Recent Developments in Drugs for GI Endoscopy Sedation

Goudra, Basavana Gouda; Gouda, Gowri; Mohinder, Preet

doi:10.1007/s10620-020-06044-5

Cited by 47 publications

(54 citation statements)

References 32 publications

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“…Procedural sedation approaches are generally based on either midazolam or propofol and are often varied widely across the globe 7,8 . Among them, propofol has been the most preferred drug for general sedation due to its excellent sedative properties and a short terminal half‐life, but it is not cost effective with regard to safety endpoints 9–11 .…”

Section: Introductionmentioning

confidence: 99%

Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non‐inferiority, phase III trial

Chen

Yuan

Zhang

et al. 2020

J of Gastro and Hepatol

154

158

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Background and Aim Remimazolam tosilate (RT) is a new short‐acting GABA(A) receptor agonist, having potential to be an effective option for procedural sedation. Here, we aimed to compare the efficacy and safety of RT with propofol in patients undergoing upper gastrointestinal endoscopy. Methods This positive‐controlled, non‐inferiority, phase III trial recruited patients at 17 centers, between September 2017 and November 2017. A total of 384 patients scheduled to undergo upper gastrointestinal endoscopy were randomly assigned to receive RT or propofol. Primary endpoint was the success rate of sedation. Adverse events (AEs) were recorded to evaluate safety. Results The success rate of sedation in the RT group was non‐inferior to that in the propofol group (97.34% vs 100.00%; difference in rate −2.66%, 95% CI −4.96 to −0.36, meeting criteria for non‐inferiority). Patients in the RT group had longer time to adequate sedation (P < 0.0001) but shorter time to fully alert (P < 0.0001) than that in the propofol group. The incidences of hypotension (13.04% vs 42.86%, P < 0.0001), treatment‐related hypotension (0.54% vs 5.82%, P < 0.0001), and respiratory depression (1.09% vs 6.88%, P = 0.0064) were significantly lower in the RT group. AEs were reported in 74 (39.15%) patients in the RT group and 114 (60.32%) patients in the propofol group, with significant difference (P < 0.0001). Conclusion This trial established non‐inferior sedation success rate of RT compared with propofol. RT allows faster recovery from sedation compared with propofol. The safety profile is favorable and appears to be superior to propofol, indicating that it was feasible and well tolerated for patients.

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Section: Introductionmentioning

confidence: 99%

Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non‐inferiority, phase III trial

Chen

Yuan

Zhang

et al. 2020

J of Gastro and Hepatol

154

158

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“…One of the most interesting findings was that a large group of respondents is familiar with effective airway management (mask ventilation in 83.9%, endotracheal intubation in 23.2%), even surpassing the results reported internationally [ 14 ]. Respiratory failure remains the cardinal life-threatening sedation-derived complication, regardless the type of sedative or analgesic used [ 2 , 15 ]. In this sense, Greek gastroenterologists display a high level of professionalism, being adequately trained in dealing with airway management techniques, as this is the first step to guarantee patient safety during endoscopic sedation in the pursuit of optimizing the quality of delivered services.…”

Section: Discussionmentioning

confidence: 99%

Sedation/Analgesia Administration Practice Varies according to Endoscopy Facility (Hospital- or Office-Based) Setting: Results from a Nationwide Survey in Greece

Tziatzios

Samonakis

Tsionis

et al. 2020

Gastroenterology Research and Practice

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Objectives. To examine the impact of endoscopy setting (hospital-based vs. office-based) on sedation/analgesia administration and to provide nationwide data on monitoring practices among Greek gastroenterologists in real-world settings. Material and Methods. A web-based survey regarding sedation/analgesia rates and monitoring practices during endoscopy either in a hospital-based or in an office-based setting was disseminated to the members of the Hellenic Society of Gastroenterology and Professional Association of Gastroenterologists. Participants were asked to complete a questionnaire, which consisted of 35 items, stratified into 4 sections: demographics, preprocedure (informed consent, initial patient evaluation), intraprocedure (monitoring practices, sedative agents’ administration rate), and postprocedure practices (recovery). Results. 211 individuals responded (response rate: 40.3%). Propofol use was significantly higher in the private hospital compared to the public hospital and the office-based setting for esophagogastroduodenoscopy (EGD) (85.8% vs. 19.5% vs. 10.5%, p<0.0001) and colonoscopy (88.2% vs. 20.1% vs. 9.4%, p<0.0001). This effect was not detected for midazolam, pethidine, and fentanyl use. Endoscopists themselves administered the medications in most cases. However, a significant contribution of anesthesiology sedation/analgesia provision was detected in private hospitals (14.7% vs. 2.8% vs. 2.4%, p<0.001) compared to the other settings. Only 35.2% of the private offices have a separate recovery room, compared to 80.4% and 58.7% of the private hospital- and public hospital-based facilities, respectively, while the nursing personnel monitored patients’ recovery in most of the cases. Participants were familiar with airway management techniques (83.9% with bag valve mask and 23.2% with endotracheal intubation), while 49.7% and 21.8% had received Basic Life Support (BLS) and Advanced Life Support (ALS) training, respectively. Conclusion. The private hospital-based setting is associated with higher propofol sedation administration both for EGD and for colonoscopy. Greek endoscopists are adequately trained in airway management techniques.

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“…16 Therefore, it is essential that it be performed under a safe anesthetic technique, which allows for quick recovery, decreases the patient's length stay in the hospital environment and reduces the costs associated with the procedure. 10,11 This study differs from the others as it standardizes the level of sedation used in each patient and measures an objective clinical parameter of recovery: the post-anesthetic recovery time. Previous studies used different levels of sedation or combinations of drugs or objectives.…”

Section: Discussionmentioning

confidence: 99%

“…Opioids, such as fentanyl, provide analgesia, while benzodiazepines, such as midazolam, promote a synergistic effect. [7][8][9][10][11] Both are currently used in colonoscopy, as they produce moderate sedation, relieve the patient's pain and discomfort during the performance of the procedure and provide a short recovery time. 6,12 However, there is still no consensus in the literature about which drug alone, or combination of drugs, is best to safely achieve the desired level of sedation, with minimal adverse effects and that will allow the patients to return quickly to their daily activities.…”

Section: Introductionmentioning

confidence: 99%

Comparison of post-anesthesia recovery time in sedated patients for colonoscopy using midazolam or fentanyl associated with propofol

Magnus

Flausino²,

Siqueira³

et al. 2020

Journal of Coloproctology

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Objective Comparison of post-anesthesia recovery time in sedated patients for colonoscopy using two drug combinations: midazolam and propofol or fentanyl and propofol. Method Fifty patients ASA I and II, from 18 to 65 years of age, candidates for elective colonoscopy under sedation administered by an anesthesiologist, were randomized in two groups: Group A (midazolam and propofol) and Group B (fentanyl and propofol). Each patient was evaluated as for the length of the exam (Exam length), length of stay in the post-anesthesia care unit 1 and 2 (LSPACU1 and LSPACU2) and hospital discharge. Episodes of awakening, and of movement, drop in SpO2 < 90%, need for mechanical ventilation, propofol consumption, heart rate (HR) and mean blood pressure (MBP) were also evaluated. Results Patients of group B had a recovery time in LSPACU1 statistically shorter than that for those in group A. In both groups, LSPACU1 was considered inversely proportional to LSPACU2. Hospital discharge time was similar between groups. Patients of group B had a significant decrease in MBP during and at the end of the exam, when compared to the initial measurement and that during sedation. Nevertheless, this variation was lower than 20%. No adverse event was observed. All patients were discharged on the same day, with no unexpected hospitalization. Conclusions The combined use of fentanyl and propofol for colonoscopy sedation had a post-anesthesia recovery time in LSPACU1 shorter than that with the combination of midazolam and propofol. Nevertheless hospital discharge time was similar between groups.

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Recent Developments in Drugs for GI Endoscopy Sedation

Cited by 47 publications

References 32 publications

Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non‐inferiority, phase III trial

Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non‐inferiority, phase III trial

Sedation/Analgesia Administration Practice Varies according to Endoscopy Facility (Hospital- or Office-Based) Setting: Results from a Nationwide Survey in Greece

Comparison of post-anesthesia recovery time in sedated patients for colonoscopy using midazolam or fentanyl associated with propofol

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