Original article. Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand

Amornyotin, Somchai; Srikureja, Wichit; Pausawasdi, Nonthalee; Kachintorn, Udom

doi:10.5372/1905-7415.0504.063

Cited by 17 publications

(20 citation statements)

References 12 publications

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“…We usually use propofol, midazolam and fentanyl for endoscopic procedures including small bowel enteroscopy. A low dose of midazolam, combined with low dose fentanyl and propofol, was safe and effective, and did not prolong recovery time even in elderly patients [10,11,16,17] . In GA, short-acting muscle relaxants (atracurium and cisatracurium) and short-acting inhalation agents (isoflurane, sevoflurane and desflurane) are commonly used for short procedures [18] .…”

Section: Discussionmentioning

confidence: 90%

“…However, it is tempting to speculate that these patients in particular may benefit from the GA technique with less experienced endoscopists. Moreover, cardiopulmonary and other diseases which are more frequent in older patients have been regarded as the major risk factors for complications associated with endoscopy or sedation [9][10][11] . Old age as an important risk factor for endoscopy, but is not an indication for providing GA more frequently for enteroscopy at our institution.…”

Section: Discussionmentioning

confidence: 99%

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Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center

Amornyotin

Kachintorn²,

Kongphlay³

2012

WJGE

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AIM:To study the anesthetic management of patients undergoing small bowel enteroscopy in the World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand. METHODS:Patients who underwent small bowel enteroscopy during the period of March 2005 to March 2011 in Siriraj Gastrointestinal Endoscopy Center were retrospectively analyzed. The patients' characteristics, pre-anesthetic problems, anesthetic techniques, anesthetic agents, anesthetic time, type and route of procedure and anesthesia-related complications were assessed. RESULTS:One hundred and forty-four patients underwent this procedure during the study period. The mean age of the patients was 57.6 ± 17.2 years, and most were American Society of Anesthesiologists (ASA) class Ⅱ (53.2%). Indications for this procedure were gastrointestinal bleeding (59.7%), chronic diarrhea (14.3%), protein losing enteropathy (2.6%) and others (23.4%). Hematologic disease, hypertension, heart disease and electrolyte imbalance were the most common pre-anesthetic problems. General anesthesia with endotracheal tube was the anesthetic technique mainly employed (50.6%). The main anesthetic agents administered were fentanyl, propofol and midazolam. The mean anesthetic time was 94.0 ± 50.5 min. Single balloon and oral (antegrade) intubation was the most common type and route of enteroscopy. The anesthesia-related complication rate was relatively high. The overall and cardiovascular-related complication rates including hypotension in the older patient group (aged ≥ 60 years old) were significantly higher than those in the younger group. CONCLUSION: During anesthetic management for small bowel enteroscopy, special techniques and drugs are not routinely required. However, for safety reasons anesthetic personnel need to optimize the patient's condition.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center

Amornyotin

Kachintorn²,

Kongphlay³

2012

WJGE

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“…Considering these changes, ERCP and EUS procedures play an important role in the delivery of gastrointestinal healthcare. The proportion of these patients is increasing, and a high number of geriatric patients undergoing gastrointestinal endoscopies (GIE) have been observed 1–3. Although concerns remain regarding the safety and potential benefits of endoscopies, previous studies have shown that ERCP and EUS procedures can be safe and well tolerated, even in very old patients 4–7.…”

Section: Introductionmentioning

confidence: 99%

Age-dependent safety analysis of propofol-based deep sedation for ERCP and EUS procedures at an endoscopy training center in a developing country

Amornyotin¹,

Leelakusolvong²,

Chalayonnawin³

et al. 2012

CEG

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IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) procedures in elderly patients are on the rise, and they play an important role in the diagnosis and management of various gastrointestinal diseases. The use of deep sedation in these patients has been established as a safe and effective technique in Western countries; however, it is uncertain if the situation holds true among Asians. The present study aimed to evaluate the age-dependent safety analysis and clinical efficacy of propofol-based deep sedation (PBDS) for ERCP and EUS procedures in adult patients at a World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand.MethodsWe undertook a retrospective review of anesthesia or sedation service records of patients who underwent ERCP and EUS procedures. All procedures were performed by staff endoscopists, and all sedations were administered by anesthesia personnel in the endoscopy room.ResultsPBDS was provided for 491 ERCP and EUS procedures. Of these, 252 patients (mean age, 45.1 + 11.1 years, range 17–65 years) were in the <65 age group, 209 patients (mean age, 71.7 + 4.3 years, range 65–80 years) were in the 65–80 year-old group, and 30 patients (mean age, 84.6 + 4.2 years, range 81–97 years) were in the >80 age group. Common indications for the procedures were pancreatic tumor, cholelithiasis, and gastric tumor. Fentanyl, propofol, and midazolam were the most common sedative drugs used in all three groups. The mean doses of propofol and midazolam in the very old patients were relatively lower than in the other groups. The combination of propofol, midazolam, and fentanyl, as well as propofol and fentanyl, were frequently used in all patients. Sedation-related adverse events and procedure-related complications were not statistically significantly different among the three groups. Hypotension was the most common complication.ConclusionIn the setting of the WGO Endoscopy Training Center in a developing country, PBDS for ERCP and EUS procedures in elderly patients by trained anesthesia personnel with appropriate monitoring is relatively safe and effective. Although adverse cardiovascular events, including hypotension, in this aged group is common, all adverse events were usually transient, mild, and easily treated, with no sequelae.

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“…Additionally, more profound falls in blood pressure occur in a hypovolemic patient. Propofol has also been proven to reduce postprocedural hypoxemic events, which may be of significance in critically ill elderly patients [20,21] and sick pediatric patients [22,23] . Prevention of this complication is to take a relevant medical and drug history before the procedure with particular detail required regarding current antihypertensives, antianginal and antiarrhythmic therapy and the use of systemic corticosteroids.…”

Section: Complicationsmentioning

confidence: 99%

Sedation-related complications in gastrointestinal endoscopy

Amornyotin

2013

WJGE

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106

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Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient's age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Sedation; Complication; Gastrointestinal; EndoscopyCore tip: Gastrointestinal endoscopic (GIE) procedures are relatively safe. However, these procedures have been shown to cause various effects on cardiorespiratory systems. Sedation-related complications while providing any level of sedation can occur. Fortunately, these complications during GIE procedures are commonly transient and of a mild degree. In addition, significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support. Periodical assessment of the level of sedation and continuous monitoring of cardiovascular and respiratory systems provides timely information. Standardized discharge criteria should be used to determine the patient's readiness for discharge.Amornyotin S. Sedation-related complications in gastrointestinal endoscopy.

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Original article. Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand

Cited by 17 publications

References 12 publications

Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center

Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center

Age-dependent safety analysis of propofol-based deep sedation for ERCP and EUS procedures at an endoscopy training center in a developing country

Sedation-related complications in gastrointestinal endoscopy

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