Dexmedetomidine versus Ketamine-Propofol for Sedation of Obese Patients Undergoing Upper Gastrointestinal Endoscopy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ola Nasser Hussain Zaher ◽  
Reem Hamdy El Kabarity ◽  
Rania Magdy Mohamed Ali ◽  
Mohamed Moien Mohamed
Keyword(s):  
Gastrointestinal Endoscopy ◽  
University Hospital ◽  
Patient Comfort ◽  
Controlled Clinical Trial ◽  
Upper Gastrointestinal Endoscopy ◽  
Obese Patients ◽  
Gamma Aminobutyric Acid ◽  
Random List ◽  
Upper Gastrointestinal ◽  
Sedation Regimen

Abstract Background Gastrointestinal endoscopy is an uncomfortable and stressful procedure for most patients. Conscious sedation is a common strategy for improving patient comfort during this procedure. Benzodiazepines (gamma-aminobutyric acid (GABA) agonists) such as midazolam have been used for sedation of patients undergoing gastrointestinal endoscopy. The effective dose ranges of such agents differ considerably among patients, making it difficult to achieve stable sedation. Also obesity is a significant health problem that has assumed epidemic proportions. As a result, the number of obese patients requiring endoscopy is increasing. It is relatively unknown how safe the current practices of sedation for endoscopic procedures are in bariatric patients. Therefore, special consideration should be given to these patients Aim of the Work To compare the sedative properties and haemodynamic and respiratory effects of Dexmedetomidine and a Ketamine-Propofol combination (ketofol) in obese patients undergoing Upper GI Endoscopy. Patients and Methods This study was conducted in the endoscopy unit of Ain Shams University Hospital after obtaining approval from the Research Ethical Committee of Ain Shams University. A prospective, randomized controlled clinical trial was found to be the most suitable design in order to achieve the study objectives. Cases were divided into 2 groups using computer generated random list of numbers in sealed opaque envelopes. Results We found that ketamine-propofol infusion (1:3) is a better sedation regimen for upper gastrointestinal endoscopy compared to dexmedetomidine as lesser time is taken to achieve optimal sedation, with no hemodynamic unstability or postprocedure complications. Conclusion In this study, we compared a group of 40 upper GIT endoscopy obese patients (BMI 30-40) who received procedural sedation with either Dexmedetomidine or propofolketamine combination, we found that ketamine-propofol infusion (1:3) is a better sedation regimen for upper gastrointestinal endoscopy compared to dexmedetomidine as lesser time is taken to achieve optimal sedation, with no hemodynamic unstability or post procedure complications.

scholarly journals Prevalence of upper digestive endoscopy and gastric histopathology findings in morbidly obese patients

2012 ◽  
Vol 49 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Judite Dietz ◽  
Jane Maria Ulbrich-Kulcynski ◽  
Katia Elisabete Pires Souto ◽  
Nelson Guardiola Meinhardt
Keyword(s):  
Bariatric Surgery ◽  
Intestinal Metaplasia ◽  
Gastrointestinal Endoscopy ◽  
Lymphoid Hyperplasia ◽  
Upper Gastrointestinal Endoscopy ◽  
Obese Patients ◽  
Digestive Endoscopy ◽  
Upper Digestive Endoscopy ◽  
H Pylori ◽  
Upper Gastrointestinal

CONTEXT: The prevalence of obesity has been increasing in modern society. Roux-en-y gastric bypass is a bariatric surgery that involves the exclusion of significant part of the stomach. Atrophy, intestinal metaplasia and gastric cancer have been associated with infection by Helicobacter pylori. OBJECTIVES: To evaluate the presence of endoscopy findings and histological changes in morbid obese patients for the presence of inflammatory cells, inflammatory activity, lymphoid hyperplasia, H. pylori infection, atrophy and intestinal metaplasia in the gastric mucosa. METHODS: Upper digestive endoscopy and gastric histopathological were studied in 126 obese patients in the preoperative evaluation for bariatric surgery. RESULTS: Upper digestive endoscopy abnormalities were diagnosed in 73/126 (57.9%) patients. In three patients (2.4%) the upper gastrointestinal endoscopy diagnosed gastric ulcer and one patient (0.8%) had duodenal ulcer. The histopathological from gastric biopsies of these obese patients showed 65.1% of mucosa inflammation, inflammatory activity in 50.0%, infection by H. pylori in 53.2%, lymphoid hyperplasia in 50.0% and atrophy and/or intestinal metaplasia in 16.7%. CONCLUSIONS: In present study, with routine preoperative upper gastrointestinal endoscopy and histopathological examination, were detected 57.9% patients with endoscopy abnormalities, high prevalence of infection by H. pylori (53%) and 16.7% of gastric atrophy and/or intestinal metaplasia.

scholarly journals Prevalence of Asymptomatic Hiatal Hernia in Obese Patient in Routine Upper Gastrointestinal Endoscopy Screening and Correlation with BMI

2020 ◽  
Author(s):  
Bandar Saad Assakran ◽  
Khaled Mohammed Alrakbi ◽  
Meshari Abdulrahman Alharbi ◽  
Moath Abdullah Almatroudi ◽  
Asim Nizar Alshowaiman ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Hiatus Hernia ◽  
Protective Factor ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Obese Patients ◽  
Chi Square ◽  
Chi Square Test ◽  
Upper Gi Endoscopy ◽  
Upper Gastrointestinal

Abstract Background In obese patients, hiatus hernia (HH) can be asymptomatic or it may present with one or few symptoms such as heartburn, nausea, or vomiting. Routine upper gastrointestinal endoscopy is the most frequent method to determine the presence of any abnormalities including hiatus hernia.Aim The aim of this study is to assess the prevalence of asymptomatic hiatal hernia in obese patients in routine upper GI endoscopy screening and correlation with BMI.Materials and Methods This was an observational retrospective cohort study conducted at King Fahad Specialist hospital-Buraydah, Qassim, Saudi Arabia. The data were extracted from the medical records and electronic charts of all obese patients who had upper gastrointestinal endoscopy screening between January 2017 – December 2019. Data were tabulated in MS Excel and were analyzed using SPSS version 21.Results Among the 690 obese patients, the prevalence of HH was 103 yielding an overall percentage of 14.3%. Chi-square test revealed that the use of Proton-pump inhibitors (PPI) (X2=6.876; p=0.009) and abdominal pain (X2=3.885; p=0.049), shortness of breath (X2=8.057; p=0.005), vomiting (X2=4.302; p=0.038), nausea (X2=4.090; p=0.043) and other HH symptoms (X2=3.897; p=0.048) significantly influenced HH but the BMI level did not (X2=2.126; p=0.345). In multivariate regression model, the use of PPI medication (AOR=0.237; CI=0.074 – 0.760; p=0.023) significantly decreased the risk of HH while vomiting (AOR=1.722; CI=1.025 – 2.890; p=0.040) and nausea (AOR=1.698; CI=1.012 – 2.849; p=0.045) significantly increased the risk of HH.Conclusion Asymptomatic HH among obese patients is not widely prevalent in our region. The use of PPI medications was a protective factor of HH while symptoms such as vomiting and nausea increased the risk of HH. However, there was no evidence found linking BMI to HH as shown in this study.

scholarly journals Prevalence of Asymptomatic Hiatal Hernia in Obese Patient in Routine Upper Gastrointestinal Endoscopy Screening and Correlation with BMI

2020 ◽  
Author(s):  
Bandar Saad Assakran ◽  
Khaled Mohammed Alrakbi ◽  
Meshari Abdulrahman Alharbi ◽  
Moath Abdullah Almatroudi ◽  
Asim Nizar Alshowaiman ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Hiatus Hernia ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Obese Patients ◽  
Microsoft Excel ◽  
Chi Square ◽  
Chi Square Test ◽  
Upper Gi Endoscopy ◽  
Upper Gastrointestinal

Abstract Background In obese patients, hiatus hernia (HH) can be asymptomatic or it may present with one or few symptoms such as heartburn, nausea, or vomiting. Routine upper gastrointestinal endoscopy is the most frequent method to determine the presence of any abnormalities including hiatus hernia. The aim of this study is to assess the prevalence of asymptomatic hiatal hernia in obese patients in routine upper GI endoscopy assessment and correlation with BMI. Methods This was an observational retrospective cohort study conducted at King Fahad Specialist hospital - Buraydah, Qassim, Saudi Arabia. The data were extracted from the medical records and electronic charts of all obese patients who had preoperative upper gastrointestinal endoscopy assessment between January 2017 – December 2019. Data were tabulated in Microsoft Excel and were analyzed using SPSS version 21. Results Among the 690 obese patients, the prevalence of HH was 103 yielding an overall percentage of 14.9%. Chi-square test revealed that the abdominal pain (X2=3.885; p=0.049), shortness of breath (X2=8.057; p=0.005), vomiting (X2=4.302; p=0.038), nausea (X2=4.090; p=0.043) and other HH symptoms (X2=3.897; p=0.048) significantly influenced HH but the BMI level did not (X2=2.126; p=0.345). In multivariate regression model, the use of PPI medication (AOR=0.237; CI=0.074 – 0.760; p=0.023), while vomiting (AOR=1.722; CI=1.025 – 2.890; p=0.040) and nausea (AOR=1.698; CI=1.012 – 2.849; p=0.045) significantly increased the risk of HH. Conclusion Asymptomatic HH among obese patients is not widely prevalent in our region. The use of PPI medications was found to decrease the symptoms associated with HH while symptoms such as vomiting and nausea increased the risk of HH. However, there was no evidence found linking BMI to HH as shown in this study.

scholarly journals AB166. SOH21AS166. An audit of the photographic documentation of upper gastrointestinal endoscopy at Cork University Hospital

2021 ◽  
Vol 5 ◽  
pp. AB166-AB166
Author(s):  
Stephen John O’Brien ◽  
Niamh Foley ◽  
Amy Edwards Murphy ◽  
Morgan McCourt ◽  
Shane Killeen ◽  
...  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
University Hospital ◽  
Upper Gastrointestinal Endoscopy ◽  
Photographic Documentation ◽  
Upper Gastrointestinal

The importance of upper gastrointestinal endoscopy in morbidly obese patients

2015 ◽  
Vol 26 (3) ◽  
pp. 228-231 ◽  
Author(s):  
Birol Baysal ◽  
Yusuf Kayar ◽  
Ahmet Danalioglu ◽  
Tuba Ozkan ◽  
Nuket Bayram Kayar ◽  
...  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Upper Gastrointestinal

scholarly journals EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPY IN PATIENTS UNDERGOING BARIATRIC SURGERY

2015 ◽  
Vol 28 (suppl 1) ◽  
pp. 39-42 ◽  
Author(s):  
Maurício Saab ASSEF ◽  
Tiago Torres MELO ◽  
Osvaldo ARAKI ◽  
Fábio MARIONI
Keyword(s):  
Bariatric Surgery ◽  
Gastrointestinal Endoscopy ◽  
Control Group ◽  
Upper Gastrointestinal Endoscopy ◽  
Upper Endoscopy ◽  
Obese Patients ◽  
Endoscopic Findings ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Upper Gastrointestinal

Background: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients. Aim: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control group. Method: A series of 35 obese patients in preoperative period for bariatric surgery compared with a control group of 30 patients submitted to upper endoscopy. There were analyzed clinical and endoscopic data. Results: The mean age of the group of patients was 43.54 years. Most individuals in the group of patients were female with median BMI of 47.26kg/m2and in control group 24.21 kg/m2. The majority of patients were asymptomatic. Upper endoscopy was altered in 81.25% of asymptomatic patients. Endoscopic findings in the patient group were 57.1% resulting from peptic ulcer disease and 34.3% associated with GERD. The analysis of endoscopic findings in patients showed no significant difference in relation of the control group. The prevalence of H. pylori infection was 60% in patients. Conclusion: It is recommended that the upper endoscopy should be made in all patients in the preoperative bariatric surgery period, although the degree of obesity is not related to a greater number of endoscopic findings. Obese patients do not have more endoscopic findings that non-obese individuals.

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