Guidelines for sedation in gastroenterological endoscopy

Obara, Katsutoshi; Haruma, Ken; Irisawa, Atsushi; Kaise, Mitsuru; Gotoda, Takuji; Sugiyama, Masanori; Tanabe, Satoshi; Horiuchi, Akira; Fujita, Naotaka; Ozaki, Makoto; Yoshida, Masahiro; Matsui, Toshiyuki; Ichinose, Masakazu; Kaminishi, Michio

doi:10.1111/den.12464

Cited by 70 publications

(87 citation statements)

References 78 publications

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“…In contrast, the combination of benzodiazepine and opioid is considered safe and cost-effective. Therefore, it is still the golden standard in many countries [8,9,11,12], and is also recommended in the guidelines by Japan Gastroenterological Endoscopy Society [12] and the American Gastroenterological Association [22].…”

Section: Discussionmentioning

confidence: 99%

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Risk Factor for Vital Signs Fluctuation during Colonoscopy under Conscious Sedation Consisting of Midazolam and Meperidine

Banno

Kato

Sunata

et al. 2017

Dig Dis

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Background: Sedatives or analgesics are widely used to relieve a patient’s discomfort during colonoscopy (CS). Although cardiopulmonary adverse events are sometimes experienced during the examination, the risk factors for vital signs fluctuation (VSF) have not been fully elucidated. This study thus aimed to identify the risk factors for VSF during the examination, as well as to evaluate the frequency and the degree of VSF. Summary: A total of 755 consecutive subjects who received CS under endoscopist-administrated sedation using midazolam, meperidine, or combination of both were retrospectively analyzed. We assessed the distribution of vital signs during the procedure and frequency of VSF. To identify independent risk factors, we analyzed the association between VSF and subjects’ characteristics and procedure information using the multivariate logistic regression model. Consequently, VSF was observed in 17% of all; hypotension and oxygen desaturation was observed in 13 and 5%, respectively. However, we could achieve the purpose of all procedure and, no one required hospitalization or extension of hospital stay. Multivariate analysis revealed that age (OR 1.05 [95% CI 1.04–1.07]), being female (OR 1.78 [95% CI 1.19–2.70]), and use of midazolam (OR 5.06 [95% CI 3.18–8.08]) were independent risk factors for VSF.

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Section: Discussionmentioning

confidence: 99%

“…benzodiazepine (i.e., midazolam) and opioids (i.e., meperidine) is considered to be safe and feasible and has been the gold standard for administering sedation during CS [8,9,11,12]. However, cardiopulmonary adverse events are sometimes experienced during the examination.…”

mentioning

confidence: 99%

Risk Factor for Vital Signs Fluctuation during Colonoscopy under Conscious Sedation Consisting of Midazolam and Meperidine

Banno

Kato

Sunata

et al. 2017

Dig Dis

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“…Second, sedation level was evaluated using RSS and not digitized by a monitor such as bispectral index. Nonetheless, RSS is also useful; indeed, it is recommended by the Japan Gastroenterological Endoscopy Society's guideline for sedation in gastroenterological endoscopy [29] . Third, to estimate the risk factors for poor response to m-NLA with midazolam and pethidine hydrochloride, quartiles and tertiles were created for cumulative alcohol intake and major specimen size, respectively.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Poor Response to Modified Neuroleptanalgesia with Midazolam for Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

Ominami¹,

Nagami²,

Shiba³

et al. 2016

Digestion

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Background/Aims: Modified neuroleptanalgesia (m-NLA) with midazolam is often used for sedation and analgesia during endoscopic submucosal dissection (ESD) for gastrointestinal neoplasia. However, interruption due to poor response to midazolam is often experienced during ESD for esophageal squamous cell carcinoma (ESCC) because most patients with ESCC have a history of heavy alcohol intake. We examined the incidence and risk factors for poor response to m-NLA with midazolam and pethidine hydrochloride. Methods: This retrospective cross-sectional study was conducted at a single institution. Between April 2007 and July 2013, 151 patients with superficial ESCC who underwent ESD under sedation using m-NLA with midazolam and pethidine hydrochloride were enrolled. Poor response to sedation was defined as the use of a second drug when Ramsay Sedation Score 1-2. Results: Poor response to sedation occurred in 66.2% patients. Most cases of poor response were controlled by using additional flunitrazepam. Multivariate logistic regression analysis showed that cumulative alcohol intake and major specimen size were independent risk factors for poor response to sedation (OR 3.63, 95% CI 1.20-10.99, and OR 3.23, 95% CI 1.26-8.25). Conclusion: Our study indicated that cumulative alcohol intake and major specimen size were associated with poor response to m-NLA with midazolam and pethidine hydrochloride.

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“…A Ramsay score 26 of three or four corresponds to moderate sedation (conscious sedation). 27 Intravenous benzodiazepine drugs (i.e. midazolam, diazepam, and flunitrazepam) are feasible for sedation for endoscopy.…”

Section: Sedationmentioning

confidence: 99%

Basic principles and practice of gastric cancer screening using high‐definition white‐light gastroscopy: Eyes can only see what the brain knows

Gotoda

Uedo

Yoshinaga³

et al. 2016

Digestive Endoscopy

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Endoscopic diagnosis of gastrointestinal tumors consists of the following processes: (i) detection; (ii) differential diagnosis; and (iii) quantitative diagnosis (size and depth) of a lesion. Although detection is the first step to make a diagnosis of the tumor, the lesion can be overlooked if an endoscopist has no knowledge of what an earlystage 'superficial lesion' looks like. In recent years, image-enhanced endoscopy has become common, but white-light endoscopy (WLI) is still the first step for detection and characterization of lesions in general clinical practice. Settings and practice of routine esophagogastroduodenoscopy (EGD) such as use of antispasmodics, number of endoscopic images taken, and observational procedure are customarily decided in each facility in each country and are not well standardized. Therefore, in the present article, we attempted to outline currently available evidence and actual Japanese practice on gastric cancer screening using WLI, and provide tips for detecting EGC during routine EGD which could become the basis of future research.Key words: gastric atrophy, gastric cancer, Helicobacter pylori, Kimura-Takemoto classification, screening gastroscopy MEDICAL INTERVIEW PRIOR TO ESOPHAGOGASTRODUODENOSCOPY M EDICALINTERVIEW BEFORE esophagogastroduodenoscopy (EGD) is important in terms of the following two points. One is to confirm indication of the EGD and the other is to assess risk of examinees. Whether indication for EGD is to screen for early gastric cancer (EGC) or to make a diagnosis of a patient's symptoms or abnormal findings in other diagnostic examinations should be distinguished. In the screening endoscopy, the entire gastric mucosa is thoroughly observed to detect any suspicious findings for neoplasia, whereas only the presence of apparent lesions that may cause symptoms or abnormal image findings are investigated. Although endoscopy is usually intended to make a diagnosis of symptoms or abnormal findings in other diagnostic images, EGC are often found in patients with neither obvious symptoms nor abnormal findings in other diagnostic tests.1 Therefore, in high-risk patients, it is important to screen for EGC unrelated to symptoms or abnormal find-ings of other diagnostic tests during EGD. The examinee should be asked about status and history of eradication therapy of Helicobacter pylori (H. pylori), 2-4 family history of gastric cancer, smoking and drinking habits. [5][6][7][8] Another reason for the medical interview is to reduce 10 and an anti-foaming agent 11 reduces time and effort for washing out mucus or bubbles to improve quality of observation. A mixture of 4 mL anti-foaming agent (dimethicone, Gascon ® 20 mg/mL; Horii Pharmaceutical Industry, Osaka Japan), 20 000 U mucolytic agent (Pronase MS ® ; Kaken Pharmaceutical, Tokyo, Japan), and 1 g sodium bicarbonate dissolved in 50 mL water is given 10 min before the examination. 12Usefulness of a topical pharyngeal anesthetic is controversial although it is commonly used before gastroscopy. 13,14 UK data show that to...

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Guidelines for sedation in gastroenterological endoscopy

Cited by 70 publications

References 78 publications

Risk Factor for Vital Signs Fluctuation during Colonoscopy under Conscious Sedation Consisting of Midazolam and Meperidine

Risk Factor for Vital Signs Fluctuation during Colonoscopy under Conscious Sedation Consisting of Midazolam and Meperidine

Prediction of Poor Response to Modified Neuroleptanalgesia with Midazolam for Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

Basic principles and practice of gastric cancer screening using high‐definition white‐light gastroscopy: Eyes can only see what the brain knows

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