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Drews J, Harder J, Kaiser H, Soenarjo M, Spahlinger D, Wohlmuth P, Wirtz S, Eberhardt R, Bornitz F, Bunde T, von Hahn T. Impact of a simple non-invasive nasal mask device on intraprocedural hypoxemia in overweight individuals undergoing upper gastrointestinal endoscopy with sedation provided by a non-anesthesiologist provider. Clin Endosc 2024; 57:196-202. [PMID: 37430405 PMCID: PMC10984753 DOI: 10.5946/ce.2023.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND/AIMS Hypoxemia is a common side effect of propofol sedation during endoscopy. Applying mild positive airway pressure (PAP) using a nasal mask may offer a simple way to reduce such events and optimize the conditions for diagnostic and therapeutic upper gastrointestinal endoscopies. METHODS We compared overweight patients (body mass index >25 kg/m2) with a nasal PAP mask or standard nasal cannula undergoing upper gastrointestinal endoscopies by non-anesthesiologists who provided propofol sedation. Outcome parameters included the frequency and severity of hypoxemic episodes. RESULTS We analyzed 102 procedures in 51 patients with nasal PAP masks and 51 controls. Episodes of hypoxemia (oxygen saturation [SpO2] <90% at any time during sedation) occurred in 25 (49.0%) controls compared to 8 (15.7%) patients with nasal PAP masks (p<0.001). Severe hypoxemia (SpO2 <80%) occurred in three individuals (5.9%) in both groups. The mean delta between baseline SpO2 and the lowest SpO2 recorded was significantly decreased among patients with nasal PAP mask compared to controls (3.7 and 8.2 percentage points difference, respectively). There were significantly fewer airway interventions performed in the nasal PAP mask group (15.7% vs. 41.2%, p=0.008). CONCLUSION Using a nasal PAP mask may be a simple means of increasing patient safety and ease of examination.
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Affiliation(s)
- Jan Drews
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Jonas Harder
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Hannah Kaiser
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Miriam Soenarjo
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Dorothee Spahlinger
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Peter Wohlmuth
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Asklepios Proresearch Research Institute, Hamburg, Germany
| | - Sebastian Wirtz
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Department of Anesthesiology and Surgical Critical Care, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Ralf Eberhardt
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Department of Pneumology and Medical Critical Care, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Florian Bornitz
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
- Department of Pneumology and Medical Critical Care, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Torsten Bunde
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany
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Ang TL, Seet E, Goh YC, Ng WK, Koh CJ, Lui HF, Li JW, Oo AM, Lim KBL, Ho KS, Chew MH, Quan WL, Tan DMY, Ng KH, Goh HS, Cheong WK, Tseng P, Ling KL. Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:24-39. [PMID: 35091728 DOI: 10.47102/annals-acadmedsg.2021306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. METHODS The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process. RESULTS The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists. CONCLUSION These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
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Ahmed SA, Hawash N, Rizk FH, Elkadeem M, Elbahnasawy M, Abd-Elsalam S. Randomised Study Comparing the use of Propofol Versus Dexmedetomidine as a Sedative Agent for Patients Presenting for Lower Gastrointestinal Endoscopy. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885514666190904161705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives::
Dexmedetomidine, the alpha 2 agonist sedative and an analgesic agent may
be beneficial in sedation for endoscopic intervention. Our aim was to compare the use of dexmedetomidine
versus the traditional use of propofol as a sedative agent for colonoscopies.
Methods::
This study included 100 patients presenting for elective colonoscopy under sedation with
random and equal allocation of patients into two groups; group P, in which patients received propofol
in a loading dose of 1.5 mg/kg and maintenance dose of 0.5 mg/kg/hr, and group D, in which
patients received dexmedetomidine at a loading dose of 1ug/kg and maintenance dose of 0.5
ug/kg/hr. In addition to the demographic data, time to recovery, time of discharge, and endoscopist
rating were measured. Also, the hemodynamic parameters were recorded, and also the incidence of
postoperative complications.
Results::
The basic patients' characteristics, time to recovery, and time of discharge were comparable
between the two groups. Moreover, the endoscopist did not significantly report more convenient
procedure with one group over the other. Also, there was no significant difference in hemodynamic
parameters or in the incidence of complications between the two studied groups. However the use
of dexmedetomidine decreased the incidence of hypoxemia.
Conclusion::
The use of dexmedetomidine seems to have a similar effect to the use of propofol as a
sedative agent for lower GIT endoscopy with the positive effect of dexmedetomidine in decreasing
the incidence of perioperative hypoxemia.
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Affiliation(s)
- Sameh A. Ahmed
- Department of Anesthesia, Tanta University, Tanta, Egypt
| | - Nehad Hawash
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, El-Geish Street, Tanta, Egypt
| | - Fatma H. Rizk
- Department of Physiology, Tanta University, Tanta, Egypt
| | - Mahmoud Elkadeem
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, El-Geish Street, Tanta, Egypt
| | - Mohamed Elbahnasawy
- Department of Emergency Medicine and Traumatology, Tanta University, Tanta, Egypt
| | - Sherief Abd-Elsalam
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, El-Geish Street, Tanta, Egypt
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Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol 2013; 19:463-81. [PMID: 23382625 PMCID: PMC3558570 DOI: 10.3748/wjg.v19.i4.463] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/11/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate (conscious) sedation. Moderate sedation, using midazolam and an opioid, is the standard method of sedation, although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation. Moreover, the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and, consequently, its low risk of inducing hepatic encephalopathy. In the future, propofol could become the preferred sedation agent, especially for routine colonoscopy. Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. Among opioids, pethidine and fentanyl are the most popular. A number of other substances have been tested in several clinical trials with promising results. Among them, newer opioids, such as remifentanil, enable a faster recovery. The controversy regarding the administration of sedation by an endoscopist or an experienced nurse, as well as the optimal staffing of endoscopy units, continues to be a matter of discussion. Safe sedation in special clinical circumstances, such as in the cases of obese, pregnant, and elderly individuals, as well as patients with chronic lung, renal or liver disease, requires modification of the dose of the drugs used for sedation. In the great majority of patients, sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide. In this review, an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.
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