Efficacy and safety of EBUS‐TBNA under conscious sedation with meperidine and midazolam

Abstract Background EUS-gastroenterostomy (EUS-GE) is a novel modality in the management of malignant gastric outlet obstruction (MGOO). It is, however, technically challenging limiting its widespread application. To facilitate EUS-GE, a double balloon catheter has been developed in Japan. While this tool is not available outside of Asia, we have conceived a similar device using a widely available vascular balloon catheter. We aim to determine the clinical efficacy and safety of EUS-GE using this double balloon device (DBD). Aims We aim to determine the clinical efficacy and safety of EUS-GE using this double balloon device (DBD). Methods This is a single-centre, retrospective study of consecutive patients who underwent DBD assisted EUS-GE for MGOO from January 2019-June 2020 (IRB approved). The DBD consists of two 60 mm vascular balloons (Coda, Cook Medical, USA) fashioned together with the balloons 10 cm apart (Figure 1). It is inserted across the obstruction over a wire to the ligaments of Treitz. Both balloons are then inflated followed by saline and contrast infusion into the occluded small bowel segment to facilitate EUS-guided insertion of a 15 mm cautery assisted lumen apposing metal stent (AxiosTM, Boston Scientific Inc, USA). The primary endpoint is the rate of technical success defined as adequate deployment of the stent. Secondary endpoints include rate of clinical success and adverse events. Results A total of 11 patients were included in this study. 45% were female with a mean age of 64.9 ± 8.6 years old. The etiology of MGOO was 73% pancreatic cancer, 9% gastric cancer, 9% duodenal cancer, and 9% metastatic cervical cancer. Procedures were performed under general anesthesia and conscious sedation in 82% and 18%, of patients respectively. The mean procedure time was 64.8 ± 25.8 minutes. Technical and clinical success (intention to treat) was 91%. The only technical failure was due to poor patient tolerance of the procedure under conscious sedation. There was one adverse event (9%) due to stent migration rated as severe. Two patients (18%) required re-intervention for stent obstruction secondary to food impaction associated with non-compliance to a low-residue diet. Following re-enforced instructions, no further obstruction occurred. All patients started a clear liquid diet within 1 day of the procedure with a mean time to a low residue diet of 3.25 days ± 2.5. The median length of hospital stay following the procedure was 5 days ± 13. The median follow-up time was 84 days (IQR 152). Conclusions DBD assisted EUS-GE is clinically effective and safe. This balloon device may greatly facilitate the technical aspect of EUS-GE while potential enhancing its safety and clinical use. Larger studies are needed to validate this approach to EUS-GE. Funding Agencies None

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Sedation in Uncooperative Children Undergoing Dental Procedures: A Comparative Evaluation of Midazolam, Propofol and Ketamine.

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.32.1.v74872j8n74qu81k ◽

2007 ◽

Vol 32 (1) ◽

pp. 1-4 ◽

Cited By ~ 15

Author(s):

Kavitha Rai ◽

Amitha Hegde ◽

Kukul Goel

Keyword(s):

Side Effects ◽

Pediatric Patients ◽

Conscious Sedation ◽

Cooperative Behavior ◽

Parental Consent ◽

Efficacy And Safety ◽

Oral Rehabilitation ◽

Duration Of Action ◽

Dental Procedures ◽

Future Evaluation

Dentists usually face a common problem dealing with pediatric patients due to their high levels of anxiety and fear, associated with dental procedures. Such children are usually managed by various pharmacological methods. The efficacy and safety of conscious sedation, using intravenous short acting group of drugs(midazolam, propofol and ketamine ) in uncooperative children, requiring oral rehabilitation was thus evaluated in this study. A total of 30 uncooperative children, aged 3-6 years, belonging to ASA I, II category formed the study group. The efficacy of the three group of drugs was evaluated on the basis of the onset of sedation, duration of action, side effects encountered, and the overall cooperative behavior of the child throughout the course of the procedure, after obtaining parental consent. Results showed that propofol was highly effective in terms of onset of sedation, although increased body movements and crying, pain on injection and intermittent cough was observed as the main side effects of the drug. Midazolam showed the longest duration of action, but was not very effective in terms of treatment completion due to increased movements and crying. Maximum cooperation during the procedure was obtained with ketamine and no adverse effects were encountered. We preferred ketamine from the results of our study and recommended future evaluation of ketamine in combination with other sedatives.

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Efficacy and Safety of Dexmedetomidine for Conscious Sedation During Endoscopic Submucosal Dissection

The American Journal of Gastroenterology ◽

10.14309/00000434-201610001-00337 ◽

2016 ◽

Vol 111 ◽

pp. S156

Author(s):

Taeko Ninomiya ◽

Yosuke Tsuji ◽

Mitsuhiro Fujishiro ◽

Chiaki Kobayashi

Keyword(s):

Endoscopic Submucosal Dissection ◽

Conscious Sedation ◽

Efficacy And Safety ◽

Submucosal Dissection

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The Efficacy and Safety of Percutaneous Kyphoplasty in the Management of Patients With Painful Spinal Osteoblastic Metastases

10.21203/rs.3.rs-410317/v1 ◽

2021 ◽

Author(s):

Wence Wu ◽

Huanmei Liu ◽

Xinxin Zhang ◽

Shengji Yu

Keyword(s):

Minimally Invasive ◽

Conscious Sedation ◽

Short Form ◽

Karnofsky Performance Score ◽

Efficacy And Safety ◽

Performance Score ◽

Invasive Approach ◽

Percutaneous Kyphoplasty ◽

Vas Scores

Abstract Background: The study aimed to evaluate the clinical efficacy and safety of minimally invasive approach for painful spinal osteoblastic metastases by percutaneous kyphoplasty (PKP).Methods: A total of 30 patients (11 males and 19 females, average age, 58.9 ± 8.7 years) with 56 spinal osteoblastic lesions underwent PKP under conscious sedation were reviewed retrospectively. Visual analogue scale (VAS) score was employed to assess pain. Karnofsky performance score (KPS), quality of life (QOL) score (short form with 36 questions) and related complications were used to evaluate the clinical outcomes of the procedures.Results: All patients underwent PKP successfully and the pain was significantly alleviated after PKP. Mean VAS scores decreased significantly from 6.07 ± 1.84 preoperatively to 2.70 ± 1.56 at 3 days after PKP (P<0.001), and remained largely immutable at 1 month (2.03 ± 0.72; 30 patients; P<0.001), 3 months (2.38 ± 1.24; 29 patients; P<0.001) and 1 year (3.04 ± 1.00; 26 patients; P<0.001). Mean KPS and QOL scores were 59.33 ± 19.11 and 91.20 ± 12.88 preoperatively and improved to 69.31 ± 19.81 (P < 0.001) and 99.61 ± 12.29 (P < 0.001) at 3 months after PKP, respectively. Two (6.7%) patients suffered from the leakage of bone cement.Conclusions: As a minimally invasive surgery, PKP may not only effectively allevated the pain, but also safely improved the QOL of spinal osteoblastic metastatic patients.

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