Sedation for gastrointestinal endoscopy: the changing landscape

Trummel, John Michael

doi:10.1097/aco.0b013e32827ab467

Cited by 27 publications

(8 citation statements)

References 21 publications

(22 reference statements)

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“…The rate of bag valve mask ventilation for additional sedation with propofol in small dosages can lead to the delay described in mobilization and micturition and an increased rate of nausea. The order of 1/500 to 1/1,000 cases [15] did not occur in our study.…”

Section: Sedationmentioning

confidence: 62%

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Schmittner¹,

Janke²,

Limmer³

et al. 2009

Med Princ Pract

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Objectives: Additional intra-operative sedation may help improve acceptability and comfort of anaesthesia in patients undergoing minor anorectal (perianal) procedures under spinal saddle block. This observational study was done to determine which patients request sedatives and to what extent sedatives affect the patients’ recovery. Subjects and Methods: During a 6-month period, 500 patients undergoing minor perianal procedures received 1.0 ml hyperbaric bupivacaine (0.5%). On request, a light sedation with propofol in bolus application was provided. Patients were evaluated postoperatively using a standardized questionnaire about their perceptions before, during and 48 h after the administration of anaesthesia. Results: More female (91/143, 63.6%) than male (136/259, 52.5%) patients (p = 0.0312) received sedation. Patients with sedation were significantly younger (46.7 ± 13.8 vs. 50 ± 13.8 years, p = 0.0171) and had a lower body mass index (BMI; 25.6 ± 4.3 vs. 27.5 ± 5.1, p < 0.0001). Time to mobilization and first micturition was significantly longer in patients with sedation (4.8 vs. 4.4 h, p = 0.0194 and 5.8 vs. 5.4 h, p = 0.0188), which was associated with a higher incidence of nausea (7.5 vs. 1.7%, p = 0.0083). Conclusions: Female gender, younger age, lower body weight and lower BMI were associated with higher subjective requirements for sedation. The use of sedation showed prolongation of time to first mobilization and micturition and a higher incidence of nausea.

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Section: Sedationmentioning

confidence: 62%

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Schmittner¹,

Janke²,

Limmer³

et al. 2009

Med Princ Pract

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“…Several studies have tried to compare different drug combinations [12,16,17]; however, a major cornerstone of anaesthesia for ERCP procedures should be the achievement of conscious sedation combined with deep analgesia. This allows the patient to respond to verbal stimuli and to maintain both cardiovascular and respiratory balance.…”

Section: Discussionmentioning

confidence: 99%

“…In this setting it is mandatory to avoid deep sedation because this could inadvertently progress to general anaesthesia with loss of protective airway reflexes [31,32]. In a study involving 80 healthy outpatients undergoing various endoscopic procedures who were given midazolam and remifentanil to achieve moderate sedation, deep sedation occurred in 68% of all patients, but varied with procedure type – 45% colonoscopy, 60% EGDS, 80% endoscopic ultrasound and 85% ERCP [17]. …”

Section: Discussionmentioning

confidence: 99%

Ketamine, propofol and low dose remifentanil versus propofol and remifentanil for ERCP outside the operating room: Is ketamine not only a “rescue drug”?

Nucera

Marsili

Malyan³

et al. 2012

Med Sci Monit

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SummaryBackgroundEndoscopic retrograde cholangiopancreatography ERCP is a painful and long procedure requiring transient deep analgesia and conscious sedation. An ideal anaesthetic that guarantees a rapid and smooth induction, good quality of maintenance, lack of adverse effects and rapid recovery is still lacking.This study aimed to compare safety and efficacy of a continuous infusion of low dose remifentanil plus ketamine combined with propofol in comparison to the standard regimen dose of remifentanil plus propofol continuous infusion during ERCP.Material/Methods322 ASAI-III patients, 18–85 years old and scheduled for planned ERCP were randomized. Exclusion criteria were a predictable difficult airway, drug allergy, and ASA IV–V patients.We evaluated Propofol 1 mg/kg/h plus Remifentanil 0.25 μg/kg/min (GR) vs. Propofol 1 mg/kg/h plus Ketamine 5 μg/kg/min and Remifentanil 0.1 μg/kg/min (GK).Main outcome measures were respiratory depression, nausea/vomiting, quality of intraoperative conditions, and discharge time. P≤0.05 was statistically significant (95% CI).ResultsRespiratory depression was observed in 25 patients in the GR group compared to 9 patients in the GK group (p=0.0035). ERCP was interrupted in 9 cases of GR vs. no cases in GK; patients ventilated without any complication. Mean discharge time was 20±5 min in GK and 35±6 min in GR (p=0.0078) and transfer to the ward delayed because of nausea and vomiting in 30 patients in GR vs. 5 patients in GK (p=0.0024). Quality of intraoperative conditions was rated highly satisfactory in 92% of GK vs. 67% of GR (p=0.028).ConclusionsThe drug combination used in GK confers clinical advantages because it avoids deep sedation, maintains adequate analgesia with conscious sedation, and achieves lower incidence of postprocedural nausea and vomiting with shorter discharge times.

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“…23,24 Toward improving patient safety, this study was designed to determine whether administration of the AMPAKINE CX717 would offer protection against propofol-induced respiratory depression. The hypothesis is based on the fact that CX717 increases the strength and efficacy of glutamatergic neurotransmission via AMPARs that is essential for controlling neuronal excitability in key respiratory neuronal populations.…”

Section: Discussionmentioning

confidence: 99%

Coadministration of the AMPAKINE CX717 with Propofol Reduces Respiratory Depression and Fatal Apneas

et al. 2013

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Background: Propofol (2,6-diisopropylphenol) is used for the induction and maintenance of anesthesia in human and veterinary medicine. Propofol's disadvantages include the induction of respiratory depression and apnea. Here, the authors report a clinically feasible pharmacological solution for reducing propofol-induced respiratory depression via a mechanism that does not interfere with anesthesia. Specifically, they test the hypothesis that the AMPAKINE CX717, which has been proven metabolically stable and safe for human use, can prevent and rescue from propofol-induced severe apnea. Methods: The actions of propofol and the AMPAKINE CX717 were measured via (1) ventral root recordings from newborn rat brainstem-spinal cord preparations, (2) phrenic nerve recordings from an adult mouse in situ working heartbrainstem preparation, and (3) plethysmographic recordings from unrestrained newborn and adult rats. Results:In vitro, respiratory depression caused by propofol (2 μM, n = 11, mean ± SEM, 41 ± 5% of control frequency, 63 ± 5% of control duration) was alleviated by CX717 (n = 4, 50-150 μM). In situ, a decrease in respiratory frequency (44 ± 9% of control), phrenic burst duration (66 ± 7% of control), and amplitude (78 ± 5% of control) caused by propofol (2 μM, n = 5) was alleviated by coadministration of CX717 (50 μM, n = 5). In vivo, pre-or coadministration of CX717 (20-25 mg/kg) with propofol markedly reduced propofol-induced respiratory depression (n = 7; 20 mg/kg) and propofol-induced lethal apnea (n = 6; 30 mg/kg). Conclusions: Administration of CX717 before or in conjunction with propofol provides an increased safety margin against profound apnea and death. P ROPOFOL (2,6-diisopropylphenol) is used for the induction and maintenance of anesthesia in human and veterinary medicine. Propofol's favorable attributes are its pharmacokinetic properties that result in a rapid, clear emergence. Its disadvantages include the induction of respiratory depression, apnea, and blood pressure reductions.1,2 Furthermore, there are increasing reports What We Already Know about This Topic• Propofol depresses respiration partly due to the activation of γ-aminobutyric acid receptors within brainstem respiratory center AMPAKINEs effectively alleviates opioid-induced respiratory depression without interfering with analgesia in rodentsWhat This Article Tells Us That Is New Address correspondence to Dr. Greer: University of Alberta, Department of Physiology, Centre for Neuroscience, Women and Children's Health Research Institute, 3-020M Katz Building, Edmonton, Alberta, Canada T6G 2S2. john.greer@ualberta.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology's articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.

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Sedation for gastrointestinal endoscopy: the changing landscape

Cited by 27 publications

References 21 publications

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Ketamine, propofol and low dose remifentanil versus propofol and remifentanil for ERCP outside the operating room: Is ketamine not only a “rescue drug”?

Coadministration of the AMPAKINE CX717 with Propofol Reduces Respiratory Depression and Fatal Apneas

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