In this edition of Digestive Endoscopy, Han and colleagues present a prospective double-blind randomized trial comparing the combination of fentanyl and propofol to fentanyl and midazolam in patients aged over 80 years who are undergoing endoscopic retrograde cholangiopancreatogra-phy (ERCP). 1 A total of 100 patients were randomized with the primary outcome being safety and a secondary outcome surrounding the efficacy of ERCP. As opposed to many other studies in this genre, the authors assured the presence of a native papilla and the lack of any post-surgical anatomy in order to reduce any confounding because of altered anatomy. The authors targeted moderate sedation which was defined as a modified assessment of alertness/sedation score of three. Sedation efficacy was assessed by a visual analog scale (VAS) score derived satisfaction analysis and comparison of the induction and recovery times. The groups were well matched for age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, presence of comorbid diseases and baseline physiological data. The incidence of cardiopulmonary complications were the same for both the midazolam and the propofol sedation arms (24% vs 22%). Subcategories of cardiopulmonary complications including hypotension, bradycardia, tachycardia, and hypoxia were the same. There was a trend for increased oxygen supply in the propofol arm (42% vs 32%), but this did not reach statistical significance. Subjects receiving propofol exhibited a significantly shorter recovery time to a modified Aldrete score of 10. Patient, endoscopist and nurse satisfaction were the same between the two sedation arms. Technical procedural success was 100% in both sedation arms. Although procedure time was slightly longer in the propofol arm, this did not reach statistical significance. There are very few studies which address the performance of ERCP in the elderly population. Riphaus et al. random-ized 150 patients to propofol or a combination of meperidine and midazolam. 2 In this study, as well as in others cited below, it is unlikely that patients receiving propofol alone were targeted to moderate sedation owing to the fact that propofol has no analgesic qualities. As such, one would expect be incidence and perhaps the severity of cardiopul-monary unplanned events to be higher. The subjects in this study exhibited a higher comorbidity burden as 91% of them were classified as ASA class III or greater. The incidence of hypoxemia and hypotension was similar between the two sedation arms. Mean recovery time was significantly shorter in patients receiving propofol. Also of note, was that in the recovery phase of the study, the incidence of desaturation was much higher in patients receiving propofol than in those receiving meperidine and midazolam. Schilling and colleagues randomized 150 patients over 80 years old undergoing advanced endoscopic procedures such as balloon enteroscopy, ERCP and endoscopic ultrasonography (EUS) to receive either propofol alone or a combination of mep...
Directed public education about the ear as a high-risk, common site for NMSC is needed. The authors have indicated no significant interest with commercial supporters.
In patients with suspected SOD type 3, prophylactic rectally administered indomethacin with PD stenting was not observed to affect the incidence or severity of post-ERCP pancreatitis when compared to PD stenting alone.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.