Comparison of three sedation models for same-day painless bidirectional endoscopy: A multicenter randomized controlled trial

Comparison of propofol-based sedation and midazolam sedation in pediatric bidirectional endoscopy conducted by pediatric gastroenterologists

Objectives

The effectiveness and safety of propofol-based sedation and midazolam sedation in pediatric bidirectional endoscopy were compared.

Methods

We retrospectively analyzed the cases of pediatric patients (≤15 years old) who had undergone bidirectional endoscopy, esophagogastroduodenoscopy, and colonoscopy by pediatric gastroenterologists. Demographic data, indications, sedatives/dosages, clinical outcomes, endoscopic findings, adverse events, and total patient time requirements (total time in which patients stay in our hospital) were compared in the two sedation groups.

Results

Ninety-one children (51 boys, 40 girls, mean age 13 years, range 9-15) treated at our hospital were enrolled. Propofol alone or in combination with midazolam and/or pentazocine was administered to 51 patients (propofol-based sedation group). Midazolam alone or in combination with pentazocine was administered to the other 40 patients (midazolam sedation group). In the propofol group, the following mean doses were used: propofol, 96 mg (range 40-145 mg); midazolam, 4.9 mg (range 3-5 mg); and pentazocine, 7.5 mg. In the midazolam group, the mean doses of midazolam and pentazocine were 6.2 mg (range 4-10 mg) and 15 mg, respectively. All procedures were successfully completed by pediatric gastroenterologists. The total procedure times and endoscopic findings were similar in the two groups, but the median patient time requirement in the propofol group was significantly shorter versus the midazolam group (7.3 h vs. 8.4 h, p < 0.001). No adverse events occurred in either group.

Conclusions

Propofol-based sedation in pediatric bidirectional endoscopy was safely and effectively performed by pediatric gastroenterologists, and its patient time requirement was shorter than that for midazolam sedation.

Operation sequence of bidirectional endoscopy with topical anesthesia affected colonoscopy performance: a randomized controlled trial

BACKGROUND

The operation sequence of bidirectional endoscopy with topical anesthesia varies among endoscopists, which interferes with clinical procedure. The study aimed to investigate the influence of different operation sequences on the outcomes of quality indicators and improve bidirectional endoscopy performance.

METHODS

A randomized trial was conducted at the affiliated hospital of a medical university in China. Outpatients who initially underwent bidirectional endoscopy with topical anesthesia were enrolled. Eligible patients were randomized to either the colonoscopy-first group or the esophagogastroduodenoscopy-first group. Dyclonine hydrochloride mucilage and oxybuprocaine hydrochloride gel were administered for topical anesthesia. After finishing the previous process, the subsequent one was performed immediately. Quality indicators of esophagogastroduodenoscopy and colonoscopy were compared between the groups.

RESULTS

Analyzing 395 combined procedures, the cecal intubation rate, discomfort score during esophagogastroduodenoscopy, examination score of esophagogastroduodenoscopy, and colorectal polyp detection rate were similar between the two groups. The colonoscopy-first group had lower colonic spasm incidence (66.0% vs. 30.3%, p < 0.001), shorter median cecal intubation time (254 s vs. 211 s, p < 0.001), and higher colonoscopy comfort rate (72.5% vs. 85.6%, p < 0.001) compared with the esophagogastroduodenoscopy-first group. Operation sequence significantly affected the incidence of colonic spasm (OR 4.739, 95%CI 3.054-7.352, p = 0.000), which correlated with cecal intubation time (r = 0.196, p < 0.001) and patient discomfort score (r = 0.136, p = 0.007).

CONCLUSION

In bidirectional endoscopy with topical anesthesia, performing colonoscopy first may improve colonoscopy performance without affecting esophagogastroduodenoscopy examination. The study was registered prior to conducting the research in the Chinese Clinical Trial Registry ( https://www.chictr.org.cn ) on November 7, 2023 with the trial identification number ChiCTR2300077408.

An observational study on the modulation of anxiety, depression, and adverse event incidence in painless colonoscopy patients through venous access nursing

To investigate the clinical significance of venous access nursing in modulating anxiety, depression, and adverse event incidence among patients undergoing painless colonoscopy. Sixty patients who underwent painless colonoscopy in our hospital from September 2021 to September 2022 were selected as the control group (CG, receiving routine perioperative nursing). Sixty patients who underwent painless colonoscopy in our hospital from October 2022 to August 2023 were taken as the study group (SG, receiving venous access nursing modulation). After nursing, patients in the SG exhibited lower scores of the Self-Rating Anxiety Scale and the Self-Rating Depression Scale than those in the CG (P < .05). The SG showed significantly lower mean Ottawa Bowel Preparation Score, but exhibited higher adequacy of bowel preparation compared with the CG (P < .05). The colonoscopy insertion time was (7.18 ± 1.02) minutes in the SG and (8.69 ± 1.00) minutes in the CG, and the colonoscopy withdrawal time was (4.66 ± 1.66) minutes in the SG and (5.64 ± 1.06) minutes in the CG, which showed statistically significant differences between the 2 groups (P < .05). The total incidence of adverse events did not have statistical significance between the 2 groups (P > .05). Application of venous access nursing in patients undergoing painless colonoscopy may help alleviate adverse emotions and shorten colonoscopy insertion time and colonoscopy withdrawal time, thus warranting recognition for its safety and efficacy.

Comparison of remimazolam and propofol combined with low dose esketamine for pediatric same-day painless bidirectional endoscopy: a randomized, controlled clinical trial

Background: Remimazolam has shown similar or even superior properties to propofol in procedural sedation in adults, but few studies have been conducted in pediatric populations. Thus, we aimed to compare the effect and safety of remimazolam and propofol combined with low dose esketamine for pediatric same-day bidirectional endoscopy (BDE). Methods: Pediatrics <18 years scheduled for elective BDE under sedation were included and randomly assigned to remimazolam group (R group) or propofol group (P group). The primary outcome was the success rate of sedation. Secondary outcomes include sedation-related information and adverse events. Mean arterial pressure (MAP), heart rate (HR), and perfusion index (PI) were recorded during sedation. Results: A total of 106 patients were enrolled and analyzed. The success rate of sedation was 100% in both groups. Compared with the P group, the induction time of the R group was significantly prolonged (p < 0.001), and the incidence of injection pain, intraoperative respiratory depression, hypotension and bradycardia was significantly lower (p < 0.001). The changes in MAP, HR and PI were relatively stable in the R group compared with the P group. Additionally, awake time significantly decreased with age by approximately 1.12 index points for each increase in age in the P group (p = 0.002) but not in the R group (p > 0.05). Furthermore, the decline in PI and PI ratio during BDE was related to body movement in the P group. Conclusion: Remimazolam combined with low dose esketamine has a non-inferior sedative effect than propofol for pediatric BDE, with no injection pain, less respiratory depression, more stable hemodynamics. Moreover, early detection of the decline in PI may avoid harmful stimulation under light anesthesia. Clinical trial registration: https://www.clinicaltrials.gov/study/NCT05686863?id=NCT05686863&rank=1, NCT05686863.