Application of topical pharyngeal anesthesia to reduce adverse reactions during painless gastroscopy: A prospective randomized study

Efficacy of low-dose esketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia

BACKGROUND

Propofol/etomidate mixture is a common anesthetic for painless gastroscopy, but the anesthetic effect is not satisfactory. Esmketamine can achieve ideal anesthetic effect, and low-dose esmketamine has more reliable safety. However, the application of low-dose esmketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia has been less explored.

AIM

To evaluate the efficacy of low-dose esketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia.

METHODS

A prospective study was conducted on patients who were scheduled to undergo painless gastroscopy at the Hangzhou Traditional Chinese Medicine Hospital from June 2023 to June 2024. They were randomly divided into a control group and a combination group according to the random number table method. Both groups were given a mixture of propofol and etomidate, and the combination group was additionally given a low dose of esketamine. The anesthesia effects and incidence of adverse reactions (nausea and vomiting, hypotension, respiratory depression, and postoperative delirium) were compared between the two groups, as well as hemodynamic parameters [heart rate (HR) and mean arterial pressure (MAP)], respiratory parameters [respiratory rate (RR), arterial oxygen saturation] at the time of entering the room (T₁), starting sedation (T₂), inserting the gastroscope (T₃), withdrawing the gastroscope (T₄), and at the end of the operation (T₅), and cognitive function [mini-mental state examination (MMSE) score] at 15 min and 30 min after awakening.

RESULTS

The time to onset of anesthesia, time to recovery, and post-anesthesia care unit stay time in the combination group were shorter than those of the control group, and the number of additional anesthetic drugs and the total amount of additional anesthetic drugs used were less than those of the control group (P < 0.05). The interaction effect of HR, MAP, and RR at different time points between the two groups was statistically significant (P < 0.05). At T₁-T_2, the inter-group effects of the univariate repeated measures analysis of variance showed that there were no significant changes in HR, MAP, and RR in the two groups (P > 0.05). HR showed a trend of first increasing and then decreasing, while MAP showed a trend of first decreasing and then increasing at T₃-T₅ (P < 0.05). RR showed a decreasing trend at T₃-T₅ in the control group (P < 0.05). The inter-group effect of multivariate analysis of variance showed that the HR in the combination group was lower than that of the conventional group, while MAP and RR were higher at T₃-T₅ (P < 0.05). The results of univariate and multivariate analyses using the generalized estimating equation model showed that there were significant differences in HR, MAP, and RR among groups, times, and their interaction terms (P < 0.05). The MMSE scores of the combination group were higher than those of the control group at 15 minutes and 30 minutes after awakening (P < 0.05). The incidence of respiratory depression and delirium in the combination group was lower than that of the control group (P < 0.05).

CONCLUSION

The anesthetic effect of low-dose esketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia is good, which can maintain stable hemodynamics, reduce interference with breathing, accelerate postoperative cognitive function recovery, and reduce the incidence of respiratory depression and postoperative delirium.

Efficacy of low-dose esketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia

BACKGROUND

Propofol/etomidate mixture is a common anesthetic for painless gastroscopy, but the anesthetic effect is not satisfactory. Esmketamine can achieve ideal anesthetic effect, and low-dose esmketamine has more reliable safety. However, the application of low-dose esmketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia has been less explored.

AIM

To evaluate the efficacy of low-dose esketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia.

METHODS

A prospective study was conducted on patients who were scheduled to undergo painless gastroscopy at the Hangzhou Traditional Chinese Medicine Hospital from June 2023 to June 2024. They were randomly divided into a control group and a combination group according to the random number table method. Both groups were given a mixture of propofol and etomidate, and the combination group was additionally given a low dose of esketamine. The anesthesia effects and incidence of adverse reactions (nausea and vomiting, hypotension, respiratory depression, and postoperative delirium) were compared between the two groups, as well as hemodynamic parameters [heart rate (HR) and mean arterial pressure (MAP)], respiratory parameters [respiratory rate (RR), arterial oxygen saturation] at the time of entering the room (T₁), starting sedation (T₂), inserting the gastroscope (T₃), withdrawing the gastroscope (T₄), and at the end of the operation (T₅), and cognitive function [mini-mental state examination (MMSE) score] at 15 min and 30 min after awakening.

RESULTS

The time to onset of anesthesia, time to recovery, and post-anesthesia care unit stay time in the combination group were shorter than those of the control group, and the number of additional anesthetic drugs and the total amount of additional anesthetic drugs used were less than those of the control group (P < 0.05). The interaction effect of HR, MAP, and RR at different time points between the two groups was statistically significant (P < 0.05). At T₁-T_2, the inter-group effects of the univariate repeated measures analysis of variance showed that there were no significant changes in HR, MAP, and RR in the two groups (P > 0.05). HR showed a trend of first increasing and then decreasing, while MAP showed a trend of first decreasing and then increasing at T₃-T₅ (P < 0.05). RR showed a decreasing trend at T₃-T₅ in the control group (P < 0.05). The inter-group effect of multivariate analysis of variance showed that the HR in the combination group was lower than that of the conventional group, while MAP and RR were higher at T₃-T₅ (P < 0.05). The results of univariate and multivariate analyses using the generalized estimating equation model showed that there were significant differences in HR, MAP, and RR among groups, times, and their interaction terms (P < 0.05). The MMSE scores of the combination group were higher than those of the control group at 15 minutes and 30 minutes after awakening (P < 0.05). The incidence of respiratory depression and delirium in the combination group was lower than that of the control group (P < 0.05).

CONCLUSION

The anesthetic effect of low-dose esketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia is good, which can maintain stable hemodynamics, reduce interference with breathing, accelerate postoperative cognitive function recovery, and reduce the incidence of respiratory depression and postoperative delirium.

The Study of Remazolam Combined With Propofol on Painless Gastroscopy: A Randomized Controlled Trial

PURPOSE

Gastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. Remazolam besylate, a new type of ultrashort-acting benzodiazepine drug, has been less studied in gastroscopy. In this study, we studied the efficacy and safety of remazolam combined with propofol for painless gastroscopy.

DESIGN

This was a single-center, placebo-controlled randomized trial.

METHODS

One hundred patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups (n = 50 per group): the control group (Con group) and the remazolam group (Rem group). Sufentanil, remazolam, and propofol were used to anesthetize the patients, and then, the effects of different solutions on these patients were compared and analyzed. The patient's general condition, vital signs at different times, the dosage of propofol (mg) and additional times, complications, duration of gastroscopy (minutes), recovery time (minutes), length of stay in the recovery room (minutes), and adverse reactions were recorded.

FINDINGS

Rem group systolic blood pressure was more stable (P < .05). The amount of additional propofol in Rem group was less (P < .05). The incidence of hypotension, bradycardia, and dizziness was lower in Rem group, as well as the time of awakening and stay in the recovery room were shorter (P < .05).

CONCLUSIONS

Remazolam combined with sufentanil and propofol has less effect on hemodynamics in painless gastroscopy, and the patients have shorter awakening times.

Effect of ciprofol on swallowing function in patients undergoing painless gastrointestinal endoscopy

BACKGROUND

Gastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. This study compared the effect of ciprofol and propofol on swallowing function during painless gastroenteroscopy.

METHODS

This was a single-center, placebo-controlled randomized trial. Three hundred sixty-eight patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups: the propofol group (PRO group, n = 183) and the ciprofol group (CIP group, n = 185). Sufentanil, ciprofol, and propofol are used to anesthetize the patients, and the effects of different solutions on these patients are compared and analyzed. The patient's general condition, vocal cord adduction reflex, dysphagia severity score, penetration and aspiration scale score, vital signs at different times, complications, recovery time (minutes), residence time in the resuscitation room (minutes), and adverse reactions were recorded.

RESULTS

During the examination, the incidence of severe swallowing dysfunction in CIP group was lower than that in PRO group (P < .05). The BP in CIP group was higher than that in PRO Group (P < .05). The HR of CIP group was lower than that of PRO Group (P < .05). SpO2 in CIP group was higher than that in PRO Group (P < .05). The recovery time of CIP group was longer than that of PRO Group, and the postanesthesia care unit stay time of PRO group was longer than that of CIP group(P < .05). The incidence of respiratory depression, hypotension and cough in CIP group was lower than that in PRO Group (P < .05). The incidence of injection pain in CIP group was lower than that in PRO Group (P < .05).

CONCLUSION

Compared with propofol, ciprofol has less inhibition on swallowing function, less impact on hemodynamics, less respiratory depression, and less injection pain, which is more suitable for painless gastroscopy.

The study of different dosages of remazolam combined with sufentanil and propofol on painless gastroscopy: A randomized controlled trial

BACKGROUND

Gastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. Remazolam besylate, a new type of ultrashort-acting benzodiazepine drug, has been less studied in gastroscopy. In this study, we studied the efficacy and safety of remazolam combined with propofol for painless gastroscopy.

METHODS

This is a single-center, randomized controlled clinical trial. Hundred patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups (n = 50 per group): the remazolam 3 mg group (R3 group) and the remazolam 6 mg group (R6 group). Sufentanil, remazolam, and propofol are used to anesthetize the patients, and then, the effects of different dosages of remazolam on these patients are compared and analyzed. The patient's general condition, vital signs at different times, the dosage of propofol (mg) and additional times, complications, duration of gastroscopy (minute), awakening time (minute), residence time in the resuscitation room (minute), and adverse reactions were recorded.

RESULTS

R3 group systolic blood pressure and diastolic blood pressure are more stable (P < .05); The number of additional propofol in R6 group was less (P < .05). The incidence of hypotension was lower in R3 group, as well as the time of awakening and staying in the resuscitation room were shorter (P < .05).

CONCLUSION

Remazolam 3mg combined with sufentanil and propofol have less effect on hemodynamics in painless gastroscopy, and the patients have shorter awakening time.