonoscopy) and control group (n = 104, no music during colonoscopy) to compare patients satisfaction, anxiety score, pain score, vital signs, endoscopic difficulty score, and willingness to undergo colonoscopy again. RESULTS There were no significant differences in vital signs, pre-colonoscopic state anxiety score, and trait anxiety score before and after colonoscopy, and willingness to undergo colonoscopy again between the 2 groups (P > .05). The difficulty of colonoscopy operation and the score of state anxiety after colonoscopy in the piano group were lower than those in the control group (P < .05), and the satisfaction of colonoscopy process, pain management and overall service satisfaction were better than those of the control group (P < .05), and they were more likely to listen to music in the next examination (P < .001). CONCLUSION The light music played by piano can relieve patients' anxiety, improve the satisfaction of colonoscopy process, pain management and service satisfaction, reduce the difficulty of colonoscopy, which have no obvious adverse reactions. Therefore, it is worthy of promotion.
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Affiliation(s)
- Dong-Jie Sun
- Department of Digestive Diseases, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Department of Digestive Diseases, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
- Department of Digestive Diseases, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Yi-Xiang You
- Department of Digestive Diseases, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xiao-Jian He
- Department of Digestive Diseases, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
- Department of Digestive Diseases, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Hai-Tao Li
- Department of Digestive Diseases, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
- Department of Digestive Diseases, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Xiang-Peng Zeng
- Department of Digestive Diseases, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
- Department of Digestive Diseases, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Da-Zhou Li
- Department of Digestive Diseases, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
- Department of Digestive Diseases, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Wen Wang
- Department of Digestive Diseases, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
- Department of Digestive Diseases, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
- * Correspondence: Wen Wang, Department of Digestive Diseases, The Fuzong Clinical Medical College, Fujian Medical University, 156 North Road of West No.2 Ring, Fuzhou 350025, China (e-mails: )
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Roelandt P, Haesaerts R, Demedts I, Bisschops R. Implementation of the Aldrete score reduces recovery time after non-anesthesiologist-administered procedural sedation in gastrointestinal endoscopy. Endosc Int Open 2022; 10:E1544-E1547. [PMID: 36531676 PMCID: PMC9754857 DOI: 10.1055/a-1964-7458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background and study aims Procedural sedation and analgesia (PSA) by trained non-anesthesiologist physicians and/or nurses is often performed during endoscopic procedures. Discharge from the recovery area after monitored observation is frequently based on fixed time parameters or subjective clinical assessment. In this study, the effect of implementation of the Aldrete score on recovery time after procedural sedation was analyzed in a real-life setting. Patients and methods A prospective observational study of patients undergoing procedural sedation and analgesia during gastroscopy, colonoscopy or endoscopic ultrasound was performed. All procedures were randomly included to represent a real-life situation with different endoscopists, recovery nurses, endoscopy systems and indications. After a first observation period, all endoscopy nurses were trained to implement the Aldrete score when discharging patients, followed by a second observation period. Results During the first observation period, the average time spent in the recovery area was 59 ± 22 minutes after procedural sedation. After implementation of the Aldrete score, the recovery time decreased significantly to 47 ± 25 minutes ( P < 0.01) with identical doses of procedural sedation and analgesia. The decrease in time was between 19 % and 35 % for the different endoscopic procedures. Conclusions Implementation of the Aldrete score after procedural sedation and analgesia significantly reduces the time spent in the recovery area. The score can be used to safely implement a discharge policy that provides more efficient and standardized management for an endoscopy service.
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Affiliation(s)
- Philip Roelandt
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium,Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Rico Haesaerts
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
| | - Ingrid Demedts
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium,Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium,Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
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Park SY, Lee JK, Park CH, Kim BW, Lee CK, Park HJ, Jang BI, Kim DU, Park JM, Lee JM, Cho YS, Chon HK, Seo SY, Paik WH, the Committees of Quality Management and Conscious Sedation of Korean Society of Gastrointestinal Endoscopy (KSGE). Endoscopist-Driven Sedation Practices in South Korea: Re-evaluation Considering the Nationwide Survey in 2019. Gut Liver 2022; 16:899-906. [PMID: 35912649 PMCID: PMC9668492 DOI: 10.5009/gnl210466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to determine changes in endoscopist-driven sedation practices 5 years after the first nationwide survey in 2014 by the Korean Society of Gastrointestinal Endoscopy (KSGE). METHODS A 59-item survey covering current practices was electronically mailed to all members of the KSGE in 2019. RESULTS In total, 955 (12.8%) out of 7,486 questionnaires were returned. A total of 738 (77.7%) out of 955 respondents attended dedicated sedation education programs. The American Society of Anesthesiologists class was recorded by 464 (51.2%) out of 907 respondents. The recording rate was higher in respondents who completed sedation education (p=0.014) and worked in general or tertiary hospitals (p<0.001). Compared to that reported in the previous survey, the reported use of propofol was higher in 2019. The respondents had higher satisfaction scores for propofol-based sedation compared with midazolam monotherapy (p<0.001). The rates of oxygen supplementation (p<0.001) and oxygen saturation level monitoring (p<0.001) during sedative endoscopy were higher in 2019 than in the previous survey. A total of 876 (98.4%) out of 890 respondents reported a separate recovery bay, and 615 (70.5%) out of 872 respondents reported that personnel were assigned solely to the recovery bay. CONCLUSIONS Endoscopist-driven sedation and monitoring practices in 2019 were significantly different than those in 2014. The respondents favored propofol-based sedation and utilized oxygen supplementation and monitoring of O2 saturation more frequently in 2019 than in 2014.
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Affiliation(s)
- Seon-Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Chang-Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Chang Kyun Lee
- Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hong Jun Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University School of Medicine, Pusan, Korea
| | - Jin Myung Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Sin Cho
- Division of Gastroenterology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyung Ku Chon
- Institute of Wonkwang Medical Science, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
| | - Seung Young Seo
- Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Woo Hyun Paik
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Yong KK, He Y, Cheung HCA, Sriskandarajah R, Jenkins W, Goldin R, Beg S. Rationalising the use of specimen pots following colorectal polypectomy: a small step towards greener endoscopy. Frontline Gastroenterol 2022; 14:295-299. [PMID: 37409340 PMCID: PMC11138171 DOI: 10.1136/flgastro-2022-102231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Aims In this study, we aim to determine whether combining multiple small colorectal polyps within a single specimen pot can reduce carbon footprint, without an associated deleterious clinical impact. Methods This was a retrospective observational study of colorectal polyps resected during 2019, within the Imperial College Healthcare Trust. The numbers of pots for polypectomy specimens were calculated and corresponding histology results were extracted. We modelled the potential reduction in carbon footprint if all less than 10 mm polyps were sent together and the number of advanced lesions we would not be able to locate if we adopted this strategy. Carbon footprint was estimated based on previous study using a life-cycle assessment, at 0.28 kgCO2e per pot. Results A total of 11 781 lower gastrointestinal endoscopies were performed. There were 5125 polyps removed and 4192 pots used, equating to a carbon footprint of 1174 kgCO2e. There were 4563 (89%) polyps measuring 0-10 mm. 6 (0.1%) of these polyps were cancers, while 12 (0.2%) demonstrated high-grade dysplasia. If we combined all small polyps in a single pot, total pot usage could be reduced by one-third (n=2779). Conclusion A change in practice by placing small polyps collectively in one pot would have resulted in reduction in carbon footprint equivalent to 396 kgCO2e (emissions from 982 miles driven by an average passenger car). The reduction in carbon footprint from judicious use of specimen pots would be amplified with a change in practice on a national level.
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Affiliation(s)
- Karl King Yong
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Yun He
- School of Medicine, Imperial College School of Medicine, London, UK
| | | | | | - William Jenkins
- School of Medicine, Imperial College School of Medicine, London, UK
| | - Robert Goldin
- Division of Digestive Diseases, Imperial College School of Medicine, London, UK
| | - Sabina Beg
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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Chen Y, Sun J, Lu Y, Fu L, Xiang X, Liu Y, Zhuo X, Kurban M, Li C. Efficacy and safety of midazolam combined with dezocine for sedation and analgesia in digestive endoscopy: A prospective open single-center study. Front Pharmacol 2022; 13:945597. [PMID: 36408218 PMCID: PMC9669085 DOI: 10.3389/fphar.2022.945597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/13/2022] [Indexed: 07/27/2023] Open
Abstract
Objective: Digestive endoscopy is an important means of diagnosing and treating gastrointestinal diseases and a tool for screening and monitoring early gastrointestinal tumors. Digestive endoscopy can be performed using midazolam combined with dezocine for sedation and analgesia. This study explored the efficacy and safety of midazolam combined with dezocine. Methods: A total of 135 patients undergoing digestive endoscopy in the Department of Gastrointestinal Endoscopy of the Sixth Affiliated Hospital, Sun Yat-sen University, from June 2021 to September 2021, were enrolled and non-blindly and non-randomly divided into a sedation-endoscopy-group (SEG, n = 45), anesthesia-endoscopy-group (AEG, n = 44), and ordinary-endoscopy-group (OEG, n = 46). Vital signs, levels of sedation and analgesia, the degree of pain during colonoscopy, satisfaction, and the incidence of complications were compared among the three groups. Results: There were no statistically significant differences in vital signs (blood pressure, pulse, respiration, and blood oxygen saturation) among the three groups before endoscopy (p > 0.05). The AEG reported no pain during colonoscopy, and the pain score during colonoscopy for the SEG was lower than that for the OEG (1.11 ± 1.21 vs. 3.00 ± 1.16, p < 0.001). The scores for satisfaction were 8.84 ± 1.30 points in the SEG, 8.95 ± 1.10 points in the AEG, and 6.37 ± 0.90 points in the OEG; the differences were statistically significant (p < 0.001). The total incidence of complications in the AEG was 38.64% (17/44), which was significantly higher than that in the SEG [13.33% (6/45)] and OEG [13.04% (6/46)] (p < 0.001). In the SEG, the overall incidence of complications in women was significantly higher than that in men (p = 0.027). Conclusion: Digestive endoscopy using midazolam combined with dezocine for sedation makes patients more comfortable, more satisfied and more compliant than the ordinary endoscopy. Additionally, it is comparable to endoscopy under general anesthesia with propofol with regard to comfort, satisfaction, and patient compliance and comparable to the ordinary endoscopy with regard to safety. Considering the shortage of anesthesiologists, the application of midazolam combined with dezocine in digestive endoscopy is worthy of clinical popularization. This study has been registered in the Hospital Ethics Committee of the Sun Yat-sen University Sixth Affiliated Hospital (Ethical Number: 2021ZSLYEC-182).
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Affiliation(s)
- Yongpeng Chen
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiachen Sun
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yi Lu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liping Fu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xueyuan Xiang
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanan Liu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xianhua Zhuo
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mirigul Kurban
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Small Bowel Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chujun Li
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Zhang F, Xu Y, Zhou Z, Zhang H, Yang K. Critical element prediction of tracheal intubation difficulty: Automatic Mallampati classification by jointly using handcrafted and attention-based deep features. Comput Biol Med 2022; 150:106182. [PMID: 36242810 DOI: 10.1016/j.compbiomed.2022.106182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/14/2022] [Accepted: 10/01/2022] [Indexed: 11/20/2022]
Abstract
Preoperative assessment of the difficulty of tracheal intubation is of great importance in anesthesia practice because failed intubation can lead to severe complications and even death. The Mallampati score is widely used as a critical assessment criterion in combination with other measures to assess the difficulty of tracheal intubation. The performance of existing methods for Mallampati classification with artificial intelligence (AI) is unreliable to the extent that the current clinical judgment of the Mallampati score relies entirely on doctors' experience. In this paper, we propose a new method for automatic Mallampati classification. Our method extracts deep features that are more favorable for the Mallampati classification task by introducing an attention mechanism into the basic deep convolutional neural network (DCNN) and then further improves the classification performance by jointly using attention-based deep features with handcrafted features. We conducted experiments on a dataset consisting of 321 oral images collected online. The proposed method has a classification accuracy of 97.50%, a sensitivity of 96.52%, a specificity of 98.05%, and an F1 score of 96.52% after five-fold cross-validation. The experimental results show that our proposed method is superior to other methods, can assist doctors in determining Mallampati class objectively and accurately, and provide an essential reference element for assessing the difficulty of tracheal intubation.
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Affiliation(s)
- Fan Zhang
- Unmanned System Research Institute, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi, China.
| | - Yuelei Xu
- Unmanned System Research Institute, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi, China.
| | - Zhaoyun Zhou
- Department of Anesthesiology, Tai'an Central Hospital, Tai'an, 271000, Shandong, China.
| | - Han Zhang
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
| | - Ke Yang
- Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, 650102, Yunnan, China.
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Evaluation of 30-day mortality in patients undergoing gastrointestinal endoscopy in a tertiary hospital: a 3-year retrospective survey. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000977. [DOI: 10.1136/bmjgast-2022-000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectiveDespite international guidelines recommendations to use mortality as a quality criterion for gastrointestinal (GI) procedures, recent studies reporting these data are lacking. Our objective was to report death causes and rate following GI endoscopies in a tertiary university hospital.DesignWe retrospectively reviewed all GI procedures made between January 2017 and December 2019 in our tertiary hospital in Switzerland. Data from patients who died within 30 days of the procedure were recorded.ResultsOf 18 233 procedures, 251 patients died within 30 days following 345 (1.89%) procedures (244/9180 gastroscopies, 53/5826 colonoscopies, 23/2119 endoscopic ultrasound, 19/911 endoscopic retrograde cholangiopancreatography, 6/197 percutaneous endoscopic gastrostomies). Median age was 70 years (IQR 61–79) and 173/251 (68.92%) were male. Median Charlson Comorbidity Index was 5 (IQR 3–7), and 305/345 procedures (88.4%) were undertaken on patients with an ASA score ≥3. Most frequent indications were suspected GI bleeding (162/345; 46.96%) and suspected cancer or tumourous staging (50/345; 14.49%). Major causes of death were oncological progression (72/251; 28.68%), cardiopulmonary failure or cardiac arrest of unkown origin (62/251; 24,7%) and liver failure (20/251; 7.96%). No deaths were caused by complications such as perforation or bleeding.ConclusionsProgression of malignancies unrelated to the procedure was the leading cause of short-term death following a GI procedure. After improvements in periprocedural care in the last decades, we should focus on patient selection in this era of new oncological and intensive care therapies. Death rate as a quality criterion is subject to caution as it depends on indication, setting and risk benefit ratio.
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