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Comparative observation of the effectiveness and safety of remimazolam besylate versus dexmedetomidine in gastrointestinal surgery in obese patients

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WORLD JOURNAL OF GASTROINTESTINAL SURGERY 2024年第5期16卷 1320-1327页

作者： Deng, Yu-Fu Jiang, Xue-Run Feng, Zeng-Guang Xiangtan Cent Hosp Dept Anesthesiol 120 Heping Rd Xiangtan 411100 Hunan Peoples R China

BACKGROUND Surgery for obese patients carries a higher risk of anesthesia complications compared with surgery for nonobese patients. Thus, a safe and effective anesthesia strategy is necessary to improve the medical experience of such patients and ensure their safety. AIM To compared the effectiveness and safety of remimazolam besylate versus dexmedetomidine (DEX) in gastrointestinal surgery in obese patients. METHODS The study cohort included 60 obese patients undergoing gastrointestinal surgery between July 2021 and April 2023, comprising 30 patients who received DEX intervention (control group) and 30 patients who received remimazolam besylate intervention (research group). Heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), blood oxygen saturation (SpO(2)), safety (nausea and vomiting, bradycardia, hypotension, and apnea), anesthesia and examination indices [induction time, anesthesia recovery time, and postanesthesia care unit (PACU) discharge time], sedation effect (Ramsay sedation Scale), and postoperative pain visual analog scale were comparatively analyzed before anesthesia (T0), during anesthesia (T1), and after anesthesia (T2). RESULTS At T1, the research group showed significantly smaller changes in HR, RR, MAP, and SpO(2) than the control group, with a significantly lower adverse reaction rate and shorter induction, anesthesia recovery, and PACU discharge times. Additionally, the intra- and postoperative Ramsay sedation Scale scores were statistically higher in the research group than in the control group. CONCLUSION Remimazolam besylate was significantly more effective than DEX in gastrointestinal surgery in obese patients and had a higher safety profile and value in clinical promotion.

关键词： Remimazolam besylate Dexmedetomidine Obesity Gastrointestinal surgery Effectiveness Safety sedation EFFICACY

Deep sedation for endoscopic retrograde cholangiopacreatography

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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

Anesthesia and sedation in pediatric gastrointestinal endoscopic procedures: A review

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World Journal of Gastrointestinal Endoscopy 2010年第7期2卷 257-262页

作者： Abdul Q Dar Zahoor A Shah Anesthesiology and Critical Care Sheri Kashmir Institute of Medical SciencesSrinagarKashmir 190011India

Gastrointestinal(GI) endoscopic procedure has become an essential modality for evaluation and treatment of GI diseases.Intravenous(IV) sedation and General Anesthesia(GA) have both been employed to minimize discomfort and provide amnesia.Both these procedures require,at the very least,monitoring of the level of consciousness,pulmonary ventilation,oxygenation and hemodynamics.Although GI endoscopy is considered safe,the procedure has a potential for complications.Increased awareness of the complications associated with sedation during GI endoscopy in children,and involving the anesthesiologists in caring for these children,may be optimal for safety.Belonging to a younger age group,having a higher ASA class and undergoing IV sedation were identified as risk factors for developing complications.Reported adverse events included inadequate sedation,low oxygen saturation,airway obstruction,apnea needing bag mask ventilation,excitement and agitation,hemorrhage and perforation.A complication rate of 1.2% was associated with procedures performed under GA,as compared to 3.7% of complications associated with IV sedation.IV sedation was seen to be independently associated with a cardiopulmonary complication rate 5.3% times higher when compared to GA.GA can therefore be considered safer and more effective in providing comfort and amnesia.

关键词： Gastrointestinal Endoscopy Pediatrics sedation General anesthesia

Process Management of Analgesia and sedation Can Reduce the Incidence of Delirium

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Surgical Science 2019年第11期10卷 405-411页

作者： Hao Wang Shaolong Yi Hu Wang Minying Chen Department of the Second Intensive Care Unit The First People’s Hospital of Kashi District Kashi China Department of Surgical Intensive Care Unit The First Affiliated Hospital of Sun Yat-sen University Guangzhou China

Background: Critical patients in ICU have to experience pain, anxiety, and sleep deprivation which always cause delirium, which will prolong the hospital stay and come up with higher mortality. Analgesia based sedation can reduce the accumulation of sedative effects, and shorten ventilator time and ICU length of stay. Process management of analgesia and sedation can reduce the incidence of delirium. Objectives: To explore the clinical benefits of procedural analgesia and sedation for critical ill patients. Methods: This is a prospective, two-phase study that focuses on patients who required mechanical ventilation after surgery. Comparing patients’ pain and agitation scores, the species and dosage of sedative and analgesic, the incidence of delirium in the observation period and intervention period, data in two groups were collected and analyzed. Results: During the observational and interventional periods, we enrolled 213 patients before protocol implantation and 196 patients after protocol implantation. We found that there existed impropriate pain and sedation assessment in patients involved, and after training for procedural protocol, the average dosage of sedatives was decreased (p > 0.05). The percentage of reaching standard COPT score was 73.7% vs 84.1% (p > 0.05) and RASS score was 70.9% vs 79.6% (p > 0.05) in the observation period and intervention period, and the incidence of delirium was significantly reduced (31.9% vs 23.5%, p Conclusion: We concluded that protocol implantation of analgesia and sedation can reduce the incidence of delirium.

关键词： Procedural Analgesia sedation Intensive Care Unit Delirium

Preoperative sedation, Hemodynamic Stability during General Anesthesia and Improving Postoperative Pain: Pregabalin Is the Answer

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Open Journal of Anesthesiology 2018年第1期8卷 14-26页

作者： Heba El-Hussiny Huda Fahmy Ayman Mohammad Eldemrdash Department of Anesthesia Aswan University Hospital Aswan Egypt

Background: Tracheal intubation is a noxious stimulus that tends to provoke a marked sympathetic response which is potentially deleterious in some patients. Various methods have been used to minimize and attenuate these potentially harmful responses. Aim of the study: The present study compared the efficacy and safety of two different doses (150 mg and 300 mg) of oral pregabalin premedication on attenuation of the hemodynamic pressor response to airway instrumentation, perioperative hemodynamic stability, preoperative sedation, and postoperative pain reduction. Patients and methods: This prospective, observational study consisted of 60 adult patients scheduled for laparoscopic cholecystectomy. The patients were randomized into three groups of 20 patients each. Group I (P0) received an oral placebo, group II (P150) received 150 mg of oral pregabalin and group III (P300) received 300 mg of oral pregabalin 1 h prior to induction. All patients were assessed for pre-operative sedation, perioperative hemodynamic changes, Post-operative pain and analgesic consumption. Results: Regarding the efficacy of the preoperative administration of oral pregabalin, a dose dependent attenuation in the increased in heart rate, systolic, and diastolic blood pressure, and mean arterial blood pressure resulting from laryngoscopy and intubation was observed (300 mg > 150 mg), along with a subsequent decrease in intraoperative fentanyl supplementation. On anxiolysis, patients were more comfortable and asleep in the pregabalin groups as compared with the control group, in which more patients were awake and agitated. Post-operative pain and analgesic consumption were effectively reduced by (150 mg and 300 mg) pregabalin in a dose-dependent manner. Postoperative nausea and vomiting were significantly lower with the administration of pregabalin compared with the placebo group (P < 0.008). Additionally, pregabalin increased the incidence of dizziness and visual disturbances in a dose-dependent manner. Conclusion: Oral pregabalin premedication

关键词： Pregabalin Premedication sedation Postoperative Pain

Procedural sedation and Analgesia in Children in Emergency Department—Role of Adjunct Therapies

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Open Journal of Anesthesiology 2017年第11期7卷 371-380页

作者： Nirupama Kannikeswaran Ahmad Farooqi Cindy Chidi Deepak Kamat Carman and Ann Adam Department of Pediatrics Children’s Hospital of Michigan Detroit MI USA Wayne State University School of Medicine Detroit MI USA

Objective: To compare sedation efficacy and parent/consultant satisfaction between standard sedation, sedation with music listening, and sedation with Certified Child life Specialists (CCLS) in children undergoing procedural sedation in the Pediatric Emergency Department (PED). Methods: Eligible children, aged 3 - 18 years, were randomly allocated to one of 3 groups: 1) standard sedation;2) sedation with music listening;3) sedation with CCLS intervention. All 3 groups received intravenous ketamine. The child life group received age appropriate comforting measures, while the music group listened to music of their choice during the procedure. The primary outcome was sedation efficacy, measured by Ramsay sedation scale, FACES-P scale and need for re-dosing. The secondary outcome was parent/consultant satisfaction. Results: Fifty nine patients were analyzed (standard sedation: 20;sedation with music listening: 20;and sedation with CCLS: 19). There was no significant difference in mean initial ketamine dosing (1.58 ± 0.44 vs. 1.68 ± 0.36 vs. 1.42 ± 0.47, p = 0.26). There was no significant difference in median Ramsay sedation scores [6(IQR:4,6) vs. 6 (IQR:4,6) vs. 6 (IQR:5,6)], FACES-R pain score [0 (IQR:0.0) vs. 0 (IQR:0.0) vs. 0 (IQR:0.0)] and need for re-dosing [9/20 (45%) vs. 4/20 (20%) vs. 8/19 (42.1%)] amongst the 3 groups. Parent and consultant satisfaction was high in all 3 groups. Conclusion: Our pilot study did not demonstrate a difference in sedation efficacy or parent/consultant satisfaction when adjunct therapies were used during PSA. Further studies with a large sample size are needed to define the role for such adjunct therapies during procedural sedation in PED.

关键词： Procedural sedation Music Therapy Certified Child Life Specialists Emergency Department Children

Acute respiratory distress syndrome:focusing on secondary injury

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Chinese Medical Journal 2021年第17期134卷 2017-2024页

作者： Pan Pan Long-Xiang Su Da-Wei Liu Xiao-Ting Wang on behalf of the Chinese Critical Ultrasound Study Group(CCUSG) College of Pulmonary and Critical Care Medicine The General Hospital of the People’s Liberation ArmyBeijing 100091China Department of Critical Care Medicine Peking Union Medical College and Chinese Academy of Medical SciencesBeijing 100730China 不详

Acute respiratory distress syndrome(ARDS)is one of the most common severe diseases seen in the clinical setting.With the continuous exploration of ARDS in recent decades,the understanding of ARDS has improved.ARDS is not a simple lung disease but a clinical syndrome with various etiologies and pathophysiological changes.However,in the intensive care unit,ARDS often occurs a few days after primary lung injury or after a few days of treatment for other severe extrapulmonary diseases.Under such conditions,ARDS often progresses rapidly to severe ARDS and is difficult to treat.The occurrence and development of ARDS in these circumstances are thus not related to primary lung injury;the real cause of ARDS may be the“second hit”caused by inappropriate treatment.In view of the limited effective treatments for ARDS,the strategic focus has shifted to identifying potential or high-risk ARDS patients during the early stages of the disease and implementing treatment strategies aimed at reducing ARDS and related organ failure.Future research should focus on the prevention of ARDS.

关键词： Acute respiratory distress syndrome Secondary lung injury Spontaneous breathing Pulmonary circulation sedation

Airway Characteristics and Safe Management of Spontaneously Breathing Patients: Risks of sedation and Analgesia and Changes in Wakefulness

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International Journal of Clinical Medicine 2016年第11期7卷 726-735页

作者： Adrian Reber Department of Anesthesia and Intensive Care Medicine Hospital of Zollikerberg Zollikerberg Switzerland

The goal of safe airway management is to maintain a patent airway. Lack of knowledge of the anatomical morphology and changes that may occur in the upper airway during sedation and unconsciousness may lead to critical incidents and hazardous complications. This review focuses on the risks of sedation and analgesia and changes in wakefulness on airway patency in spontaneously breathing patients. Furthermore, key elements of airway management are presented and discussed.

关键词： Airway Analgesia Anesthetics Anesthesia Breathing Chin Lift Diagnostics Emergency Jaw Thrust sedation Maneuvers Obesity Obstructive Sleep Apnea Posture Sleep

Preoperative Oral sedation with Midazolam and Paracetamol vs sedation Nasally with Midazolam and Ketamine for Children Scheduled for Dental Treatment

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Open Journal of Anesthesiology 2017年第7期7卷 184-193页

作者： Walid Y. Kamel Aktham A. Shoukry Department of Anaesthesia ICU and Pain Management Faculty of Medicine Ain Shams University Cairo Egypt

Background: Preoperative anxiety is common among children. It can result in adverse physiological and psychological outcomes. Pharmacological and non-pharmacologic techniques used preoperatively to decrease anxiety and improve cooperation in pediatric patients. The extent of an individual child’s risk for stress reflects genetics, personality, parenting, and previous life experience. Children 1 to 5 years of age are at the highest risk for extreme preoperative anxiety. Material and methods: The study is a double blinded clinical trial that conducted in Ain Sham University on 90 children for pulpotomy in the period from august 2015 to may 2017 after approval of the ethical committee and informed written consent from the guardians. The patients were divided randomly into two groups. Fifteen min. before the procedure, In group O, midazolam/paracetamol at a dose of 0.5 and 15 mg/kg respectively was given orally. In group N, midazolam/Ketamine 0.5 mg/kg and 10 mg/kg sprayed nasally. Ramsay sedation scale, child separation, mask acceptance, Aldrete’s scoring system, postanesthetic discharge criteria and parent satisfaction scores were recorded. Results: group N showed more smooth parenteral separation [88.9 vs 8.9%] and better tolerance to the face mask “scale 1” [73.3% vs 22.2%] meanwhile the PACU discharge [88.9% vs 66.7%] and the hospital discharge [77.8% vs 46.7%] were earlier in group O with a higher satisfaction score [77.7% vs 22.2%]. Conclusion: The combination of midazolam/paracetamol is orally comparable to the combination of midazolam/ket-amine nasally;however “midazolam/paracetamol” achieves a higher parents satisfaction and earlier postoperative discharge.

关键词： sedation Children Discharge Dental Oral Nasal