Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients

Kilic, Ertugrul; Demiriz, Barış; Işıkay, Nurgül; Yıldırım, Abdullah Emre; Can, Selman; Basmaci, Cem

doi:10.15537/smj.2016.11.14557

Cited by 8 publications

(3 citation statements)

References 21 publications

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“…Gastroscopy is a noninvasive operation, but gastroscopy without sedation/anesthesia often causes adverse reactions such as nausea, vomiting, and coughing ( Meng et al, 2016 ). To provide patients with comfortable (i.e., painless) gastroscopy, propofol is considered the best sedation anesthetic according to many studies ( Smith et al, 1994 ; Ellett, 2010 ; Olofsen et al, 2010 ; LaPierre et al, 2012 ; Zhang et al, 2014 ; Kılıc et al, 2016 ; Ma et al, 2016 ). Propofol has no analgesic effect; so, propofol combined with opioids can alleviate the cardiovascular response, reduce noxious stimuli, and reduce the dose of propofol ( LaPierre et al, 2012 ; Anesthesiology Branch of Chinese Medical Association, Digestive Endoscopy Branch of Chinese Medical Association, 2014 ; Zhang et al, 2014 ; Kılıc et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

“…To provide patients with comfortable (i.e., painless) gastroscopy, propofol is considered the best sedation anesthetic according to many studies ( Smith et al, 1994 ; Ellett, 2010 ; Olofsen et al, 2010 ; LaPierre et al, 2012 ; Zhang et al, 2014 ; Kılıc et al, 2016 ; Ma et al, 2016 ). Propofol has no analgesic effect; so, propofol combined with opioids can alleviate the cardiovascular response, reduce noxious stimuli, and reduce the dose of propofol ( LaPierre et al, 2012 ; Anesthesiology Branch of Chinese Medical Association, Digestive Endoscopy Branch of Chinese Medical Association, 2014 ; Zhang et al, 2014 ; Kılıc et al, 2016 ). Too large a dose of opioid drugs could inhibit the patients’ respiratory and circulatory systems, and too small a dose of opioid drugs could not help patients to finish a gastroscope placement.…”

Section: Introductionmentioning

confidence: 99%

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Effective Doses of Nalbuphine Combined With Propofol for Painless Gastroscopy in Adults: A Randomized Controlled Trial

Wang

Chen

et al. 2021

Front. Pharmacol.

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Objective: This prospective study evaluated the 50% effective dose (ED50) and 95% effective dose (ED95) of nalbuphine combined with propofol during painless gastroscopy.Methods: Seventy-five patients who underwent painless gastroscopy were randomly divided into five groups (group N0, N0.05, N0.1, N0.15, and N0.2), with doses of 0, 0.05, 0.1, 0.15, or 0.2 mg/kg nalbuphine in each group. Propofol was given to all groups as the sedative. The bispectral index (BIS) value, propofol dose, examination time, and awakening time were recorded. The number of patients with intolerance indexes (coughing, retching, swallowing, or limb movement) was recorded in each group. The ED50/ED95 of nalbuphine combined with propofol for gastroscopy were calculated.Results: Compared with those of groups N0, N0.05, or N0.1, the propofol dose and awakening time were significantly reduced in group N0.15 or N0.2 (p < 0.05). The successful rate of painless gastroscopy in group N0.15 or N0.2 significantly increased compared to that of group N0 or N0.05 (p < 0.05). When combined with propofol, nalbuphine had an ED50 and ED95 for painless gastroscopy of 0.078 mg/kg (95% CI, 0.056–0.098 mg/kg) and 0.162 mg/kg (95% CI, 0.134–0.217 mg/kg), respectively.Conclusion: The ED50/ED95 of nalbuphine combined with propofol are 0.078 and 0.162 mg/kg, respectively, for painless gastroscopy. Nalbuphine at 0.162 mg/kg combined with propofol is effective and safe for painless gastroscopy in adults.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effective Doses of Nalbuphine Combined With Propofol for Painless Gastroscopy in Adults: A Randomized Controlled Trial

Wang

Chen

et al. 2021

Front. Pharmacol.

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“…18 For sedation during colonoscopy, gastrointestinal system endoscopy and hip fracture surgery, alfentanil and propofol have been extensively utilized. [19][20][21] However, there are cardiac side effects associated with a combination of alfentanil and propofol, such as systolic hypotension, bradycardia and hypoxemia, 22 which should not be ignored. A recent published research showed that moderate sedation induced by remimazolam and alfentanil caused less adverse events compared to propofol-alfentanil combination during third molar extraction.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial

Wang¹,

Wang²,

Ma³

et al. 2023

DDDT

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Purpose This study aimed to compare the cardiopulmonary safety of remimazolam and propofol in patients undergoing cervical conization. Methods This was a single-blind, parallel, randomized controlled study. A total of 204 patients scheduled for day surgery of cold knife cervical conization received either remimazolam-alfentanil anesthesia (remimazolam group) or propofol-alfentanil anesthesia (propofol group). The primary outcome was the incidence of intraoperative cardiopulmonary adverse events (a composite outcome of hypotension, bradycardia and hypoxemia). The occurrence of hypotension, bradycardia, hypoxemia and the degree of body movement were secondary outcomes, as well as the moment at which consciousness was lost, the interval between the end of anesthesia and the operating room’s release of the patient, and the overall dosage of alfentanil administered during the procedure. Results The incidence of intraoperative cardiopulmonary adverse events was 45 (44.1%) in the remimazolam group and 72 (70.6%) in the propofol group (absolute risk difference [95% CI], −26.47% [−39.55% to −13.39%]; odds ratio (OR) [95% CI], 0.43 [0.28 to 0.65]; P < 0.001). The remimazolam group showed lower incidences of hypotension and hypoxemia compared to the propofol group ( P = 0.01 for both). No significant differences were observed in the overall alfentanil dosages administered, bradycardia, bodily movement, or time to losing consciousness between the two groups. Conclusion In patients who underwent cold knife cervical conization, remimazolam-alfentanil anesthesia was associated with a reduced incidence of intraoperative cardiopulmonary adverse events compared with propofol-alfentanil anesthesia.

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Improving haemodynamics in acute gastrointestinal bleeding: Ketamine for endoscopic sedation in active gastrointestinal bleeding in critically Ill patients

Edelson

Rockey

et al. 2020

GastroHep

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Background: We aimed to investigate the safety and efficacy of ketamine in sedation for active gastrointestinal bleeding (GIB). Early endoscopy for GIB likely improves clinical outcomes, is often limited acutely by unfavourable haemodynamics, which make safe and effective sedation challenging. Ketamine has favourable haemodynamic properties that make its use desirable in patients with active GIB. Methods: We performed a retrospective cohort study from a large military tertiary referral centre of critically ill patients who received ketamine (n = 15) and matched 3:1 to patients who received benzodiazepine/opiate based moderate sedation (n = 45). Data abstracted included procedural indication, demographics, medication doses, pre-procedural labs, transfusions, vital signs and adverse events. Results: The overall patient cohorts had clinically significant GIB (most commonly upper) with abnormal haemodynamics and substantial blood transfusion requirements. Pre-endoscopy Rockall score and Charlson Comorbidity Index were higher in patients receiving ketamine. The median ketamine dose was 1 mg/kg. The median midazolam dose was 5 mg in controls vs 2 mg (P = .002) in the ketamine group. Fentanyl doses were also higher in the control group with a median of 100 mcg (range 25-200) compared to 75 (range 0-200) for ketamine (P = .02). There was one adverse event in the control group and none in the ketamine group. Mean arterial pressure (MAP) dropped significantly during endoscopy in the moderate sedation group and increased in the ketamine group (P < .0001). Discussion: Ketamine is a safe and effective for sedation in patients with active GIB. Ketamine resulted in increased MAP during procedures as well as significantly reduced administration of benzodiazepines and opiates. | 289 EDELSON Et aL. How to cite this article: Edelson JC, Edelson CV, Rockey DC, et al. Improving haemodynamics in acute gastrointestinal bleeding: Ketamine for endoscopic sedation in active gastrointestinal bleeding in critically Ill patients. GastroHep.

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Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients

Cited by 8 publications

References 21 publications

Effective Doses of Nalbuphine Combined With Propofol for Painless Gastroscopy in Adults: A Randomized Controlled Trial

Effective Doses of Nalbuphine Combined With Propofol for Painless Gastroscopy in Adults: A Randomized Controlled Trial

Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial

Improving haemodynamics in acute gastrointestinal bleeding: Ketamine for endoscopic sedation in active gastrointestinal bleeding in critically Ill patients

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