scholarly journals Effect of Nalbuphine Combined With Intravenous Propofol for Anesthesia During Intestinal Endoscopic Submucosal Dissection in the Elderly

2021 ◽  
Author(s):  
Jingjing Liu ◽  
Biwei Zhan ◽  
Yongjun Zeng
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Dose Group ◽  
Total Duration ◽  
The Elderly ◽  
Neurocognitive Function ◽  
High Dose ◽  
Blood Oxygen Saturation ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
Medium Dose

Abstract Objective: To investigate the effects of different doses of nalbuphine combined with an intravenous propofol pump for anesthesia during intestinal endoscopic submucosal dissection (ESD) in the elderly.Methods: A total of 85 elderly patients attending the Hanchuan People's Hospital from January 2016 to January 2018 were divided into low, medium, and high dose groups according to the intravenous dosing of nalbuphine given with a continuous propofol pump.The heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SaO2) were evaluated at five different time points (T1-T2).The levels of norepinephrine (NE), cortisol and blood glucose were intervals recorded. The occurrence of adverse reactions, hospitalization days, visual analogue scale (VAS) score, Ramsay sedation, and wake score after waking from anesthesia were assessed. Neurocognitive function was assessed at discharge and after surgery using the Montreal Cognitive Assessment (MoCA). Results: MR, MAP and SaO2 decreased significantly at T0-T4 in tested groups. The levels of NE, Cor, and Glu were significantly increased in three groups at T1-T3 and decreased among the medium-dose group. There was no statistically significant difference between the three groups in the total duration of anesthesia and the operative duration. The medium-dose group was performing significantly better than the low and high dose groups in clinical indicators. The postoperative VAS and Ramsay scores were higher in the low dose group (P＜0.05). There was a significant difference in neurocognitive function scores and no significant differences in postoperative anesthesia satisfaction and hospitalization days were observed amongst the three groups (P>0.05).Conclusions: The use of nalbuphine (0.1 mg/kg) combined with propofol for anesthesia during intestinal ESD in the elderly can shorten recovery times and reduce the incidence of postoperative adverse events and neurocognitive disorders.

Vonoprozan: potentially new first-line treatment for delayed upper gastrointestinal bleeds following endoscopic procedures? A letter to the editor

2022 ◽  
Vol 71 (12) ◽  
pp. 2838-2838
Author(s):  
Muhammad Umer ◽  
Syed Wasif Bukhari
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Gastrointestinal Diseases ◽  
High Dose ◽  
First Line ◽  
Gastroesophageal Varices ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
H Pylori ◽  
Line Of Therapy

Endoscopy nowadays is widely used as a diagnostic and therapeutic tool for various gastrointestinal diseases due to it being less invasive and safer. However, amongst some adverse events is delayed bleeding. The definition of delayed bleeding requires endoscopic hemostasis and/or blood transfusion after at least two days of treatment. (1) Oesophageal cancer is comparatively more common in Pakistan, being 7th most common malignancy in men and 6th most common in women in Karachi. (2) Oesophageal endoscopic submucosal dissection (E-ESD) employed in the treatment of the above- mentioned cancer has an incidence of delayed bleeding of about 1.3-6.7%. (1) The prevalence of gastric cancer across Pakistan was about 2-18% (3), for which endoscopic submucosal dissection is often used has an incidence of delayed bleeding of 4.7-15.6%. (1) Endoscopic therapy for gastroesophageal varices can also result in delayed bleeding, the incidence of which easily reaches up to 10%. (1) In a retrospective cohort study of 124,422 patients conducted in Japan, it was found that vonoprazan was more effective in reducing the risk of delayed bleeding compared to omeprazole. (OR= 0.75) (1) Vonoprazan works by competitively inhibiting the potassium-acid channel resulting in strong and sustained acid inhibition. (4) It was also found to have a superior effect in the eradication of H Pylori and an equal effect in acid-related disorders. (5)  In the retrospective study mentioned above, it is also worth noting that the efficacy of vonoprazan was variable with respect to procedures and was most prominent with gastroduodenal endoscopic submucosal dissection (OR=0.70). (1) Other procedures did not elicit any significant difference. In addition, standard/high dose vonoprazan proved to be most efficacious in reducing the risk of delayed bleeding compared with standard/high-dose PPI and low-dose vonoprazan. It was also observed that patients taking anti-thrombotic medications at a higher risk of delayed bleeding also benefited from high-dose vonoprazan. (OR=0.74) (1) The findings above compel the conclusion that high dose vonoprazan should be ideal for reducing the risk of delayed bleeding in patients who have undergone gastroduodenal endoscopic submucosal dissection and/or are on anti-thrombotics. Though high-dose vonoprazan does look promising, it is imperative that more randomized controlled trials on more diverse populations be conducted to further explore its efficacy and safety as the drug might be a potential first line of therapy.

Gender difference in arsenic biotransformation is an important metabolic basis for arsenic toxicity

2021 ◽  
Author(s):  
Maihaba Muhetaer ◽  
Mei Yang ◽  
Rongxiang Xia ◽  
Jun Wu
Keyword(s):  
Gender Differences ◽  
Dose Group ◽  
Low Dose ◽  
Female Rats ◽  
Male Rats ◽  
High Dose ◽  
Arsenic Toxicity ◽  
Male And Female ◽  
Significant Difference ◽  
Medium Dose

Abstract Background: There are gender differences in the biotransformation of arsenic. We investigated the effects of gender differences on arsenic metabolism and arsenic toxicity mechanisms in rat liver tissues. Methods: Rats were treated with different amounts of arsenic compounds. Arsenic form MMA and DMA in the liver was determined by high performance liquid chromatography-hydride generation atomic fluorescence spectroscopy. SAM, ARR, NAD, PNP, PK, and MPO in rat liver were determined by enzyme-linked immunoassay. RT-qPCR was used to determine AS3MT in the liver. Results: Compared with male and female animals in the same group, MMA and DMA were statistically significant in the three groups of iAs3 + high, iAs3 + medium and iAs5+ low (P <0.05). The MMA of male rats in iAs3+ high and medium groups was higher than that of female rats, and the DMA of male rats was lower than that of female rats. As3MT mRNA in the male iAs3+ high group was higher than that of females. Besides, compared between male and female, only in iAS3+ low dose, iAS3+ medium dose, iAS5+ low dose, and iAS5+ medium dose groups, there was significant difference in SAM level (P<0.05). Compared with male and female animals in the same group, male rats had significantly higher PNP and ARR activities while lower PK activity than female rats (P<0.05). Between the male and female groups, only the iAS3+ high dose and medium dose group had a statistically significant difference (P<0.05). The NAD activity of females in iAS3+ high dose group was higher than that of males. Conclusion: Conclusively, under the same arsenic exposure, there were gender differences between female and male rats, and arsenic metabolism was more cytotoxic to male rats than to females.

scholarly journals Outcomes of endoscopic submucosal dissection for superficial esophageal cancer in an elderly population: a retrospective single center cohort study

2019 ◽  
Vol 07 (03) ◽  
pp. E355-E360 ◽  
Author(s):  
Toshiro Iizuka ◽  
Daisuke Kikuchi ◽  
Shu Hoteya
Keyword(s):  
Esophageal Cancer ◽  
Elderly Patients ◽  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
The Elderly ◽  
Superficial Esophageal Cancer ◽  
Younger Patients ◽  
Submucosal Dissection ◽  
Significant Difference

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is increasingly being used to treat superficial esophageal cancer in the elderly. However, data on clinical outcomes in this age group are limited. The aim of this study was to evaluate the safety and efficacy of ESD in treatment of superficial esophageal cancer and its effect on long-term outcome in the elderly. Patients and methods In total, 664 consecutive patients with a histological diagnosis of squamous cell carcinoma or high-grade intraepithelial neoplasia who underwent ESD between April 2008 and March 2016 at our institution were enrolled. Clinical outcomes and prognostic factors were compared retrospectively between those aged 75 years or older (n = 162) and those aged younger than 75 years (n = 502). Results There was no significant difference in post-ESD bleeding (0 vs. 0.8 %, P = 0.27) and perforation rates (1.8 vs. 1.2 %, P = 0.47) between the two age groups; however, stricture rate was higher in younger patients than in elderly patients (20.8 % vs 11 %; P = 0.036). There was no significant difference in the rate of locoregional recurrence between the two groups. Overall survival was significantly different between the two groups, but cause-specific survival was similar. Conclusion These findings confirm the efficacy of ESD for superficial esophageal cancer in selected elderly patients (75 years or older) who were fit for the treatment because they can achieve similar long-term survival to younger patients.

scholarly journals Safety and efficacy of Edaravone Dexborneol versus edaravone for patients with acute ischaemic stroke: a phase II, multicentre, randomised, double-blind, multiple-dose, active-controlled clinical trial

2019 ◽  
Vol 4 (3) ◽  
pp. 109-114
Author(s):  
Jie Xu ◽  
Yilong Wang ◽  
Anxin Wang ◽  
Zhiqiang Gao ◽  
Xiaoping Gao ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Multiple Dose ◽  
Dose Group ◽  
Low Dose ◽  
Control Group ◽  
High Dose ◽  
Score Change ◽  
Double Blind ◽  
Significant Difference ◽  
Medium Dose

BackgroundEdaravone Dexborneol is a novel neuroprotective agent that comprised edaravone and (+)-borneol, a food additive with an anti-inflammatory effect in animal ischaemic stroke models. This study aims to assess the safety and efficacy of Edaravone Dexborneol compared with edaravone in treating patients with acute ischaemic stroke (AIS).MethodsIn this multicentre, randomised, double-blind, multiple-dose, active-controlled, phase II clinical trial, patients with AIS within 48 hours after stroke onset were randomly assigned (1:1:1:1) to low-dose (12.5 mg), medium-dose (37.5 mg) or high-dose (62.5 mg) Edaravone Dexborneol groups, and an active control group with edaravone (30 mg) by 30 min intravenous infusion every 12 hours, for 14 consecutive days. The primary efficacy outcome was the proportion of modified Rankin Scale (mRS)score ≤1 at 90 days and National Institutes of Health Stroke Scale (NIHSS) score change from baseline to 14 days after randomisation. The safety outcome included any adverse event during 90 days after treatment.ResultsOf 385 patients included in the efficacy analysis, 94 were randomised to low-dose group, 97 to medium-dose group, 98 to high-dose group and 96 to the control group. No significant difference was observed among the four groups on mRS score (mRS ≤1, p=0.4054) at 90 days or NIHSS score change at 14 days (p=0.6799). However, a numerically higher percentage of patients with mRSscore ≤1 at 90 days in the medium-dose (69.39%) and high-dose (65.63%) groups was observed than in the control group (60.64%). No significant difference in severe adverse events was found among the four groups (p=0.3815).ConclusionsCompared with edaravone alone, Edaravone Dexborneol was safe and well tolerated at all doses, although no significant improvement in functional outcomes was observed at 90days.Trial registration numberNCT01929096.

scholarly journals A clinical comparison of high dose and low dose of Suxamethonium

2014 ◽  
Vol 9 (2) ◽  
pp. 1-8
Author(s):  
RK Yadav ◽  
PC Majhi ◽  
D Tiwari
Keyword(s):  
Intraocular Pressure ◽  
Dose Group ◽  
Low Dose ◽  
Cardiovascular Responses ◽  
High Dose ◽  
Clinical Effects ◽  
Duration Of Action ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Background: Suxamethonium having its rapid onset and short duration of action makes this drug unique amongst the neuromuscular blocking drugs described so far. However, use of suxamethonium is associated with a large number of undesirable side effects. Objective: To evaluate clinical effects of high and low dose of suxamethonium and to determine whether lower dose of suxamethonium can be used for any beneficial effects in terms of its various adverse effects e.g. cardiovascular responses, post-operative muscle pains and intraocular pressure. Methods: A total of 100 patients were included in this prospective study. All these patients on preoperative clinical evaluation were assessed to have adequate airway. All the patients were divided in two groups, low dose group (group I) and High dose group (group II) with 50 patients in each at random. A standard anesthetic technique was adhered to all the patients and following parameters were observed on comparative basis: a. Fasciculation and post operative myalgia. b. Cardiovascular effects, c. Intraocular pressure. Observation: The incidence of post Suxamethonium pain was significantly greater in group II. Increase in heart rate from baseline was significant in both groups. There was no significant difference between the two groups in the diastolic pressure but rise in systolic blood pressure was significant at all assessment times in both groups. This rise from control was statistically significant. Conclusion: Suxamethonium can be used in lower doses (0.5 mg/kg) in elective cases without airway compromise. It gives benefits of reduced muscle pains, cardiovascular responses and intraocular hypertension. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 1-8 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9677

scholarly journals Safety and Efficacy of Nonanesthesiologist-Administrated Propofol during Endoscopic Submucosal Dissection of Gastric Epithelial Tumors

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Keiichiro Abe ◽  
Keiichi Tominaga ◽  
Akira Kanamori ◽  
Tsunehiro Suzuki ◽  
Hitoshi Kino ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
University Hospital ◽  
Physical Status ◽  
Safety And Efficacy ◽  
Submucosal Dissection ◽  
Epithelial Tumors ◽  
Physical Status Classification ◽  
Significant Difference ◽  
Status Classification

Objective. There is no consensus regarding administration of propofol for performing endoscopic submucosal dissection (ESD) in patients with comorbidities. The aim of this study was to evaluate the safety and efficacy of propofol-induced sedation administered by nonanesthesiologists during ESD of gastric cancer in patients with comorbidities classified according to the American Society of Anesthesiologists (ASA) physical status. Methods. Five hundred and twenty-two patients who underwent ESD for gastric epithelial tumors under sedation by nonanesthesiologist-administrated propofol between April 2011 and October 2017 at Dokkyo Medical University Hospital were enrolled in this study. The patients were divided into 3 groups according to the ASA physical status classification. Hypotension, desaturation, and bradycardia were evaluated as the adverse events associated with propofol. The safety of sedation by nonanesthesiologist-administrated propofol was measured as the primary outcome. Results. The patients were classified according to the ASA physical status classification: 182 with no comorbidity (ASA 1), 273 with mild comorbidity (ASA 2), and 67 with severe comorbidity (ASA 3). The median age of the patients with ASA physical status of 2/3 was higher than the median age of those with ASA physical status of 1. There was no significant difference in tumor characteristics, total amount of propofol used, or ESD procedure time, among the 3 groups. Adverse events related to propofol in the 522 patients were as follows: hypotension (systolic blood pressure<90 mmHg) in 113 patients (21.6%), respiratory depression (SpO2<90%) in 265 patients (50.8%), and bradycardia (pulse rate<50 bpm) in 39 patients (7.47%). There was no significant difference in the incidences of adverse events among the 3 groups during induction, maintenance, or recovery. No severe adverse event was reported. ASA 3 patients had a significantly longer mean length of hospital stay (8 days for ASA 1, 9 days for ASA 2, and 9 days for ASA 3, P=0.003). However, the difference did not appear to be clinically significant. Conclusions. Sedation by nonanesthesiologist-administrated propofol during ESD is safe and effective, even for at-risk patients according to the ASA physical status classification.

Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population

2007 ◽  
Vol 22 (3) ◽  
pp. 311-314 ◽  
Author(s):  
Naomi Kakushima ◽  
Mitsuhiro Fujishiro ◽  
Shinya Kodashima ◽  
Yosuke Muraki ◽  
Ayako Tateishi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Japanese Population ◽  
The Elderly ◽  
Gastric Neoplasms ◽  
Technical Feasibility ◽  
Submucosal Dissection ◽  
Elderly Japanese

scholarly journals Continuous use of low-dose warfarin for gastric endoscopic submucosal dissection: a prospective study

2017 ◽  
Vol 05 (05) ◽  
pp. E348-E353 ◽  
Author(s):  
Hideaki Harada ◽  
Satoshi Suehiro ◽  
Daisuke Murakami ◽  
Takanori Shimizu ◽  
Ryotaro Nakahara ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Low Dose ◽  
Postoperative Bleeding ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Safety And Efficacy ◽  
Submucosal Dissection ◽  
Day Range ◽  
Dose Warfarin ◽  
Significant Difference

Abstract Background and study aims Patients who receive warfarin usually require heparin bridge therapy (HBT) to prevent thromboembolic events during endoscopic submucosal dissection (ESD); however, clinical evidence demonstrating the safety and efficacy of HBT during gastric ESD is limited. Conversely, warfarin can be continuously used as a substitute for HBT to endoscopic procedures which have a low risk of bleeding. This study aimed to clarify the safety and efficacy of continuous low-dose warfarin (LDW) for gastric ESD. Patients and methods This was a prospective observational study at a single institution. A total of 22 patients who received warfarin between December 2014 and January 2016 were enrolled. The patients were treated with gastric ESD with a low dose of warfarin ( ≤ 4 mg) at approximately 1.6 – 2.6 of the international normalized ratio (INR) levels. Furthermore, we analyzed a total of 23 patients with HBT who underwent gastric ESD between January 2011 and November 2014. Results The average of warfarin dose and the INR level on the day of gastric ESD in the continuous LDW group were 2.3 mg/day (range 0.5 – 4.0) and 1.87 (range 1.41 – 2.75), respectively. Two of the 22 patients (9.1 %) in the continuous LDW group and 5 of the 23 patients (21.7 %) in the HBT group had postoperative bleeding after gastric ESD. Although the postoperative bleeding rate in the continuous LDW group was lower than that in the HBT group, no significant difference was observed between the 2 groups (P = 0.414). Conclusions Gastric ESD with continuous LDW as a substitute for HBT was feasible and may be acceptable.

High-dose dexamethasone may prevent esophageal stricture after endoscopic submucosal dissection

2010 ◽  
Vol 3 (3) ◽  
pp. 155-158 ◽  
Author(s):  
Satoshi Ono ◽  
Mitsuhiro Fujishiro ◽  
Shinya Kodashima ◽  
Chihiro Minatsuki ◽  
Kousuke Hirano ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Esophageal Stricture ◽  
High Dose ◽  
Submucosal Dissection ◽  
High Dose Dexamethasone
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