High Flow Nasal Oxygen versus Conventional Oxygen Therapy in Gastrointestinal Endoscopy with Conscious Sedation: A Systematic Review and Meta-Analysis

Review question / Objective: To compare the efficacy of high flow nasal oxygen with conventional oxygen therapy to prevent hypoxemia in gastrointestinal endoscopy with conscious sedation. Condition being studied: High flow nasal oxygen, a novel technique, may be an alternative to conventional oxygen therapy. High flow nasal oxygen can deliver heated and humidified oxygen via special nasal cannula with high flow (up to 70 L/min). It has been applied to improve oxygenation in clinical entities, favored by increasing evidence supporting its efficacy. Recently, the use of high flow nasal oxygen has spreaded to gastrointestinal endoscopy. However, the efficacy of high flow nasal oxygen in gastrointestinal endoscopy has not yet been well evaluated due to small sample size of the individual study and conflicting results.

The superiority of midazolam-pethidine combination in three different anesthetic methods applied in conscious sedation during transesophageal echocardiography procedure

Background: During the transesophageal echocardiography (TEE) procedure, as in many other diagnostic semi-invasive applications, moderate sedation is preferred over deep sedation. Rarely, patients who cannot tolerate moderate sedation may require deep sedation when difficulties are encountered during TEE probe insertion. Although many different methods have been tried for the TEE procedure in clinical practice, the most appropriate sedation method is still controversial. Aims and Objectives: We aimed to evaluate the clinical effects of three different sedoanalgesia methods consisting of midazolam, propofol, and midazolam-pethidine combination protocols applied for conscious sedation in the patients undergoing a TEE procedure, and to evaluate the patient and doctor satisfaction during the procedure. Materials and Methods: One-hundred twenty five patients who underwent TEE for diagnostic purposes in our hospital were included consecutively in our prospective randomized trial. The patients were divided into three groups as those who were administered midazolam (group M), propofol (group Pr), and midazolam-pethidine (group MPe) during the TEE procedure. Results: In the MPe group, both patient and doctor satisfaction were significantly higher than the two groups. The rate of difficulty in probe placement was lower in the Pr and MPe groups compared to the M group (P<0.05). Conclusion: In this study, it has been observed that conscious sedation with the combination of midazolam-pethidine was significantly advantageous in terms of patient and physician satisfaction compared to the use of only midazolam and only propofol.

General Anesthesia Versus Conscious Sedation for Mechanical Thrombectomy in Acute Anterior Circulation Ischemic Stroke

BACKGROUND Retrospective studies suggested that general anesthesia (GA) for mechanical thrombectomy has worse outcomes compared with conscious sedation (CS). However, randomized single‐center trials suggested noninferiority of GA to CS. We investigated the impact of anesthesia techniques on thrombectomy, and hypothesized that the routine use of GA with a defined protocol would not adversely affect thrombectomy delivery or outcomes. METHODS A total of 451 consecutive patients receiving mechanical thrombectomy for anterior circulation ischemic stroke from 2016 to 2019 were identified from the local registry. Patients were divided into cohort A when both GA and CS were used, and cohort B (from October 2017) when GA became the default method. Favorable functional outcome was defined as modified Rankin scale of 0 to 2 at 3 months. Intraprocedural blood pressures were audited annually. RESULTS In cohort A, compared with patients receiving CS, patients with GA had prolonged median arrival to arterial puncture time (26 versus 18 minutes; P <0.001) and comparable favorable functional outcome at 3 months (37.7% versus 45.1%; P =0.355). In cohort B, the median arrival to arterial puncture was reduced to 10 minutes, with comparable favorable functional outcome of 46.7%, and reduced mortality compared with cohort A (14.2% versus 22.7%; P =0.024). Yearly audits demonstrated good adherence to the protocol. Binary logistic regression analysis showed only old age (odds ratio [OR], 1.04; 95% CI, 1.02–1.07 [ P =0.003]), high National Institute of Health Stroke Scale at presentation (OR, 1.17; 95% CI, 1.08–1.26 [ P <0.001]), and poor collateral status (OR, 0.29; 95% CI, 0.12–0.72 [ P =0.008]) were independent factors predicting for poor prognosis, not GA (OR, 0.71; 95% CI, 0.32–1.60 [ P =0.408]). CONCLUSIONS Patients treated under GA for mechanical thrombectomy achieved comparable functional outcome at 3 months compared with those under CS. Through practice and a defined protocol, GA for mechanical thrombectomy can achieve sustainable good functional outcomes. Large clinical trials are needed to confirm these findings.

Dexmedetomidine - Oxycodone Combination for Conscious Sedation During Colonoscopy in Obese Patients: A Randomised Controlled Trial

Background: The objective of this trial was to investigate the effectiveness and safety of dexmedetomidine plus oxycodone for conscious sedation during colonoscopy in obese patients. Methods: A total of 138 patients undergoing colonoscopy were randomly assigned into one of two groups: group Dex+oxy received sedation with dexmedetomidine plus oxycodone; while group Pro+suf received anaesthesia with propofol plus sufentanil. Parameters including blood pressure, heart rate, respiration, blood oxygen saturation, injection pain, and recovery were recorded for both groups. Results: The incidence of hypoxaemia was significantly reduced in group Dex+oxy compared with group Pro+suf (4.9% vs 20.3%, P = 0.011). Blood pressure was significantly increased, and heart rate was reduced in group Dex+oxy compared with group Pro+suf (P < 0.05). Moreover, the caecal insertion time, recovery time to orientation, and recovery time to walking were significantly reduced in group Dex+oxy compared with group Pro+suf (P < 0.05). Endoscopist satisfaction scores were significantly higher in group Dex+oxy compared with group Pro+suf (P = 0.042). Conclusion: Dexmedetomidine plus oxycodone provides effective sedation with minimal adverse effects for obese patients, while also reducing colonoscopy operation difficulty by allowing obese patients to reposition. Thus, dexmedetomidine plus oxycodone could be used safely as a conscious sedation method for colonoscopy in obese patients.Trial registration The protocol was registered at www.chictr.org.cn (ChiCTR1800017283, 21/07/2018)

Local Anesthesia and Conscious Sedation Does Not Affect Patient's Mood and Anxiety Levels during Percutaneous Endoscopic Lumbar Diskectomy: A Prospective Study

Background and Study Aims Undergoing a surgical procedure can be very stressful for patients and can lead to high anxiety levels during both the preoperative and the postoperative period. Levels of anxiety and fear may depend on multiple factors including the type of anesthesia to be used. The objective of this study is to evaluate whether patient's awareness of the surgical environment in the operating room under local anesthesia and conscious sedation (LACS) affects their mood and anxiety levels. Methods We performed a prospective study for a series of consecutive patients who underwent transforaminal percutaneous endoscopic lumbar diskectomy (PELD) for the treatment of lumbar disk herniation. The patients completed Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) forms in the preoperative period and in the early postoperative period. We divided the patients into two groups according to the type of anesthesia applied during surgery: LACS and general anesthesia (GA) groups. We compared the preoperative and postoperative POMS and STAI scores between groups and the change of these scores between the preoperative and postoperative periods in each group. Results In this study, we included 30 patients who underwent PELD between May and December 2019 and met the inclusion criteria. The GA group consisted of 16 patients and the LACS group consisted of 14 patients. In each group, POMS and STAI scores decreased in the early postoperative period compared with the preoperative period. We found no significant difference in percentage of POMS and STAI TX-1 score changes between the LACS and GA groups. Conclusion The results of our study show that patients' awareness of the surgical environment in the operating room under LACS does not significantly affect their mood and anxiety levels and patients do not seem to endure increased emotional stress during the PELD operation, as compared with PELD operation under GA.

BRONCHOSCOPIC BALLOON DILATATION COMBINED WITH ELECTRIC CAUTERIZATION OF TRACHEAL STENOSIS UNDER CONSCIOUS SEDATION: A CASE REPORT

Post intubation tracheal stenosis remains the most common indication of tracheal resection and reconstruction. It can cause respiratory symptoms that can often be misdiagnosed as obstructive lung disease. Various treatment modalities are available. As ofce-based procedures have been common, awake or mildly sedated endoscopic procedures with spontaneous ventilation are now being performed by exible bronchoscopy. We report a case involving a 45-year-old male who presented with dyspnea and stridor from 15 days. Patient had past history of intubation and icu stay one month back. After proper topicalization of upper airway of the patient, electric cauterization and balloon dilation was performed by exible bronchoscope under conscious sedation and spontaneous ventilation. Conscious sedation was achieved by graded doses of propofol and fentanyl. Post-operative period was uneventful, and patient didn’t describe any discomfort. Improvement in symptoms were reported. Endoscopic procedures for tracheal pathology under conscious sedation seems to be feasible and safe procedure.