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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

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 mg.kgl.h＂1） and remifentanil （0.05 IJg.***.rain1）. 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 and HR increased significantly but mildly immediat

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

sedation reversal trends at outpatient ambulatory endoscopic center vs in-hospital ambulatory procedure center using a triage protocol

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 413-423页

作者： Saqib Walayat Peter Stadmeyer Azfar Hameed Minahil Sarfaraz Paul Estrada Mark Benson Anurag Soni Patrick Pfau Paul Hayes Brittney Kile Toni Cruz Deepak Gopal Department of Gastroenterology University of IllinoisPeoriaIL 61605United States Department of Gastroenterology University of WisconsinMadisonWI 53792United States Department of Internal Medicine Texas Health DentonDentonTX 76201United States Department of Internal Medicine Allama Iqbal Medical CollegeLahore 042Pakistan Department of Gastroenterology Texas Tech University Health Services CenterEl PasoTX 79911United States Department of Gastroenterology and Hepatology University of WisconsinMadisonWI 53705United States Finance Business Partners UW Health University of WisconsinMadisonWI 53792United States UW Health Digestive Health Center Endoscopy University of WisconsinMadisonWI 53792United States Division of Gastroenterology and Hepatology Department of MedicineUniversity of Wisconsin Hospitals and ClinicsMadisonWI 53705United States

BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings.A known risk of performing endoscopy under moderate sedation is the potential for over-sedation,requiring the use of reversal agents.More needs to be reported on rates of reversal across different outpatient settings.Our academic tertiary care center utilizes a triage tool that directs higher-risk patients to the in-hospital ambulatory procedure center(APC)for their procedure.Here,we report data on outpatient sedation reversal rates for endoscopy performed at an inhospital APC vs at a free-standing ambulatory endoscopy digestive health center(AEC-DHC)following risk stratification with a triage tool.AIM To observe the effect of risk stratification using a triage tool on patient outcomes,primarily sedation reversal events.METHODS We observed all outpatient endoscopy procedures performed at AEC-DHC and APC from April 2013 to September 2019.Procedures were stratified to their respective sites using a triage tool.We evaluated each procedure for which sedation reversal with flumazenil and naloxone was recorded.Demographics and characteristics recorded include patient age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,procedure type,and reason for sedation reversal.RESULTS There were 97366 endoscopic procedures performed at AEC-DHC and 22494 at the APC during the study period.Of these,17 patients at AEC-DHC and 9 at the APC underwent sedation reversals(0.017%vs 0.04%;P=0.06).Demographics recorded for those requiring reversal at AEC-DHC vs APC included mean age(53.5±21 vs 60.4±17.42 years;P=0.23),ASA class(1.66±0.48 vs 2.22±0.83;P=0.20),BMI(27.7±6.7 kg/m^(2) vs 23.7±4.03 kg/m^(2);P=0.06),and female gender(64.7%vs 22%;P=0.04).The mean doses of sedative agents and reversal drugs used at AEC-DHC vs APC were midazolam(5.9±1.7 mg vs 8.9±3.5 mg;P=0.01),fentanyl(147.1±49.9μg vs 188.9±74.1μg;P=0.10),flumazenil(0.3±0.18μg vs 0.17±0.17μg;P=0.13)and naloxone(0.32±0.10 mg vs 0.28±0.12 mg;P=0.35).Procedur

关键词： Ambulatory care conscious sedation Endoscopy Colonoscopy Risk assessment Risk factors

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 tumors.Considering the need to treat increasingly fragile patients,general anesthesia is sometimes avoided due to respiratory complications.Therefore,surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach.Epidural anesthesia has been shown to reduce respiratory complications,especially in elderly patients with pre-existing lung disease.CASE SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma.The patient was suffering from hypertension,diabetes and chronic obstructive pulmonary disease.The 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 anesthesia.No modification of the standard surgical technique was necessary.Hemodynamics were stable and bleeding was minimal.The postoperative course was uneventful.CONCLUSION 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

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 procedures.However,some patients experience paradoxical reactions characterized by excessive movement or excitement.AIM To investigate the rate of recurrence of paradoxical reactions to midazolam during an upper endoscopy.METHODS 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 2018.Among them,361 patients with a history of paradoxical reaction during sedative upper endoscopy were enrolled.The characteristics of patients in the recurrent and non-recurrent groups were compared via multivariable analysis using logistic regression.RESULTS Paradoxical reactions occurred in 0.86%(1054/122152)of endoscopies,and in 1.51%(888/58553)of patients.Among the 361 subjects with previous paradoxical reactions in sedative endoscopies,111(30.7%)experienced further paradoxical reactions.Univariable 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 group.Multivariable 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 dosage.The 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

Comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during coblation-assisted upper airway procedure

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Chinese Medical Journal 2012年第5期125卷 869-873页

作者： MA Xiao-xu FANG Xiang HOU Tie-ning Department of AnesthesiologyAffiliated SirRun Run Shaw Hospital Zhejiang University School of MedicineHangzhou Zhejiang 310016 China Department ofOtolaryngology Head and Neck Surgery Affiliated SirRun Run Shaw Hospital Zhejiang University School of MedicineHangzhou Zhejiang 310016 China Department of Anesthesiology First Affiliated Hospital ZhejiangUniversity School of Medicine Hangzhou Zhejiang 310016China

Background sedation for the coblation-assisted upper airway procedure has lacked easy modulation between appropriate pain control and airway protection. This study aimed to compare the effectiveness of dexmedetomidine versus target controlled propofol infusion in providing sedation during a coblation-assisted upper airway procedure.

关键词： conscious sedation dexmedetomidine propofol,＂ obstructive sleep apnea syndrome

Does Anesthesiologist-Directed sedation Afford Superior Deep Cannulation Rates and Procedural Outcomes for ERCP in the Community Setting?

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Open Journal of Gastroenterology 2016年第2期6卷 46-52页

作者： Brad Bowyer Kathy Geissler Robert Barclay Sumeet Tewani James Frakes Nicholas Brown Matthew Houlihan Kunal Patel Andrew Spiel Rockford Gastroenterology Associates Rockford IL USA University of Illinois College of Medicine Rockford Rockford IL USA

Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2005 to May 2011. Eight hundred thirty seven patients were excluded due to prior papillary intervention or attempted ERCP. A total of 1079 patients were included. The 981 patients who underwent gastroenterologist directed sedation (GDS) served as the control population, while the 98 patients who received anesthesiologist directed sedation (ADS) served as the case population. Medical records were analyzed for patient demographics, procedure indication, adverse events, case complexity, procedural failure and sedation failure. Case complexity was defined by the grading system proposed by the working party of the ASGE Quality Committee. sedation failure was defined by agitation or airway compromise prompting termination of the ERCP. Reasons for procedural failure included surgically altered anatomy, luminal obstruction, and technical failure. Study endpoint was defined as successful deep cannulation of the intended target duct. Results: Demographic distribution did not differ between the GDS and the ADS groups. Cannulation success rates were similar between the two groups, with 89.85% in the GDS group, and 89.58% in the ADS group (P = 0.864). There were no statistical differences between sedation groups in procedural or respiratory adverse events. Technical failure was the predominant basis for deep cannulation failure in both groups. Agitation and airway compromise accounted for deep cannulation failure similarly in both groups. The need for reversal agents was low but similar in both groups. There was no statistical advantage in deep cannulation success rate by complexity grade in either sedation class. Conclusion: Excellent procedural outcomes and low adverse event rates were achieved using GDS, a more accessible and cost-effective method in a community-based setting.

关键词： ERCP Community-Based Medicine conscious sedation Anesthesiologist-Directed sedation Gastroenterologist-Directed sedation

sedation in gastrointestinal endoscopy: Where are we at in 2014?

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World Journal of Gastrointestinal Endoscopy 2015年第2期7卷 102-109页

作者： Alexandre Oliveira Ferreira Marília Cravo Serviço de Gastrenterologia Centro Hospitalar do AlgarveUnidade Hospitalar de Portimão8500 PortimãoPortugal Serviço de Gastrenterologia Hospital BeatrizÂngelo2674-514 LouresPortugal

Gastrointestinal endoscopies are invasive and unpleasant procedures that are increasingly being used worldwide. The importance of high quality procedures(especially in colorectal cancer screening), the increasing patient awareness and the expectation of painless examination, increase the need for procedural sedation. The best single sedation agent for endoscopy is propofol which, due to its' pharmacokinetic/dynamic profile allows for a higher patient satisfaction and procedural quality and lower induction and recovery times, while ma-intaining the safety of traditional sedation. Propofol is an anesthetic agent when used in higher doses than those needed for endoscopy. Because of this important feature it may lead to cardiovascular and respiratory depression and, ultimately, to cardiac arrest and death. Fueled by this argument, concern over the safety of its administration by personnel without general anesthesia training has arisen. Propofol usage seems to be increasing but it's still underused. It is a safe alternative for simple endoscopic procedures in low risk patients even if administered by non-anesthesiologists. Evidence on propofol safety in complex procedures and high risk patients is less robust and in these cases, the presence of an anesthetist should be considered. We review the existing evidence on the topic and evaluate the regional differences on sedation practices.

关键词： Hypnotics and sedatives Propofol conscious sedation Endoscopy Gastrointestinal

Comparison between the performance of bispectral index and Skin conductance monitoring during propofol sedation with target-controlled infusion

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Comparison between the performance of bispectral index and S...