Sedation and monitoring for gastrointestinal endoscopy

2013

WJGE

Self Cite

105

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.

Section: Flumazenilmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sedation-related complications in gastrointestinal endoscopy

2013

WJGE

Self Cite

105

“…Benzodiazepines and propofol in various combinations are administered to the patients to provide sedation [1,[6][7][8] . The synergistic effect of midazolam and propofol is more apparent and has proven to be safe and effective.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, routine administration of sedative and analgesic drugs is widely provided for this procedure. Combination of benzodiazepines and opiates is the most common practice [1] . Consequently, multi-drug regimens exist including opioids, benzodiazepines, ketmine and propofol.…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy of Combination of Propofol and Ketamine(Ketofol) for Deep Sedation in Colonoscopic Procedure

Journal of Gastroenterology and Hepatology Research

Kongphlay

2015

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AIM:To compare and evaluate the clinical efficacy of the combination of propofol and ketamine (ketofol) versus propofol alone when each regimen is used as sedative agents for colonoscopy. METHODS: 100 patients who underwent colonoscopy in two years, were randomly assigned to PN and PK groups. 50 patients in group PN received propofol and normal saline and 50 patients in group PK received propofol and ketamine for deep sedation. All patients were premedicated with 0.02-0.03 mg/kg of midazolam. Immediately after the procedure, the endoscopist was asked to rate tolerability for the patient, discomfort during insertion and satisfaction. As well, a blinded member of the research team evaluated the patient satisfaction, procedural pain, recovery time and recovery score. The primary outcome was the successfully completed colonoscopic procedure. The secondary outcome variables were patient tolerance, discomfort during insertion, patient and endoscopist satisfaction, recovery time and recovery score, hemodynamic parameters, as well as adverse events during and immediately after procedure. RESULTS: All endoscopies were completely successfully. Mean total dose of midazolam in group PK and PN was 0.027±0.005 mg/kg and 0.026±0.005 mg/kg, respectively (p=0.469). Mean total dose of propofol in group PK and PN was 7.28±3.03 mg/kg/ h and 8.02±2.99 mg/kg/h, respectively (p=0.451). Mean total dose of ketamine in group PK was 1.49±0.61 mg/kg/h. There were no significant differences in the patient and endoscopist satisfaction, procedural pain and recovery time, but the recovery score at 30 min post-procedure in group PK was significantly lower than group PN (p=0.025). Tolerability of the patient and comfort during insertion in group PN were statistically significantly lower than the patients in group PK. Overall and sedation-related adverse event rate in group PN were also significantly higher than in group PK. However, these adverse events were transient and easily treated with no sequelae. CONCLUSION: Deep sedation in both regimens provided effective and safe for colonoscopy. No serious adverse events were observed. However, the combination of propofol and ketamine (ketofol) used as sedative agents for deep sedation had significantly higher efficacy than the propofol alone.

“…In addition, the internal organs such as pancreas, gallbladder, common bile duct and part of the liver are commonly seen during the examination [6,7] . EUS is an invasive and prolonged gastrointestinal endoscopic (GIE) procedure [8] . It creates pain and requires some forms of sedation and/ or anesthesia during the procedure.…”

Section: Pain Score Within Twenty-four Hours Post-endoscopic Ultrasonmentioning

confidence: 99%

Pain Score within Twenty-Four Hours Post-Endoscopic Ultrasonography: A Comparison Between with or without Fine Needle Aspiration Procedure

Journal of Gastroenterology and Hepatology Research

Saivaew

Vichitmala

2015

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AIMS:To compare the pain score within twenty-four hours postendoscopic ultrasonography (EUS) with or without fine needle aspiration (FNA) procedure in adult patients. METHODS: We prospectively analyzed the patients who underwent EUS procedures from January, 2009 to December, 2009. Pain score was compared by using verbal rating scale (VRS, 0-100) and pain rescued medications at 2, 6, 12, 18, 24 hours postprocedure. RESULTS: One hundred and twenty-four patients, 84 patients only with EUS procedure (group D) and 40 patients with EUS and FNA procedures (group F), were enrolled. All procedures were completed successfully. Sedative and analgesic agents in both groups were propofol, midazolam and fentanyl and were comparable the dose among the two groups. The mean procedural time in D and F was 39.8±19.1 and 60.6±26.0 minutes, respectively. Mean pain score at baseline and at 2, 6, 12, 18 and 24 hours post-EUS was not significantly different between the two groups. Additionally, total dose of pethidine used for pain control after EUS procedure in both groups was not significantly different. CONCLUSION: EUS-induced abdominal pain is mild and mainly occurs within six hours after the procedure. Pain score within twenty-four hours after EUS with or without fine needle aspiration procedure is comparable.