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Upper gastrointestinal endoscopy:Are preparatory interventions or conscious sedation effective? A randomized trial

World Journal of Gastroenterology 2004年第22期10卷 3313-3317页

作者： LucioTrevisani SergioSartori PiergiorgioGaudenzi GiuseppeGilli GiancarloMatarese SergioGullini VincenzoAbbasciano DigestiveEndoscopyService DepartmentofInternalMedicineS.AnnaHospitalFerraraItaly HealthPhysicsDepartment S.AnnaHospitalFerraraItaly

AIM: The fears and concerns are associated with gastroscopy (EGD) decrease patient compliance. conscious sedation (CS) and non-pharmacological interventions have been proposed to reduce anxiety and allow better execution of EGD. The aim of this study was to assess whether CS, supplementary information with a videotape, or presence of a relative during the examination could improve the tolerance to EGD. METHODS: Two hundred and twenty-six outpatients (pts), scheduled for a first-time non-emergency EGD were randomly assigned to 4 groups: Co-group (62 pts): throat anaesthesia only; Mi-group (52 pts): CS with i.v. midazolam; Re-group (58 pts): presence of a relative throughout the procedure; Vi-group (54 pts): additional information with a videotape. Anxiety was measured using the “Spielberger State and Trait Anxiety Scales” The patients assessed the overall discomfort during the procedure on an 100-mm visual analogue scale, and their tolerance to EGD answering a questionnaire. The endoscopist evaluated the technical difficulty of the examination and the tolerance of the patients on an 100-mm visual analogue scale and answering a questionnaire. RESULTS: Pre-endoscopy anxiety levels were higher in the Mi-group than in the other groups (Pconscious sedation can improve the tolerance to EGD. Male gender and young age are predictive factors of bad tolerance to the procedure.

关键词： conscious sedation Adult Anxiety control Endoscopy, Digestive System Fear Female Gastrointestinal Diseases Humans Male Middle Aged Patient Compliance Patient Education Prospective Studies Videotape Recording

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Superiority of split dose midazolam as conscious sedation for outpatient colonoscopy

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World Journal of Gastroenterology 2009年第30期15卷 3783-3787页

作者： Hyuk Lee Jeong Hwan Kim Department of Medicine Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea Department of Internal Medicine Armed Forces Capital HospitalSeongnam 135-710South Korea Department of Internal Medicine Konkuk University School of MedicineSeoul 143-729South Korea

AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A (n = 40) received a split dose of midazolam in combination with meperidine. Group B (n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. RESULTS: Group A had a lower frequency of significant hypoxemia (P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B (P = 0.043). Group B recovered from sedation slightly sooner than group A (P sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.

关键词： Amnesia Colonoscopy conscious sedation Midazolam

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A pilot study of the effect of pressure-driven lidocaine spray on airway topical anesthesia for conscious sedation intubation

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Chinese Medical Journal 2011年第23期124卷 3997-4001页

作者： JIANG Hai MIAO Hai-sheng JIN San-qing CHEN Li-hong TIAN Jing-ling Department of Anesthesia Sixth Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong 510655 China

Background Difficult airway remains not only a challenge to the anesthesiologists, but also a life-threatening event to the patients. Awake intubation is the principal choice to deal with difficult airway, and a key point for awake intubation is airway topical anesthesia. Yet, so far there is no ideal topical anesthesia approach for awake intubation. This study aimed at evaluating the effect of pressure-driven （by 10 L/min oxygen flow） lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation. Methods Thirty adult patients referred for elective surgery under general anesthesia, aged 18-60 years and Mallampati class I or II, were recruited for the study. Before topical anesthesia, the observer＇s assessment of alert and sedation （OAA/S） scale was controlled between 3 and 4 by intravenous midazolam （0.03 mg/kg）, propofol （2 ***.h＂1） and remifentanil （0.05 ***1）. Ten minutes after sedation, topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min. After topical anesthesia, tracheal intubation was performed and the intubation condition was assessed with modified the Erhan＇s intubation condition score by an experienced anesthesiologist, and a score of less than 10 was considered to be satisfactory. Attempts to intubate the patient were recorded, and the complications such as local anesthetic toxicity, mucosa injury, and respiration depression were also recorded. The mean arterial blood pressure （MAP）, heart rate （HR） and pulse oxygen saturation （SpO2） were recorded at different time points before and after intubation. Patients were asked 24 hours after the operation whether they could recall the events during intubation. Results All patients were intubated at the first attempt, the average intubation condition score was 7.0＋_1.1, from 6 to 10 satisfied intubation condition. MAP an

关键词： anesthesia, local, lidocaine spray intubation, intracheal conscious sedation

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Safety of same-day endoscopic ultrasound and endoscopic retrograde cholangiopancreatography under conscious sedation

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World Journal of Gastroenterology 2010年第26期16卷 3287-3291页

作者： Kendrick Che Natasha Muckova Snorri Olafsson Wichit Srikureja Department of Internal Medicine Division of Gastroenterology Loma Linda University Medical Center Loma Linda CA 92354 United States

AIM: To assess the tolerability and safety of same-day tandem procedures, endoscopic ultrasound (EUS) followed by endoscopic retrograde cholangiopancreatography (ERCP) under conscious sedation. METHODS: A retrospective review was conducted at Loma Linda University Medical Center, a tertiary-care center. All 54 patients who underwent EUS followed by ERCP (group A) from 2004 to 2006 were included in the study. A second group of 56 patients who underwent EUS only (group B), and a third group of 53 patients who underwent ERCP only (group C) during the same time period were selected consecutively as control groups for comparison. RESULTS: conscious sedation was used in 96% of patients in group A. Mean dosages of meperidine and midazolam used in group A were signifi cantly higher than in group B or C. Mean recovery time in group A was not statistically longer than in group B or C. Therewas no signifi cant difference in the incidence of sedation-related and procedural-related complications. CONCLUSION: Tandem EUS/ERCP procedure can be safely performed under conscious sedation with minimal adverse events. Combined procedures, however, are associated with higher dosages of sedatives, and slightly longer recovery time.

关键词： conscious sedation Safety Same-day Endoscopic ultrasound Endoscopic retrograde cholangiopancreatography

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Safety of gastrointestinal endoscopy with conscious sedation in obstructive sleep apnea

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World Journal of Gastrointestinal Endoscopy 2017年第11期9卷 552-557页

作者： Christian M Andrade Brijesh Patel Meghana Vellanki Ambuj Kumar Gitanjali Vidyarthi the James A. Haley Veterans Affairs Department of Gastroenterology Division of Digestive Diseases and Nutrition University of South Florida Morsani College of Medicine University of South Florida Tampa Comparative Effectiveness Research Morsani College of Medicine University of South Florida

AIM To perform a systematic review and meta-analysis to assess the safety of conscious sedation in patients with obstructive sleep apnea(OSA).METHODS A comprehensive electronic search of MEDLINE and EMBASE was performed from inception until March 1, 2015. In an effort to include unpublished data, abstracts from prior gastroenterological society meetings as well as other reference sources were interrogated. After study selection, two authors utilizing a standardized data extraction form collected the data independently. Any disagreements between authors were resolved by consensus among four authors. The methodological quality was assessed using the Newcastle Ottawa tool for observational studies. The primary variables of interest included incidence of hypoxia, hypotension, tachycardia, and bradycardia. Continuous data were summarized as odds ratio(OR) and 95%CI and pooled using generic inverse variance under the random-effects model. Heterogeneity between pooled studies was assessed using the I2 *** Initial search of MEDLINE and EMBASE identified 357 citations. A search of meeting abstracts did not yield any relevant citations. After systematic review and exclusion consensus meetings, seven studies met the a priori determined inclusion criteria. The overall methodological quality of included studies ranged from moderate to low. No significant differences between OSA patients and controls were identified among any of the study variables: Incidence of hypoxia(7 studies, 3005 patients; OR = 1.11; 95%CI: 0.73-1.11; P = 0.47; I2 = 0%), incidence of hypotension(4 studies, 2125 patients; OR = 1.10; 95%CI: 0.75-1.60; P = 0.63; I2 = 0%), incidence of tachycardia(3 studies, 2030 patients; OR = 0.94; 95%CI: 0.53-1.65; P = 0.28; I2 = 21%), and incidence of bradycardia(3 studies, 2030 patients; OR = 0.88; 95%CI: 0.63-1.22; P = 0.59; I2 = 0%).CONCLUSION OSA is not a significant risk factor for cardiopulmonary complications in patients undergoing endoscopic procedures

关键词： conscious sedation Obstructive sleep apnea Endoscopy Complications Safety Meta-analysis

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How to improve patient satisfaction during midazolam sedation for gastrointestinal endoscopy?

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World Journal of Gastroenterology 2017年第6期23卷 1098-1105页

作者： Eun Hyo Jin Kyoung Sup Hong Young Lee Ji Yeon Seo Ji Min Choi Jaeyoung Chun Sang Gyun Kim Joo Sung Kim Hyun Chae Jung Department of Internal Medicine Healthcare Research InstituteSeoul National University Hospital Healthcare System Gangnam Center Department of Internal Medicine Liver Research InstituteSeoul National University College of Medicine Department of Biostatistics and Bioinformatics Healthcare Research InstituteSeoul National University Hospital Healthcare System Gangnam Center

To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve *** prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and *** study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy *** is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.

关键词： conscious sedation Patient satisfaction Endoscopy Midazolam Surveys and questionnaires

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Midazolam dose is associated with recurrence of paradoxical reactions during endoscopy

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World Journal of Clinical Cases 2021年第29期9卷 8763-8772页

作者： Eun Hyo Jin Ji Hyun Song Jooyoung Lee Jung Ho Bae Su Jin Chung Department of Internal Medicine Healthcare Research InstituteHealthcare System Gangnam CenterSeoul National University HospitalSeoul 06236South Korea

BACKGROUND Midazolam is commonly used for sedation during gastrointestinal ***,some patients experience paradoxical reactions characterized by excessive movement or *** To investigate the rate of recurrence of paradoxical reactions to midazolam during an upper *** We retrospectively reviewed 122152 sedative endoscopies among a total of 58553 patients at the Seoul National University Hospital,Healthcare System Gangnam Center,from July 2013 to December *** them,361 patients with a history of paradoxical reaction during sedative upper endoscopy were *** characteristics of patients in the recurrent and non-recurrent groups were compared via multivariable analysis using logistic *** Paradoxical reactions occurred in 0.86%(1054/122152)of endoscopies,and in 1.51%(888/58553)of *** the 361 subjects with previous paradoxical reactions in sedative endoscopies,111(30.7%)experienced further paradoxical *** analysis revealed that the total midazolam dose used was higher in the recurrent group(6.74±2.58 mg)than in the non-recurrent group(5.49±2.04 mg;P<0.0001).Patients were administered a lower dose of midazolam than previous doses:1 mg less in the recurrent group and 2 mg less in the non-recurrent *** analysis showed that the midazolam dose difference was an independent risk factor for recurrent paradoxical reaction(odds ratio:1.213,95%CI:1.099-1.338,P=0.0001).CONCLUSION The rate of recurrence of paradoxical reactions is significantly associated with midazolam *** dose of midazolam administered to patients with previous paradoxical reactions should be less than that previously used.

关键词： Gastroscopy Endoscopy conscious sedation Midazolam Flumazenil

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Magnetic imaging-assisted colonoscopy vs conventional colonoscopy: A randomized controlled trial

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World Journal of Gastroenterology 2014年第36期20卷 13178-13184页

作者： Christopher W Teshima Sergio Zepeda-Gómez Suliman H AlShankiti Gurpal S Sandha Division of Gastroenterology University of Alberta Edmonton Alberta T6G 2X8 Canada

AIM: To compare magnetic imaging-assisted colonoscopy (MIC) with conventional colonoscopy (CC).

关键词： Colonoscopy conscious sedation Magnetic endoscope imaging Pain measurement Randomized controlled trial

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Awake robotic liver surgery:A case report

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2954-2961页

作者： Antonella Delvecchio Gaetano Pavone Maria Conticchio Claudia Piacente Miriam Varvara Valentina Ferraro Matteo Stasi Annachiara Casella Rosalinda Filippo Michele Tedeschi Carmine Pullano Riccardo Inchingolo Vito Delmonte Riccardo Memeo Unit of Hepato-Pancreatic-Biliary Surgery “F.Miulli”Regional General HospitalBari 70021Italy Unit of Anesthesia and Perioperative Medicine “F.Miulli”Regional General HospitalBari 70021Italy Villa Pia Hospital Rome 00151Italy Unit of Interventional Radiology “F.Miulli”Regional General HospitalBari 70021Italy

BACKGROUND In recent years,minimally invasive liver resection has become a standard of care for liver *** the need to treat increasingly fragile patients,general anesthesia is sometimes avoided due to respiratory ***,surgical treatment with curative intent is abandoned in favor of a less invasive and less radical *** anesthesia has been shown to reduce respiratory complications,especially in elderly patients with pre-existing lung *** SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular *** patient was suffering from hypertension,diabetes and chronic obstructive pulmonary *** National Surgical Quality Improvement Program score for developing pneumonia was 9.2%.We planned a combined spinal–epidural anesthesia with conscious sedation to avoid general *** modification of the standard surgical technique was *** were stable and bleeding was *** postoperative course was *** Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.

关键词： Robotic surgery Awake surgery Liver resection Frail patient Locoregional anesthesia conscious sedation Case report

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Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures:A three year prospective study

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World Journal of Gastroenterology 2006年第2期12卷 327-330页

作者： Stojanka Gaparovi Nadan Rustemovi Milorad Opai Marina Premuzi Andelko Korui Jadranka Bozikov Tamara Bates Department of Anesthesiology Dubrava University HospitalZagrebCroatia Department of Gastroenterology Zagreb University Hospital CenterZagrebCroatia "Andrija tampar" School of Public Health Zagreb University School of MedicineZagrebCroatia "Bates" Clinic ZagrebCroatia

AIM： To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS： In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus （0.5-1.5 mg/kg）. Arterial blood pressure （BP） was monitored at 3 rain intervals and heart rate and oxygen saturation （SpO2） were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS： A statistically significant reduction in mean arterial pressure was demonstrated （P〈0.001） when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60mmHg, was noted in only 5 patients （0.5%）. Oxygen saturation decreased from 96.5% to 94.4 % （P〈0.001）. A critical decrease in oxygen saturation （〈90%） was documented in 27 patients （2.4%）. CONCLUSION： Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effelts if carefully titrated. All the patients （and especially ASA Ⅲ group） require monitoring and care of an anesthesiologist.

关键词： Endoscopy conscious sedation Propofol Hemodynamic adverse effects

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