Can liver cirrhosis patients benefit from target controlled infusion of propofol for conscious sedation during endoscopic variceal ligation?

Background: The aim of the present study was to evaluate the feasibility of conscious sedation using target controlled infusion of propofol combined with a single dose of fentanyl during endoscopic variceal ligation in patients with liver cirrhosis.Methods: Forty-eight patients with liver cirrhosis scheduled for endoscopic variceal ligation were randomly assigned to deep sedation group (DS group) with intravenous bolus of propofol and conscious sedation group (CS group) with target controlled infusion of propofol, 1 μg/kg fentanyl was intravenously injected in each patient before administration of propofol. Cardiorespiratory parameters were monitored, and the side-effects were recorded. The depth of sedation was assessed by both of the sale of observer′s assessment of alertness/sedation (OAA/S) and the bispectral index (BIS). The quality of sedation/analgesia was evaluated by the endoscopist and patients using Visual Analog Scores (VAS). The recovery level was evaluated with the Aldrete scales.Results: No significant differences were found on demographic data and initial parameters in the two groups. Compared with the CS group, the changes of mean arterial pressure (MAP) and heart rate (HR) and the signs of respiratory depression were significant in the DS group (p<0.05). The recovery time in DS group (16.7±2.7 minutes) was much longer than that in the CS group (9.3±3.0 minutes, p<0.01). There was no difference in Visual Analogue Scale scores for endoscopist’s satisfaction between the two groups (9.2±0.6 versus 9.0±0.6, p>0.05), but a higher degree of satisfaction for patient was found in the DS group (9.3±0.6 versus 7.9±0.7, p<0.01).Conclusions: Conscious sedation with target controlled infusion of propofol combined with a single bolus of fentanyl for endoscopic variceal ligation in patients with liver cirrhosis had better hemodynamic stability, less respiratory depression and shorter recovery time.

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Comparison of Dexmedetomidine with Fentanyl and Pentazocine – Promethazine in patients undergoing dilation and curettage in monitored anesthesia care

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.076 ◽

2021 ◽

Vol 8 (3) ◽

pp. 396-400

Author(s):

Akanksha Aggarwal ◽

Divya Mahajan

Keyword(s):

Respiratory Depression ◽

Recovery Time ◽

Conscious Sedation ◽

Monitored Anesthesia Care ◽

Analgesic Effects ◽

Dilatation And Curettage ◽

Dilation And Curettage ◽

Recovery Profile ◽

Minor Surgery ◽

Sedative Drugs

Dilatation and curettage (D and C) is an essential and common minor surgery in obstetrics and gynecology. Sedation, hypnosis and analgesia are used in combination for such short procedures. These days conscious sedation is provided to patients for day care surgeries which includes analgesia, sedation and anxiolysis while rapid recovery is ensured without side effects. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and conscious sedation without respiratory depression. It was to study the effect of dexemedetomidine with fentanyl versus Pentazocine with promethazine on hemodynamic stability and recovery during sedation in dilatation and curettage procedure. The comparison included the hemodynamic data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedetomidine loading dose 1 μg/kg over 10 min and followed by 0.5 μg/kg/hr infusion till completion of surgery and group PP received pentazocine 0.5 mg/kg (max 30mg) and Promethazine 12.5 mg slow intravenous Bolus. Dexmedetomidine is a safe drug which provides good hemodynamics and less recovery time. It also exerts sedative and analgesic effects without respiratory depression unlike most analgesic/sedative drugs, such as ketamine, pentazocine and benzodiazepines. This study demonstrates that dexmedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine administration showed better preservation of MAP and SpO2.

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Comparative evaluation of hemodynamic stability and recovery during conscious sedation by dexmedetomidine with fentanyl versus ketamine with fentanyl dilatation and curettage

QJM ◽

10.1093/qjmed/hcaa039.050 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Cited By ~ 1

Author(s):

G F Kamel ◽

R M Ali ◽

A E A Ismail ◽

B E A Hanna

Keyword(s):

Respiratory Depression ◽

Recovery Time ◽

Conscious Sedation ◽

Diagnostic Procedures ◽

Locus Ceruleus ◽

Hemodynamic Stability ◽

Analgesic Effects ◽

Dilatation And Curettage ◽

Recovery Profile ◽

Sedative Drugs

Abstract Background Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, predictable recovery with minimal post-operative sequels. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and cooperative sedation without respiratory depression. it inhibits the release of norepinephrine via actions on the alpha2A (α-2A) adrenoceptors located in the locus ceruleus and the spinal cord, resulting in sedation and analgesia via sympatholysis. Objective It was to study the effect of dexemdetornidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. The comparison included the vital data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. Patients and Methods In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedtomidine loading dose 1 πg/kg over 10 min and followed by 0.5 πg/kg/hr infusion till completion of surgery and group KF received ketamine 0.5 mg/kg slow intravenous Bolus. Results Dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines and propofol. Conclusion This study demonstrates that dexrnedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine better preserved MBP and SpO2.

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Efficacy of an Oxycodone-Propofol Combination versus a Fentanyl-Propofol Combination in Conscious Sedation during Therapeutic Endoscopic Retrograde Cholangiopancreatography in Elderly Patients

Gerontology ◽

10.1159/000511173 ◽

2020 ◽

pp. 1-8

Author(s):

Peipei Guo ◽

Huisheng Wu ◽

Lan Liu ◽

Qiu Zhao ◽

Zhao Jin

Keyword(s):

Adverse Events ◽

Elderly Patients ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Postoperative Nausea ◽

Recovery Time ◽

Adverse Reactions ◽

Conscious Sedation ◽

Endoscopic Retrograde ◽

Patients Satisfaction ◽

Low Incidence

Background: With a rapidly aging population, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. The commonly used sedation anesthesia in ERCP is a combination of propofol and fentanyl, even though fentanyl may cause some adverse reactions such as respiratory depression. Objectives: This study aimed to evaluate the efficacy of oxycodone combined with propofol versus fentanyl combined with propofol for sedation anesthesia during ERCP. Methods: A total of 193 patients aged from 65 to 80 years undergoing ERCP were enrolled and randomized into two groups: an “oxycodone combined with propofol” group (group OP, n = 97) and a “fentanyl combined with propofol” group (group FP, n = 96). The rate of perioperative adverse events as well as the recovery time, patients’ satisfaction, and endoscopists’ satisfaction were noted. Results: There was no difference in the frequency of hypotension or bradycardia between the two groups, but there were more episodes of desaturation (SpO2 <90% for >10 s in 8.3%), postoperative nausea (7.3%), and vomiting (5.2%) in group FP than in group OP. Patients’ satisfaction in group FP was lower than that in group OP. The recovery time was longer in group FP than in group OP. Conclusions: Oxycodone combined with propofol was effective in ERCP, with a low incidence of perioperative adverse events.

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Conscious sedation with target-controlled infusion (TCI) of remifentanil associated with low doses of midazolam for in vitro fertilization (IVF): A suitable option?

European Journal of Anaesthesiology ◽

10.1097/00003643-201106001-00072 ◽

2011 ◽

Vol 28 ◽

pp. 23

Author(s):

H. Morue ◽

E. Engelman ◽

J. C. Salengros ◽

L. Van Obbergh ◽

L. Barvais

Keyword(s):

In Vitro Fertilization ◽

Conscious Sedation ◽

Low Doses ◽

Vitro Fertilization ◽

Target Controlled Infusion

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Endoscopic injection sclerotherapy improves liver function compared with endoscopic variceal ligation

Scientific Reports ◽

10.1038/s41598-021-99855-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tsuguru Hayashi ◽

Tatsuyuki Watanabe ◽

Michihiko Shibata ◽

Shinsuke Kumei ◽

Shinji Oe ◽

...

Keyword(s):

Liver Cirrhosis ◽

Liver Function ◽

Confidence Interval ◽

Linear Regression Analysis ◽

Meld Score ◽

Injection Sclerotherapy ◽

Endoscopic Variceal Ligation ◽

Endoscopic Injection Sclerotherapy ◽

Endoscopic Injection ◽

Liver Functions

AbstractLiver function is a most important prognostic factor in patients with liver cirrhosis. Also, portal hypertension is a fatal complication of liver cirrhosis and variceal treatment is indispensable. However, changes of liver functions after endoscopic variceal treatments are unknown. The aim of this study was to evaluate prognosis and liver functions after endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). A total of liver cirrhotic 103 patients who underwent prophylactic EIS and EVL were enrolled. Overall survival rate was higher in EIS group than EVL group (p = 0.03). Multivariate analysis showed that EIS was a negative factor for death (HR: 0.46, 95% confidence interval: 0.24–0.88, p = 0.02). Liver functions were assessed by blood test taken at before and 3 months after treatment. In EIS group, albumin and prothrombin time improved (p < 0.01), leading to improvement of Child–Pugh score, ALBI score and MELD score (p < 0.05). However, these did not improve in EVL group. EIS was a significant factor related to the elevated value of albumin after treatment in linear regression analysis (estimated regression coefficient: 0.17, 95% confidence interval: 0.05–0.29, p = 0.005). These results revealed that EIS could improve liver functions and prognosis.

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Indikationen und Limitationen des Gehtrainings bei Patienten mit Cladicatio intermittens

VASA ◽

10.1024/0301-1526.31.1.23 ◽

2002 ◽

Vol 31 (1) ◽

pp. 23-27 ◽

Cited By ~ 1

Author(s):

Takashi Ohta ◽

Sugimoto ◽

Takeuchi ◽

Hosaka ◽

Ishibashi

Keyword(s):

Exercise Training ◽

Intermittent Claudication ◽

Recovery Time ◽

Ankle Brachial Index ◽

Walking Distance ◽

Hemodynamic Parameters ◽

Arterial Reconstruction ◽

Arteriosclerosis Obliterans ◽

Degree Of Satisfaction ◽

Selection Of

Background: The selection of candidates for exercise training among patients with intermittent claudication is still a matter of debate. Patients and methods: Forty-nine patients with intermittent claudication due to arteriosclerosis obliterans were tested. Forty-six patients were men and 3 were women, with an average age of 65 years (range, 46 to 76 years). The patients walked on a treadmill at 2.4 km/h on a 12% upgrade followed by an appropriate period of rest for 30 minutes twice a day during a 3-week hospitalization. Programs were individualized for each patient. Four parameters were assessed after exercise training: (1) Ankle-brachial index (ABI) at rest, (2) Fall in ABI after 40 m of treadmill walking (ABI Fall 40), (3) the recovery time (RT 40) required for the ABI to return to resting levels after 40 m of walking, and (4) the maximal walking distance (MWD) on the treadmill. Results: The average ABI at rest before the 3-week training period was 0.60 ± 0.02 (mean ± SE), and after training it was 0.62 ± 0.02. There was a small although not statistically significant increase in the ABI after training. This increase in the ABI did not exceed 0.21. The average ABI Fall 40 before training was 0.36 ± 0.01, and after training it was 0.30 ± 0.02. The average RT 40 before training was 9.9 ± 0.8 min, and after training it was 6.2 ± 0.6 min. There were significant decreases in the ABI Fall 40 and RT 40 after training (p < 0.01 and p < 0.001, respectively). The MWD increased after training in 48 of the 49 patients. The average MWD increased from 134 ± 13 m to 226 ± 32 m after training (p < 0.001). The occlusion levels did not influence the results as training effects and hemodynamic parameters. Fourteen of 49 patients desired arterial reconstruction after exercise training. Conclusions: Patients with shorter RT 40’s before training achieved greater increases in the MWD after training. In patients with an RT 40 under 12 min, exercise training is indicated. However, there is some discrepancy between the increase in MWD and the degree of satisfaction in individual patients.

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Placebo versus low-dose ketamine infusion in addition to remifentanil target-controlled infusion for conscious sedation during oocyte retrieval

European Journal of Anaesthesiology ◽

10.1097/eja.0000000000000826 ◽

2018 ◽

Vol 35 (9) ◽

pp. 667-674 ◽

Cited By ~ 1

Author(s):

Hélène I. Morue ◽

Shalini Raj-Lawrence ◽

Sarah Saxena ◽

Anne Delbaere ◽

Edgard Engelman ◽

...

Keyword(s):

Low Dose ◽

Conscious Sedation ◽

Oocyte Retrieval ◽

Ketamine Infusion ◽

Target Controlled Infusion

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Prehospital Treatment of Severe Hypoglycaemia: A Comparison of Intramuscular Glucagon and Intravenous Glucose

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00030132 ◽

1998 ◽

Vol 13 (2-4) ◽

pp. 44-50 ◽

Cited By ~ 12

Author(s):

Søren Carstens ◽

Michael Sprehn

Keyword(s):

Recovery Time ◽

Insulin Treatment ◽

Severe Hypoglycaemia ◽

Demographic Data ◽

Intravenous Glucose ◽

Prehospital Treatment ◽

Patient Interviews ◽

Patient Will ◽

Intensified Insulin Treatment

AbstractIntroduction:By introducing an intensified insulin treatment regime to patients with insulin-dependant diabetes mellitus (IDDM), the frequency of long-term complications that the patient will experience has been shown to decrease. The price is an increase in the frequency of severe and mild hypoglycaemic events. Therefore, constant monitoring of these patients is necessary.Hypothesis:This study compares the time until full recovery of IDDM patients with severe hypoglycaemia after treatment with either intravenous glucose or intramuscular glucagon.Methods:14 patients with IDDM with severe hypoglycaemia requiring treatment by the medical staff was randomised to treatment either with 50 ml of 50% glucose intravenously or intramuscular 1 mg glucagon. The time to recovery was recorded. Plasma glucose was measured at fixed intervals to achieve a glycaemia profile. Demographic data were acquired through patient interviews following recovery.Results:Recovery time between the two groups was significantly different statistically. Recovery time ranged for 1 to 3 minutes for those receiving glucose intravenously and 8 to 21 minutes for those receiving intramuscular glucagon. Characteristic glycaemia profiles were identified and differences were present between the two groups with a greater fluctuating pattern for the glucose group compared to the steadily increasing pattern seen after glucagon treatment. Alcohol was believed to be involved in 8 out of the 14 cases, and thereby, is the major confounding factor in this study.Conclusion:Intramuscularly administered glucagon is a safe and reliable alternative to intravenous glucose infusion. The fluctuating glyceamia pattern seen after glucose treatment indicates a low risk for secondary hypoglycaemia. However, further studies are necessary to support this assertion.

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