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Deep sedation for endoscopic retrograde cholangiopacreatography

World Journal of Gastrointestinal Endoscopy 2011年第2期3卷 34-39页

作者： Irene G Chainaki Maria M Manolaraki gregorios a paspatis Departments of Anesthesiology Benizelion General Hospital Heraklion Crete 71409 Greece Departments of Gastroenterology Benizelion General Hospital Heraklion Crete 71409 Greece

Sedation and analgesia comprise an important element of unpleasant and often prolonged endoscopic retrograde cholangiopacreatography (ERCP), contributing, however, to better patient tolerance and compliance and to the reduction of injuries during the procedure due to inappropriate co-operation. Although most of the studies used a moderate level of sedation, the literature has revealed the superiority of deep sedation and general anesthesia in performing ERCP. The anes- the siol ogist's presence is mandatory in these cases. A mod erate sedation level for ERCP seems to be adeq uate for octogenarians. The sedative agent of choice for sedation in ERCP seems to be propofol due to its fast distribution and fast elimination time without a cumulative effect after infusion, resulting in shorter recovery time. Its therapeutic spectrum, however, is much narrower and therefore careful monitoring is much more de manding in order to differentiate between moder ate, deep sedation and general anesthesia. Apart from conventional monitoring, capnography and Bispectral index or Narcot rend monitoring of the level of sedation seem to be useful in titrating sedatives in ERCP.

关键词： Deep sedation Endoscopic retrograde cholangiop acreatography Monitoring Sedatives

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Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia?A pilot study

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World Journal of Gastroenterology 2004年第4期10卷 586-589页

作者： SpirosD.Ladas DimitriosPolymeros ThomasPagonis KonstantinosTriantafyllou MariaHatziargiriou SotiriosA.Raptis gregorios paspatis Gastroenterology Unit 2~(nd) Department of Internal MedicineAthens UniversityEvangelismos HospitalAthensGreece Gastroenterology Department Benizelion HospitalHerakleionCreteGreece

AIM:Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron, but patients usually face a two-month recovery period from post-haemorrhage anaemia. This prospective, randomised, open,pilot study was designed to investigate whether recombinant human erythropoietin (Epoetin) therapy accelerate haematocrit increase in the post-bleeding recovery period.METHODS:We studied hospitalised patients admitted because of acute ulcer bleeding or haemorrhagic gastritis,who had a haematocrit of 27-33% and did not receive blood transfusions.One day alter the endoscopic confirmation of cessation of bleeding, they were randomised either to erythropoietin (20000 IU Epoetin alfa subcutaneously, on days 0, 4 and 6) plus iron (100mg im, on days 1-6, (G1) or iron only (G2). Haematocrit was measured on days 0, 6, 14,30, 45, and 60, respectively.R.ESULTS: One patient from G1 and two from G2 were lost to follow-up. Therefore, 14 and 13 patients from G1 and G2 respectively were analysed. Demographic characteristics, serum iron, ferritin, total iron binding capacity, reticulocytes, and haematocrit were not significantly different at entry to the study.Median reticulocyte counts were significantly different between groups on day six (G1: 4.0,3.0-6.4 vs G2:3.5,2.1-4.4%,P=0.03) and median haematocrit on day fourteen [G1:35.9,30.7-41.0 vs G2:32.5,29.5-37.0% (median, range), P=0.04].CONCLUSION:Erythropoietin administration significantly accelerates correction of anemia alter acute ulcer bleeding.The haematocrit gain is equivalent to one unit of transfused blood two weeks alter the bleeding episode.

关键词：重组人促红细胞生成素溃疡后失血性贫血急性上消化道出血药物疗法

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