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Wang G, Zhen B, Li JJ, Jin CN, Jia J, Liu BH, Bai YH. Insights into anesthesia administration for elderly individuals undergoing painless gastroenteroscopy: A bibliometric study. World J Gastrointest Endosc 2025; 17:101382. [PMID: 39850906 PMCID: PMC11752464 DOI: 10.4253/wjge.v17.i1.101382] [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: 09/12/2024] [Revised: 10/09/2024] [Accepted: 11/08/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND Administering anesthesia to elderly patients undergoing gastroenteroscopy necessitates careful attention due to age-related physiological changes and an increased risk of complications. AIM To analyze the research trends in anesthesia management for elderly patients undergoing gastroenteroscopy. METHODS We performed a literature search using the Web of Science database to identify articles published between 2004 and 2023. Bibliometric and visual analyses were conducted using CiteSpace, R, and VOSviewer to explore the current research landscape of anesthesia administration in painless gastroenteroscopy for elderly patients and to identify future research directions by examining trends and emerging hotspots in this domain. RESULTS A total of 800 articles were examined, revealing a rising trend in annual publication counts. The United States led with 181 articles, followed by China with 112, collectively contributing over 35% of the studies among the top ten countries. The majority of publications appeared in the United States journals, with the top three being Gastrointestinal Endoscopy [impact factor (IF) = 7.7, H-index = 26], Digestive Diseases and Sciences (IF = 3.1), and Endoscopy (IF = 9.3). Six primary research clusters were identified: Obstructive sleep apnea and airway management, surveillance and risk factors, colorectal cancer examination and treatment, sedation and safety of propofol and midazolam, patient satisfaction, and mortality and complications. These findings underscore the pivotal focus areas in anesthesia for elderly patients undergoing gastroenteroscopy. CONCLUSION A comprehensive understanding of current research trends and hotspots will aid anesthesiologists in developing more evidence-based practices, thereby improving the safety and outcomes for elderly patients undergoing gastroenteroscopy.
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Affiliation(s)
- Gang Wang
- Department of Anesthesiology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Biao Zhen
- Department of Anesthesiology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Jia-Jun Li
- Department of Anesthesiology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Chun-Nv Jin
- Department of Anesthesiology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Jun Jia
- Department of Anesthesiology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Bo-Hai Liu
- Department of Anesthesiology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Yan-Hui Bai
- Department of Anesthesiology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
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Sun Y, Liu S, Si W, Zhang Q, Yu F, Su M, Sun C. The effective dose of butorphanol tartrate in patients of different ages undergoing painless gastroscopy. J Int Med Res 2024; 52:3000605241277689. [PMID: 39301791 PMCID: PMC11418491 DOI: 10.1177/03000605241277689] [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: 04/05/2024] [Accepted: 06/24/2024] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVE This study evaluated the 50% effective dose (ED50) and 95% effective dose (ED95) of butorphanol tartrate in patients undergoing painless gastroscopy. METHODS Patients who underwent painless gastroscopy at Binzhou Medical University Hospital were divided into the youth, middle-aged, and older groups. The ED50 and ED95 required for successful sedation using butorphanol tartrate were measured using the Dixon up-and-down method in patients in the different age groups. Patients in each group were administered intravenous butorphanol 5 minutes before gastroscopy. Each patient was administered 2 mg/kg propofol. The ED50 and ED95 of butorphanol were calculated using probit analysis. RESULTS In total, 95 patients were included. The ED50s of butorphanol in the youth, middle-aged, and older groups were 7.384, 6.657, and 6.364 μg/kg, respectively. The ED95s of butorphanol doses in these groups were 9.108, 8.419, and 7.348 μg/kg, respectively. CONCLUSIONS The ED50 and ED95 varied among the age groups, indicating that the effective dose decreases with age.
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Affiliation(s)
- Yaorui Sun
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China
| | - Shujiao Liu
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China
| | - Wenli Si
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China
| | - Quanyi Zhang
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China
| | - Fei Yu
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China
| | - Ming Su
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China
| | - Chao Sun
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China
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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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Zhao YR, Huang KS, Hou G, Yao L, Lu LP, Xu S, Lian YT, Yao Z, Yu Z. Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal endoscopy: a cohort study. World J Emerg Med 2023; 14:31-36. [PMID: 36713335 PMCID: PMC9842476 DOI: 10.5847/wjem.j.1920-8642.2023.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Remimazolam is a novel ultra-short-acting sedative, but its safety and adverse events (AEs) in high-risk patients in the intensive care unit (ICU) setting remain unknown. METHODS This was a single-center, retrospective study that compared remimazolam to propofol and midazolam in patients undergoing upper gastrointestinal endoscopy. The primary outcome was the incidence of treatment-related AEs. The secondary outcomes were the time to extubation, the length of ICU stay, and the average cost of sedative per case. RESULTS Of the 88 patients analyzed, 47 were treated with remimazolam (mean dose, 7.90±4.84 mg), and 41 were treated with propofol (21.19±17.98 mg) or midazolam (3.08±2.17 mg). There was no statistically significant difference in the average duration of the endoscopic procedure (35.89±13.37 min vs. 44.51±21.68 min, P=0.133) or the time to extubation (15.00±9.75 h vs. 20.59±18.71 h, P=0.211) in the remimazolam group (group I) compared to the propofol or midazolam group (group II). ICU stays (5.40±2.93 d vs. 4.63±3.31 d, P=0.072) and treatment-related AEs (48.61% vs. 51.38%, P=0.056) were similar between groups. The average cost of sedative per case was significantly lower in the group I than in the group II (RMB 16.07±10.58 yuan vs. RMB 24.37±15.46 yuan, P=0.016). CONCLUSION Remimazolam-based sedation was noninferior to the classic sedatives and had lower average cost per case, indicating that it may be used as a promising sedative for high-risk patients during endoscopic procedures in the ICU setting.
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Affiliation(s)
- Yuan-rui Zhao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Ke-sheng Huang
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Guo Hou
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Lan Yao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Li-ping Lu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Song Xu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Ying-tao Lian
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhun Yao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhui Yu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China,Corresponding Author: Zhui Yu,
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Zheng Y, Xu Y, Huang B, Mai Y, Zhang Y, Zhang Z. Effective dose of propofol combined with a low-dose esketamine for gastroscopy in elderly patients: A dose finding study using dixon’s up-and-down method. Front Pharmacol 2022; 13:956392. [PMID: 36204220 PMCID: PMC9530901 DOI: 10.3389/fphar.2022.956392] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/06/2022] [Indexed: 12/05/2022] Open
Abstract
Objective: This study aimed to determine the optimal dose of propofol combined with esketamine to inhibit the response to gastroscope insertion in elderly patients. Methods: This is a prospective, non-controlled, non-randomized, single-center study. Elderly patients aged 65–80 years were enrolled in the study with the American society of anesthesiologists (ASA) physical status I or II undergoing elective gastroscopy. All patients were administered propofol after an intravenous esketamine at the dosage of 0.3 mg/kg 30 s, the subsequent dose of propofol was determined by the response of the previous patient to gastroscope insertion (choking, body movement, etc.) using Dixon’s up-and-down method. The initial dose of propofol administered to the first elderly patient was 3.0 mg/kg, and the standard ratio of propofol dose in adjacent patients was 0.9. At least six crossover points were obtained before the conclusion of the study. By using Probit analysis the median effective dose (ED50), 95% effective dose (ED95), and the corresponding 95% confidence interval (CI) for propofol were determined. Results: The study continued until we obtained seven crossover points and 32 elderly patients (17 males and 15 females) were collected. The ED50 of propofol combined with esketamine inhibiting response to gastroscope insertion in elderly patients were found to be 1.479 mg/kg (95% CI 1.331–1.592 mg/kg), and ED95 was found to be 1.738 mg/kg (95% CI 1.614–2.487 mg/kg). Conclusion: According to the present study, propofol combined with 0.3 mg/kg esketamine is safe and effective for elderly patients undergoing gastroscopy. The ED50 and ED95 doses of propofol inhibiting response to gastroscope insertion in elderly patients when combined with 0.3 mg/kg esketamine were 1.479 and 1.738 mg/kg, respectively, without apparent adverse effects.
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Affiliation(s)
- Yuling Zheng
- Department of Anesthesiology, the Affiliated Shunde Hospital of Jinan University, Foshan, China
| | - Yafei Xu
- Department of Anesthesiology, Shunde Hospital of Southern Medical University, Foshan, China
| | - Bixin Huang
- Department of Anesthesiology, the Affiliated Shunde Hospital of Jinan University, Foshan, China
| | - Ying Mai
- Department of Anesthesiology, the Affiliated Shunde Hospital of Jinan University, Foshan, China
| | - Yiwen Zhang
- Department of Anesthesiology, Shunde Hospital of Southern Medical University, Foshan, China
| | - Zhongqi Zhang
- Department of Anesthesiology, the Affiliated Shunde Hospital of Jinan University, Foshan, China
- *Correspondence: Zhongqi Zhang,
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