检索结果-南通市图书馆

Deep sedation during gastrointestinal endoscopy: Propofol-fentanyl and midazolam-fentanyl regimens

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2013年第22期19卷 3439-3446页

作者： Marcos Eduardo Lera dos Santos Fauze Maluf-Filho Dalton Marques Chaves Sergio Eiji Matuguma Edson Ide Gustavo de Oliveira Luz Thiago Ferreira de Souza Fernanda C Simoes Pessorrusso Eduardo Guimares Hourneaux de Moura Paulo Sakai Department of Gastroenterology Hospital das Clínicas University of Sao Paulo Medical School Sao Paulo CEP 05403-900 Brazil Cancer Institute of Sao Paulo State Sao Paulo CEP 01246-000 Brazil

AIM: To compare deep sedation with propofol-fentanyl and midazolam-fentanyl regimens during upper gastrointestinal endoscopy. METHODS: After obtaining approval of the research ethics committee and informed consent, 200 patients were evaluated and referred for upper gastrointestinal endoscopy. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group).We assessed the level of sedation using the observer's assessment of alertness/sedation (OAA/S) score and bispectral index (BIS). We evaluated patient and physician satisfaction, as well as the recovery time and complication rates. The statistical analysis was performed using SPSS statistical software and included the MannWhitney test, χ 2 test, measurement of analysis of variance, and the κ statistic. RESULTS: The times to induction of sedation, recovery, and discharge were shorter in the propofolfentanyl group than the midazolam-fentanyl group. According to the OAA/S score, deep sedation events occurred in 25% of the propofol-fentanyl group and 11% of the midazolam-fentanyl group (P = 0.014). Additionally, deep sedation events occurred in 19% of the propofol-fentanyl group and 7% of the midazolamfentanyl group according to the BIS scale (P = 0.039). There was good concordance between the OAA/S score and BIS for both groups (κ = 0.71 and κ = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group and 26% of the midazolam-fentanyl group (P = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofolfentanyl and midazolam-fentanyl groups, respectively (P sedation occurred with propofolfentanyl and midazolam-fentanyl, but was more frequent in the former. Recovery was faster in the propofol-fentanyl group.

关键词： Endoscopy Deep sedation Anesthetic administration Anesthetic dose Adverse effects

Esophagogastroduodenoscopy with conscious sedation does not interfere with catheter-based 24-h pH monitoring

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2013年第11期19卷 1805-1810页

作者： Yung-Kuan Tsou Jau-Min Lien Chin-Kuo Chen Cheng-Hui Lin Hsing-Yu Chen Mu-Shien Lee Department of Gastroenterology and Hepatology Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuan 333Taiwan Department of Otolaryngology Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuan 333Taiwan Center for Traditional Chinese Medicine Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuan 333Taiwan

AIM:To investigate the impact of esophagogastroduodenoscopy with conscious sedation on the subsequent 24-h catheter-based pH monitoring.METHODS:Fifty patients with extra-esophageal symptoms of gastroesophageal reflux disease undergoing ambulatory dual-probe 24-h pH monitoring were enrolled from March 2010 to August 2011.All of the data were collected prospectively and analyzed retrospectively.Thirty-six patients(72%,group A) underwent pH monitoring shortly after esophagogastroduodenoscopy(EGD) with conscious sedation,and 14 patients(28%,group B) underwent pH monitoring without conscious sedation.The 24-h pH data from two time periods were analyzed:the first 4 h(Period Ⅰ) and the remaining time of the study(Period Ⅱ).RESULTS:The mean age of the patients was 49.6 ± 12.5 years;20 patients(40%) were men.The baseline data,including age,sex,body mass index,reflux esophagitis,the Reflux Symptom Index,and the Reflux Findings Score,were comparable between the two groups.The percentage of total time with a pH sedation does not interfere with the results of subsequent 24-h pH monitoring in patients with extra-esophageal symptoms of gastroesophageal reflux disease.

关键词： Esophagogastroduodenoscopy Conscious sedation pH monitoring Gastroesophageal reflux disease Extraesophageal symptoms

Endotracheal intubation sedation in the intensive care unit

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Critical Care Medicine 2022年第1期11卷 33-39页

作者： Pritee Tarwade Nathan J Smischney Anesthesiology and Perioperative Medicine Mayo ClinicRochesterMN 55905United States Anesthesiology and Perioperative Medicine Division of Critical Care MedicineMayo ClinicRochesterMN 55905United States

Endotracheal intubation is one of the most common,yet most dangerous procedure performed in the intensive care unit(ICU).Complications of ICU intubations include severe hypotension,hypoxemia,and cardiac arrest.Multiple observational studies have evaluated risk factors associated with these complications.Among the risk factors identified,the choice of sedative agents administered,a modifiable risk factor,has been reported to affect these complications(hypotension).Propofol,etomidate,and ketamine or in combination with benzodiazepines and opioids are commonly used sedative agents administered for endotracheal intubation.Propofol demonstrates rapid onset and offset,however,has drawbacks of profound vasodilation and associated cardiac depression.Etomidate is commonly used in the critically ill population.However,it is known to cause reversible inhibition of 11β-hydroxylase which suppresses the adrenal production of cortisol for at least 24 h.This added organ impairment with the use of etomidate has been a potential contributing factor for the associated increased morbidity and mortality observed with its use.Ketamine is known to provide analgesia with sedation and has minimal respiratory and cardiovascular effects.However,its use can lead to tachycardia and hypertension which may be deleterious in a patient with heart disease or cause unpleasant hallucinations.Moreover,unlike propofol or etomidate,ketamine requires organ dependent elimination by the liver and kidney which may be problematic in the critically ill.Lately,a combination of ketamine and propofol,“Ketofol”,has been increasingly used as it provides a balancing effect on hemodynamics without any of the side effects known to be associated with the parent drugs.Furthermore,the doses of both drugs are reduced.In situations where a difficult airway is anticipated,awake intubation with the help of a fiberoptic scope or video laryngoscope is considered.Dexmedetomidine is a commonly used sedative agent for these procedures.

关键词： Critically ill Endotracheal intubation Etomidate Hypotension Intensive care unit Ketamine Ketofol Propofol sedation

Conscious sedation: A dying practice?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2013年第28期19卷 4633-4634页

作者： Palaniappan Manickam Ziad Kanaan Khalid Zakaria Division of Gastroenterology Department of the Internal Medicine Oakland University William Beaumont School of Medicine Royal Oak MI 48037 United States Department of Internal Medicine Wayne State University Rochester MI 48307 United States

sedation practices vary according to countries with different health system regulations, the procedures done, and local circumstances. Interestingly, differences in the setting in which the practice of gastroenterology and endoscopy takes place (university-based vs academic practice) as well as other systematic practice differences influence the attitude of endoscopists concerning sedation practices. Conscious sedation using midazolam and opioids is the current standard method of sedation in diagnostic and therapeutic endoscopy. Interestingly, propofol is a commonly preferred sedation method by endoscopists due to higher satisfaction rates along with its short half-life and thus lower risk of hepatic encephalopathy. On the other hand, midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. The administration of sedation under the supervision of a properly trained endoscopist could become the standard practice and the urgent development of an updated international consensus regarding the use of sedative agents like propofol is needed.

关键词： sedation Conscious Endoscopy Propofol Fentanyl Meperidine

Anteroposterior Airway Diameter during sedation for Brain MRI in Children with and without Developmental Disabilities

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Anesthesiology 2014年第8期4卷 191-196页

作者： Nirupama Kannikeswaran Swati Mody Xinguang Chen Marwan Zidan Lalitha Sivaswamy Wayne State University School of Medicine Carman and Ann Adams Department of Pediatrics Division of Emergency Medicine Children’s Hospital of Michigan Detroit MI USA Wayne State University School of Medicine Carman and Ann Adams Department of Pediatrics Division of Neurology Children’s Hospital of Michigan Detroit MI USA Wayne State University School of Medicine Carman and Ann Adams Department of Pediatrics Division of Pediatric Radiology Children’s Hospital of Michigan Detroit MI USA Wayne State University School of Medicine Detroit MI USA Wayne State University Detroit MI USA

Objective: Our study objective was to compare the anteroposterior (AP) oropharyngeal airway diameter measured using static MRI images in children with and without developmental disabilities during sedation. Methods: We performed a secondary analysis on a prospective, observational age-matched, 1:2 case-control study of children aged 3 - 10 years who were sedated for brain MRI. AP airway diameters were determined at the level of soft palate (airway_SP) and tongue (airway_T) from midline sagittal images by a single blinded radiologist. Results: Airway diameter was evaluated in 134 controls (C) and 68 cases (D). There was no difference in the overall adverse events (D: 30% C: 32.9%;p = 0.7) as well as hypoxia (D: 10%;C: 9.3%, p = 0.9). There was no significant difference in mean airway_T (D: 10.62 ± 3.48 vs. C: 10.38 ± 3.47;p = 0.64) and airway_SP diameter (D: 4.59 ± 2.36 vs. C: 5.17 ± 3.9;p = 0.14) between the two groups. There was no significant difference in airway_T and airway_SP diameters amongst those who experienced and those who did not experience hypoxia in cases. Amongst controls however, the airway_SP was smaller in those who experienced hypoxia compared to those who did not experience hypoxia. Conclusions: There was no difference in the AP airway_T and airway_SP diameter during sedation using static MRI images in children with and without developmental disabilities. Changes in airway_SP was associated with hypoxia amongst controls in our study cohort.

关键词： sedation Magnetic Resonance Imaging Airway Diameter Developmental Disabilities Children

The Feasibility of Endotracheal Intubation with Subcutaneous Dissociative Conscious sedation versus General Anesthesia: A Prospective Randomized Trial

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Anesthesiology 2014年第2期4卷 41-45页

作者： Sanaz Shabani Mihan J. Javid Jayran Zebardast Department of Anesthesiology and Intensive Care Imam Khomaini Medical Center Tehran University of Medical Sciences Tehran Iran Registered Nurse Tehran University of Medical Sciences Tehran Iran

Despite outstanding improvements in anesthesia techniques and anesthetics, difficult airway is still a dilemma and is accompanied by morbidity and mortality. The aim of this study is to compare the feasibility of endotracheal intubation with the traditional method of general anesthesia by using muscle relaxants, and “sDCS” (Subcutaneous Dissociative Conscious sedation) which has been recently reported as an efficient method of anesthesia with the capability of maintaining spontaneous ventilation and providing an appropriate situation for larynxgoscopy and endotracheal intubation. Material and Methods: This randomized clinical trial was conducted on 100 patients who were scheduled for elective laparotomy. Patients were randomly divided into two groups: group A and group B. In group A, patients underwent general anesthesia with thiopental sodium and relaxant. In group B, patients underwent “subcutaneous Dissociative Conscious sedation” and received low dose subcutaneous ketamine and intravenous narcotic with no relaxant. The feasibility of direct laryngoscopy and tracheal intubation, hemodynamic changes, desaturation (SpO2 < 90%), patient cooperation, patient comfort, hallucination, nausea and vomiting, nystagmus and salivation were evaluated in two groups. Adverse events including apnea and need for positive pressure mask ventilation, additional dose of fentanyl were recorded in group B. The anesthesiologist who performed the procedure was asked about the patient calmness and cooperation during the procedure and the feasibility of laryngoscopy and tracheal intubation. The incidence of nausea and vomiting in post-operative care unit was recorded too. Results: Hemodynamic variables were comparable in two groups. No event of irreversible respiratory depression, desaturation, need for positive pressure ventilation and hallucination was observed in group B. All patients were cooperative and obedient during the laryngoscopy and tracheal intubation. The incidence of nausea was not statistically significant. The anesthesi

关键词： Difficult Airway Ketamine Laryngoscopy Subcutaneous Dissociative Conscious sedation Tracheal Intubation

Propofol sedation in routine endoscopy:A case series comparing target controlled infusion vs manually controlled bolus concept

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Endoscopy 2024年第1期16卷 11-17页

作者： Riad Sarraj Lorenz Theiler Nima Vakilzadeh Niklas Krupka Reiner Wiest Department of Visceral Surgery and Medicine Inselspital University HospitalBern 3010Switzerland Clinic for Anesthesia PerioperativeEmergency&Intensive Care MedicineKantonsspital AarauAarau 5001Switzerland Department of Nephrology and Hypertension University Hospital LausanneLausanne 1011Switzerland

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;Psedation 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.

关键词： sedation Endoscopy Propofol Target controlled infusion Non-anaesthesiologist propofol sedation Adverse event

Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis:A systematic review and meta-analysis of randomized controlled trials

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Endoscopy 2020年第8期12卷 241-255页

作者： John Alexander Lata Guacho Diogo Turiani Hourneaux de Moura Igor Braga Ribeiro Alberto Machado da Ponte Neto Shailendra Singh Marina Gammaro Baldavira Tucci Wanderley Marques Bernardo Eduardo Guimarães Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Gastroenterology Department of Internal MedicineWest Virginia UniversityCharlestonWV 25304United States

BACKGROUND Patients with cirrhosis frequently require sedation for elective endoscopic procedures.Several sedation protocols are available,but choosing an appropriate sedative in patients with cirrhosis is challenging.AIM To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best approach.METHODS This systematic review and meta-analysis was conducted using the PRISMA guidelines.Electronic searches were performed using MEDLINE,EMBASE,Central Cochrane,LILACS databases.Only randomized control trials(RCTs)were included.The outcomes studied were procedure time,recovery time,discharge time,and adverse events(bradycardia,hypotension,and hypoxemia).The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials(RoB-2).Quality of evidence was evaluated by GRADEpro.The meta-analysis was performed using Review Manager.RESULTS The search yielded 3,576 records.Out of these,8 RCTs with a total of 596 patients(302 in the propofol group and 294 in the midazolam group)were included for the final analysis.Procedure time was similar between midazolam and propofol groups(MD:0.25,95%CI:-0.64 to 1.13,P=0.59).Recovery time(MD:-8.19,95%CI:-10.59 to-5.79,P<0.00001).and discharge time were significantly less in the propofol group(MD:-12.98,95%CI:-18.46 to-7.50,P<0.00001).Adverse events were similar in both groups(RD:0.02,95%CI:0-0.04,P=0.58).Moreover,no significant difference was found for bradycardia(RD:0.03,95%CI:-0.01 to 0.07,P=0.16),hypotension(RD:0.03,95%CI:-0.01 to 0.07,P=0.17),and hypoxemia(RD:0.00,95%CI:-0.04 to 0.04,P=0.93).Five studies had low risk of bias,two demonstrated some concerns,and one presented high risk.The quality of the evidence was very low for procedure time,recovery time,and adverse events;while low for discharge time.CONCLUSION This systematic review and meta-analysis based on RCTs show that propofol has shorter recovery and patien

关键词： sedation Midazolam Propofol Cirrhosis Endoscopic Endoscopy Metaanalysis

Complication rates in emergent endoscopy for foreign bodies under different sedation modalities:A large single-center retrospective review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Endoscopy 2021年第2期13卷 45-55页

作者： Ming-Han Cha Rashi Sandooja Saher Khalid Nicole Lao Joseph Lim Roshan Razik Department of Internal Medicine Cleveland Clinic Akron GeneralAkronOH 44307United States Department of Gastroenterology Cleveland Clinic Akron GeneralAkronOH 44307United States

BACKGROUND Foreign object ingestion(FOI)and food bolus impaction(FBI)are common causes of emergent endoscopic intervention.The choice of sedation used is often dictated by physician experience.Many endoscopists frequently prefer to use monitored anesthesia care(MAC)and general anesthesia(GA)as opposed to conscious sedation(CS)due to the concern for inadequate airway protection.However,there is insufficient data examining the safety of different sedation modalities in emergent endoscopic management of FOI and FBI.AIM To investigate the complication rates of emergent endoscopic extraction performed under different sedation modalities.METHODS We conducted a retrospective chart review of patients presenting with acute FBI and FOI between 2010 and 2018 in two hospitals.A standardized questionnaire was utilized to collect data on demographics,endoscopic details,sedation practices,hospital stay and adverse events.Complications recognized during and within 24 h of the procedure were considered early,whereas patients presenting with a procedure-related adverse event within two weeks of the index event were considered delayed complications.Complication rates of patients who underwent emergent endoscopic retrieval were compared based on sedation types,namely CS,MAC and GA.Chi-square analysis and multiple logistic regression were used to compare complication rate based on sedation type.RESULTS Among the 929 procedures analyzed,353 procedures(38.0%)were performed under CS,278 procedures(29.9%)under MAC and the rest(32.1%)under GA.The median age of the subjects was 52 years old,with 57.4%being male.The majority of the procedures(64.3%)were FBI with the rest being FOI(35.7%).A total of 132 subjects(14.2%)had chronic comorbidities while 29.0%had psychiatric disorders.The most commonly observed early complications were mucosal laceration(3.8%)and bleeding(2.6%).The most common delayed complication was aspiration pneumonia(1.8%).A total of 20 patients(5.6%)could not adequately be sedated with CS and had to be converted to MAC or G

关键词： Foreign body Food bolus impaction Endoscopy sedation Anesthesia Complications