Conscious Sedation for Endoscopic Procedure: A Systematic Review

Background: Sedation has a beneficial impact on patient’s tolerance to the endoscopic procedure. Conscious sedation is the anesthetic techniques of choice for endoscopic procedure. Conscious sedation for endoscopic procedure could be with one drug or a combination of drugs. There have been broad variations in sedation procedure between different countries, and even between different units within the same country. All drugs which depress the central nervous system have the ability to produce respiratory or cardiovascular complications. Endoscopy has a recorded mortality of 1 in 2000 and a morbidity rate of 1 in 200. These sedation techniques have their effects on patients. The main goal of this study is to describe the effects of conscious sedation on patients' outcome for endoscopic procedure. Methods: The design for this study was a review of literature in the medical databases of PubMed, Scopus, Embase, Cochrane and hand search journals from conferences in English. All studies that evaluated the use of CS for endoscopic procedure were included. Results: The results showed that the pain level of the patient (visual analogue scale) was substantially positive when conscious sedation was used. Conscious sedation, however is a lightly sedated patient who is conscious, amnesic, co-operative on demand and free from fear and anxiety. It is often used during endoscopic procedures to minimize discomfort and relax the patients. The intraoperative hypotension has also been extreme in some medications relative to others. Conclusion: The study revealed that CS is reliable and well tolerated anesthetic technique for endoscopic procedures, and is a better option for elective endoscopic procedures CS benefits for endoscopisit and patient outcome is superior to GA such as; short recovery times, less analgesia requirement, comfortable for patient which in turn, leads to faster induction, faster endoscopy, faster discharge, and faster turnaround time. Patients are usually willing to go home after a couple of hours. Rapid recovery is a benefit not only for patients, but also for hospital and day surgery departments. This increases the overall performance of the endoscopy unit.

Open Versus Endoscopic Osteotomy of Posterosuperior Calcaneal Tuberosity for Haglund Syndrome: A Retrospective Cohort Study

Background: Although endoscopic calcaneoplasty and retrocalcaneal debridement have been extensively applied to treat Haglund syndrome, evidence of the value of the endoscopic procedure remains to be fully established. Purpose/Hypothesis: The purpose of this study was to compare the postoperative outcomes and the amount of osteotomy between open and endoscopic surgery for the treatment of Haglund syndrome. It was hypothesized that endoscopic calcaneoplasty would lead to higher patient satisfaction and lower complication rates compared with open surgical techniques. Study Design: Cohort study; Level of evidence, 3. Methods: The following postoperative outcomes were compared between the open surgery group (n = 20) and the endoscopic surgery group (n = 27): visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index, Tegner score, Ankle Activity Score, and 36-Item Short Form Health Survey; postoperative complications; and duration of surgery. To determine the extent of resection, the authors compared the calcaneal height ratio, calcaneal resection ratio, calcaneal resection angle, pitch line, and Haglund deformity height between groups. The learning curve for endoscopic calcaneoplasty was also calculated. Results: There were no significant differences between the open and endoscopic groups on any outcome score. Two patients in the open group reported temporary paresthesia around the incisional site, indicating sural nerve injuries; no complication was reported in the endoscopy group. None of the parameters for extent of resection were statistically significant between the groups. The duration of surgery was 44.90 ± 10.52 and 65.39 ± 11.12 minutes in the open and endoscopy groups, respectively ( P = .001). Regarding the learning curve for endoscopic calcaneoplasty (6 surgeons; 27 follow-up patients; 9 patients lost to follow-up), the duration of surgery reached a steady point of 55.68 ± 4.19 minutes after the fourth operation. Conclusion: The results of this study indicated that the endoscopy procedure was as effective as the open procedure. The endoscopic procedure required significantly more time than the open procedure, and the duration of the endoscopic procedure was shortened only after the fourth operation, suggesting that it requires high technical skills and familiarity with the anatomic relationships.

A Clip-with-Line Traction Suture Method for Closing Mucosal Defects after Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) is a technically difficult endoscopic procedure for treating gastrointestinal diseases. Procedure time is longer, and complications such as mucosal defects, intraoperative perforation, and bleeding occur frequently. Here, to solve these problems, we described the clip-with-line traction suture method that applied and performed for closing mucosal defects after ESD in three representative cases.

Comparison of the Effectiveness between 5% Eutectic Mixture of Local Anesthetic Cream and Ethyl Chloride Spray Applied on the Skin Prior to Intravenous Cannulation

Background: Since the patients scheduled for an endoscopic procedure had been unhappy with pain during intravenous cannulation. Objective: To compare the effectiveness between 5% eutectic mixture of local anesthetic cream and ethyl chloride spray applied on the skin prior to the procedure. Materials and Methods: One hundred eighty-six patients were randomized equally into three groups, A: 5% eutectic mixture of local anesthetic cream, B: ethyl chloride spray, and C: placebo. Then a nurse used a 22-gauge (22G) needle catheter to administer a cannula. Five minutes after the intravenous cannulation, a co-researcher assessed the patient’s pain perception and satisfaction as well as the nurse’s difficulty in performance by means of a numeric rating scale. Results: One hundred seventy-six patients completed the present study. Participants having the anesthetic cream and spray application as well as the placebo expressed their pain scores as 1.7±1.3, 1.6±1.2, and 2.2±1.3, respectively. Therefore, patients applied with local anesthetics had significantly less pain perception than those with the placebo (p=0.039); however, scores were not different between the anesthetic cream and the spray groups. Conclusion: Patients scheduled for an endoscopic procedure did not showed significant pain relief with either the 5% eutectic mixture of local anesthetic cream or the ethyl chloride spray. Keywords: 5% eutectic mixture of local anesthetic cream, Ethyl chloride spray, Endoscopic surgery, Intravenous cannulation, Pain

Incidence of Bacteremia Consequent to Different Endoscopic Procedures in Dogs: A Preliminary Study

Endoscopic procedures are widely used in veterinary medicine, and their role in producing transient bacteremia is debatable. The growing issue of antibiotic resistance requires the correct use of antibiotics, avoiding their administration when not strictly necessary. Studies highlighting post-endoscopy bacteremia in veterinary medicine are extremely rare and often involve very few animals. This study describes the results from 74 owned dogs, brought to the Veterinary Teaching Hospital of the Department of Veterinary Medical Science of the University of Bologna, for the purpose of undergoing an endoscopic procedure. Two blood samples were taken from each dog, one before and one after the procedure, in order to assess the incidence of bacteremia linked to endoscopic procedures. Eight dogs were tested positive at the second blood culture with an Incidence Risk (IR) of 10.8%. No statistical differences were found by comparing positive and negative blood cultures with respect to sex, age, weight and anesthesia duration. In addition, no difference was found between airway and digestive tract procedures. The present findings showed that the probability of developing bacteremia after an endoscopic procedure was quite low, and additional studies confirming this are certainly recommended as well as the evaluation of categories of patients potentially considered at risk.

Approach to Impacted Foreign Bodies in Upper GIT – Ayurvedic Viewpoint

Impacted foreign bodies in the Upper GIT are frequently encountered in the Gastroenterology department, identification of such foreign bodies and its safe extraction without hindering the normal physiology requires a stupendous clinical skill and technique. An earliest record of such condition and its approach based on the material trapped is detailed in Sushruta’s treatise, Sushruta Samhita. And this is the earliest use of endoscopic procedure in extracting the impacted foreign bodies. Among these methods, Sushruta’s trap method is highly praiseworthy and commendable in extraction of the foreign body.