Sedation Research Articles

Background: Choice of sedative–hypnotic agents can affect intraoperative and postoperative outcomes; however, comparative studies in adult coronary artery bypass grafting (CABG) are limited. Methods: We conducted a Bayesian network meta-analysis (NMA) of randomized controlled trials (RCTs) directly comparing two or more sedative–hypnotic agents in adult CABG patients, using PubMed, EMBASE, and the Cochrane Library through May 2025. Propofol served as the reference comparator for all outcomes except troponin release, where the control arm was used. Data were analyzed with R software (v4.4.3) using Surface Under the Cumulative Ranking (SUCRA) curves and rankograms. Higher SUCRA values indicate a greater likelihood of increased effect. Outcomes included mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), troponin release, and intensive care unit (ICU) stay, and are reported as mean difference (MD) with 95% credible interval (CrI). Results: Twelve RCTs comprising 26 arms were included. Etomidate (SUCRA 0.806; MD 26 mmHg; 95% CrI −8.8 to 60.0) and thiopentone sodium (0.748; MD 25 mmHg; 95% CrI −23 to 72) showed the greatest increase in MAP from baseline. Post-intervention MAP was highest with diazepam (0.770; MD 17 mmHg; 95% CrI −4.9 to 39.0) and etomidate (0.690; MD 13 mmHg; 95% CrI −3.8 to 30.0). For post-intervention HR, control (0.900) and thiopentone (0.810) ranked highest, while only sevoflurane significantly reduced HR versus propofol (MD −10 bpm; 95% CrI −19 to −0.35). Thiopentone (0.848; MD 11 bpm; 95% CrI −13 to 36) and midazolam (0.612; MD 4.2 bpm; 95% CrI −14 to 22) had the greatest changes in HR from baseline, whereas etomidate (0.302) had the smallest. Diazepam led SBP (0.769; MD 28 mmHg; 95% CrI −8.2 to 65.0). Troponin release did not differ significantly, though isoflurane reduced levels versus control (MD −2.9 ng/mL; 95% CrI −6.1 to 0.51). Dexmedetomidine was linked to longer ICU stays (MD 12 h; 95% CrI −21 to 45). Node-splitting analysis indicated no inconsistency between direct and indirect comparisons. Conclusion: Etomidate provided the greatest hemodynamic stability in MAP and HR measures, while sevoflurane was the sole agent to significantly reduce HR. No significant differences were observed for SBP, troponin release, or ICU stay duration. These findings can inform anesthetic selection to optimize cardiovascular stability during CABG.

Relationships among sleep quality, anxiety, and depression among Chinese nurses: A network analysis.

Embracing Diversity: Sedative effects vary across drug chemistry and frequency domains.

The safety of deep sedation for uterine dilation and evacuation in medically complex patients: a retrospective analysis at an urban center (2018-2024).

Increased NMDAR activity and GluN2A-NMDAR silent synapse expansion induced by chronic benzodiazepine treatment.

Extraction surgery often induces anxiety and fear in patients with dental phobia. Traditional sedation protocols have limitations such as insufficient depth of sedation and incomplete analgesia. Remimazolam tosilate (RT) and remifentanil hydrochloride (RH), as novel sedative-analgesic agents, have pharmacokinetic advantages of rapid onset, short duration of action, and no accumulation, and may be more suitable for the management of phobia during extraction surgery. This study aims to investigate the efficacy of RT combined with RH in alleviating phobia in patients undergoing extraction and its clinical safety. A total of 262 patients undergoing complex extraction surgery were assigned to the experimental group (EG, n = 131) and the control group (CG, n = 131). The EG was administered an individualized regimen of RT + RH, while the CG received propofol intravenous sedation. The level of fear was assessed using the dental anxiety scale (DAS, with a score range of 11-55, ≥31 indicates severe anxiety). Sedation depth (Ramsay score), visual analogue scale (VAS), vital signs, and adverse events were monitored concurrently. Patient satisfaction was also recorded (on a scale of 0-10, with ≥7 indicating satisfaction). The DAS score of the EG was significantly lower than that of the CG after surgery (12.3 ± 3.2 vs 22.5 ± 4.7, P < 0.05). The VAS pain score (1.23 ± 0.45 vs 3.48 ± 1.21, P < 0.05) and pharyngeal reflex score (1.8 ± 0.6 vs 3.5 ± 0.9, P < 0.05) of the EG were also significantly better than those of the CG. The patient satisfaction score of the EG (9.12 ± 0.89) was significantly higher than that of the CG (7.23 ± 1.45) (P < 0.05). Moreover, the postoperative systolic blood pressure (122.3 ± 10.5 vs 135.6 ± 12.3mmHg), heart rate (72.5 ± 8.3 vs 85.6 ± 9.7 beats/min), and other vital signs of the EG were more stable, and the incidence of angina (0.76% vs 2.29%) and hypertension (1.53% vs 3.82%) were significantly reduced (P < 0.05). The combination of RT and RH can effectively alleviate dental phobia in patients undergoing extraction, enhance the effects of sedation and analgesia as well as patient comfort, and has good safety, which is worthy of clinical application and promotion.

Patients with Alzheimer disease and related dementias (ADRD) face risks from medications labeled "potentially inappropriate in older adults" (risky); concurrent receipt of anti-dementia drugs may amplify risk. We studied adverse events among older adults concurrently receiving anti-dementia and risky medications. Using 2016-2019 administrative data from a random 40% sample of fee-for-service Medicare beneficiaries receiving anti-dementia medications (acetylcholinesterase inhibitors (AChEI) and/or memantine), we identified days with concurrent receipt of select, risky medications (benzodiazepines, sedative hypnotics, opioids). We measured diagnosed falls, hip fractures, and deaths among person-days with anti-dementia drug receipt comparing person-days with versus without concurrent risky drug receipt. We stratified regression analyses on long-term care (LTC) residence. We studied 633,528 beneficiaries; 64.3% were women, 33.7% met LTC residence criteria. Mean (SD) age was 80.9 (7.6) years. Each beneficiary contributed a mean (SD) of 551.7 (449.2) anti-dementia drug receipt days. Overall, 4.5% of person-days involved receipt of AChEI plus benzodiazepines; 3.8% involved AChEI plus an opioid. Falls, the most common outcome, affected 22.5% of our beneficiaries. Concurrent receipt of AChEI and opioids was associated with the greatest fall risk increase. Among community-dwelling beneficiaries, AChEI and opioid receipt (vs. AChEI alone) was associated with a hazard ratio for falls of 2.25 (95% CI: 2.19, 2.32); among LTC residents the corresponding hazard ratio was 1.46 (95% CI: 1.42, 1.51). Assessment and treatment of symptoms among people with ADRD is complex; concurrent receipt of opioids and dementia medications is uncommon but seems risky. Efforts to eliminate avoidable opioids may decrease adverse events and associated suffering in this population.

Gamma-aminobutyric acid (GABA) is a sedative drug capable of alleviating anxiety disorders, but its synthetic preparation is characterized by poor stability and insufficient bioavailability, along with its high cost. In this study, its precursor glutamic acid decarboxylase (GAD) from Lactobacillus casei IIB-09 was immobilized on biodegradable mesoporous silica nanoparticles (MSNPs) to improve the enzyme's catalytic efficiency and bioavailability, while providing a cost-effective synthetic approach. Under optimized culture conditions, i.e., 0.5% (w/v) monosodium glutamate (MSG) at pH 6.5 for 48h with an inoculum size of 2% (v/v), the highest GAD activity (3.59 ± 0.01IU/mL/min) and concentration of GABA (137 ± 0.01mM) were achieved. GAD was physically immobilized onto biodegradable MSNPs and subsequently characterized using various analytical techniques. To confirm the crystalline nature of MSNP, X-ray diffraction (XRD) analysis was performed. Further, UV-Vis, SEM, and FTIR spectra verified the immobilization of GAD on MSNPs. After optimization of the immobilization process, the immobilized enzyme showed a twofold increase in activity (2.59 ± 0.03IU/mL). A comparative analysis was done to examine the thermophilic characteristics and the activity of both free and immobilized enzymes under varying concentrations of methanol and α-ketoglutarate. The free and immobilized GAD exhibited maximum GABA production (112 ± 0.02-119 ± 0.03mM) at 45°C. This study highlights the true potential of immobilized GAD as a sustainable approach for its efficient biotransformation into GABA for applications in the pharmaceutical and functional food industries.

This study investigated Datura metel Linn. to identify phytochemicals with non-sedative analgesic potential, offering an alternative to conventional sedative drugs. Bioactive compounds were isolated from leaves via sequential solvent extraction (acetone, chloroform, water) and fractionated by column chromatography, yielding primary (GH1-GH7) and secondary fractions. Phytochemical screening confirmed alkaloids, flavonoids, saponins, and steroids. Fourier Transform Infrared (FTIR) spectroscopy revealed diverse functional groups. Early fractions (e.g., GH1F1, GH2F2) showed signatures of aromatic carboxylic acids, with patterns consistent with para-substituted benzoic acid derivatives like 4-aminobenzoic acid (PABA), indicated by carbonyl stretches (1708-1735 cm⁻¹) and aromatic vibrations. Some fractions indicated inorganic ions. Later fractions (GH3F3-GH7F2B) exhibited classical plant extract profiles with broad O-H stretches (phenols, carbohydrates), aliphatic C-H stretches (lipids), ester carbonyl bands (1727-1731 cm⁻¹), and aromatic C=C bends (1515-1567 cm⁻¹), confirming a rich mixture of flavonoids, tannins, and phenolic compounds. The successful fractionation isolated a wide spectrum of phytochemicals. The dominance of functional groups linked to phenolic acids and flavonoids, known for anti-inflammatory and non-sedative analgesic activities, underscores the plant's therapeutic potential. The phytochemical profile of Datura metel L. reveals bioactive compounds supporting its traditional use. The collective anti-inflammatory action of flavonoids, tannins, and saponins suggests a viable basis for non-sedative analgesia. Identifying these distinct chemical signatures provides a foundation for future research, recommending advanced structural elucidation via NMR and mass spectrometry, followed by biosimulation and biological assays to validate pharmacological activity.

Purpose: This study aimed to assess whether adjunctive music medicine during intravenous (IV) ketamine sedation for pediatric forearm fracture reduction can reduce the total ketamine doses required compared to ketamine alone while enhancing patient comfort. Methods: A retrospective study was conducted on pediatric patients (1–18 years) with isolated forearm fractures who received procedural sedation with IV ketamine. The control group (n = 55) received only IV ketamine, while the intervention group (n = 90) received IV ketamine and classical music therapy (Johannes Brahms’s “Wiegenlied” Op. 49). Data collected included ketamine dosing, number of additional doses, and procedure duration. Statistical analyses included chi-square test and Wilcoxon–Mann–Whitney test. Results: No significant differences were observed in ketamine dosing, additional doses, or procedural duration. Feedback from pediatric emergency physicians and orthopedic residents indicated that music intervention fostered a calmer environment, helping to manage patient anxiety and improving the overall experience. Conclusion: While no significant ketamine dosing changes were observed, music medicine contributed positively. Integrating music therapy into pediatric sedation protocols can enhance emotional and physical well-being. Future research is needed to further explore and integrate music medicine into routine pediatric care as part of a holistic approach to child-centered healthcare.

Background: Renal allograft biopsy is essential in the follow-up of pediatric kidney transplant recipients, but the optimal sedation strategy remains uncertain. Methods: We retrospectively reviewed 711 ultrasound-guided biopsies in 251 children and adolescents (2009–2024), comparing oral conscious sedation with midazolam to deep intravenous (IV) sedation with propofol, midazolam, and ketamine. Outcomes included tissue yield, diagnostic success, complications, and cost-effectiveness. Results: IV sedation was used in 77.1% of procedures and was associated with longer cortical cores (median 1.8 vs. 1.5 cm, p < 0.001) and more glomeruli (16 vs. 8, p < 0.001), improving tissue yield and consequently increasing diagnostic success from 75% to 88.5% (p < 0.001; OR 2.6). Biopsy-related complications occurred in 12.9% of cases, with no difference between groups. Sedation-related complications, all mild or moderate, occurred only with IV sedation (4.9%). The improved tissue yield reduced the cost per successful diagnosis (EUR 1243 vs. EUR 1467), making IV sedation the dominant strategy. Conclusions: IV sedation enhances the diagnostic quality and cost-effectiveness of pediatric kidney allograft biopsies without increasing overall risk, though prospective studies should also assess patient anxiety and comfort.

Ketamine, an anaesthetic and sedative drug, has emerged as a promising therapeutic option for the management of chronic refractory pain, but is used off-label in this indication and known for its psychomimetic side-effects. The primary objective of this manuscript is to synthesize the current evidence on ketamine efficacy and safety for chronic refractory pain. Furthermore, it aims to identify critical knowledge gaps and propose a framework for its rational and safe clinical application. This narrative review analyses key findings from randomised and non-randomised clinical trials investigating ketamine's use in chronic pain conditions. It also examines existing clinical guidelines and expert consensus statements to reach a comprehensive clinical perspective. Current evidence demonstrates that ketamine can provide significant short-term analgesia, especially in neuropathic pain, and is fairly well-tolerated in patients with severe refractory pain. However, long-term data on efficacy, cognitive impact, addiction risk and optimal dosing are severely lacking. The intravenous route remains the most studied, while alternatives are still underexplored. Ketamine is not a first-line treatment for pain and must be prescribed and supervised by trained specialists within a structured standard of care. Its future role in pain management hinges on collaborative translational research to define optimal administration routes, establish phenotyping strategies (on the basis of pain type, comorbidities and comedication), and conduct long-term studies assessing mood, quality of life and cognitive function to ensure both efficacy and safety.

BackgroundAutonomic nervous system (ANS) dysfunction contributes to the pathophysiology of sepsis. However, studies using reliable methods for ANS activity monitoring and evaluating its association with outcomes in sepsis patients are scarce. The Sudoscan® device offers a non-invasive method to evaluate sympathetic function by measuring electrochemical skin conductance (ESC), but its clinical relevance in sepsis remains unclear. This study aimed to assess autonomic sympathetic activity in septic patients using the Sudoscan® technology and explore its relationship with peripheral perfusion and outcomes.MethodsThis prospective, observational, single-center study included 97 consecutive adult ICU septic patients without or with shock. Sudoscan® measurements were performed at admission and serially for 72 h, alongside standard hemodynamic and peripheral perfusion assessments (e.g., knee capillary refill time [CRT], mottling, cardiac output). Associations between ESC ("sudoscore"), clinical parameters, and mortality at day-28 were analyzed.ResultsOf the 97 septic patients included, 37% had shock. Mottling was frequent (53%), and mean knee CRT was 3.3 ± 2.5 s. The mean admission Sudoscore was 31.2 ± 21 µS and was significantly higher in patients with peripheral perfusion abnormalities, such as mottling compared to no mottling (35.7 ± 21 vs 28.5 ± 19.5 µS, P = 0.04) and prolonged knee CRT > 5 s compared to CRT < 5 s (44.2 ± 25 vs 29.6 ± 18.6 µS, P = 0.03). Additionally, Sudoscore positively correlated with CRT (P = 0.01, R = 0.27). There was no difference in Sudoscore between patients receiving vasopressors or not, and between patients receiving sedative drugs or not. Longitudinally, the Sudoscore course was significantly lower over the first 72 h in survivors compared to non-survivors (P = 0.04, two-way ANOVA mixed model effect).ConclusionElectrochemical skin conductance measured via Sudoscan® may serve as a surrogate marker of autonomic sympathetic hyperactivation during sepsis and is associated with peripheral circulatory impairment. Although admission values were not independently predictive of mortality, elevated and persistently high Sudoscores are associated with death at day 28. Sudoscan® may offer a non-invasive window into sympathetic activity during septic shock and warrants further investigations.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40635-025-00813-0.

Background and objectivesTransvaginal ultrasound-guided oocyte retrieval, a core component of in vitro fertilization-embryo transfer (IVF-ET) techniques, is an outpatient procedure that requires rapid awakening while ensuring adequate analgesia. The currently widely used regimen of propofol-remifentanil presents limitations. The aim of this study was to evaluate the clinical efficacy and safety of dexmedetomidine-dezocine in transvaginal ultrasound-guided oocyte retrieval.MethodsA single-center prospective randomized controlled trial included 124 patients randomly divided into Group D (dexmedetomidine-dezocine, n = 62), and Group P (propofol-remifentanil, n = 62). The primary outcome measure was time to complete wakefulness (time from drug withdrawal to OAA/S score ≥ 4). Secondary outcome measures included intraoperative body movement scale, Ramsay sedation scale, hemodynamic parameters, and adverse reactions.ResultsThere were no statistical differences between the two groups in intraoperative limb movement grading (p = 0.12), operator satisfaction score (4.65 ± 0.78 vs. 4.55 ± 0.72, p = 0.3348), and patient satisfaction (7.39 vs. 7.10, p = 0.407). Group D had higher oxygen saturation than Group P (97.8% vs. 96.3%, p = 0.002) and a more stable respiratory rate (14.8 ± 2.3 vs. 13.0 ± 2.6, p < 0.001). Group D also had a shorter time to complete wakefulness than Group P (15.02 vs. 15.87 min, minutes, p = 0.019) and a higher Observer’s Assessment of Alertness/Sedation (OAA/S) score at the end of the procedure (2.06 vs. 1.64, p = 0.011). Mean arterial pressure and heart rate were not significantly different between the two groups (p = 0.88 and p = 0.93, respectively). The incidence of major adverse events was similar between groups. However, this study did not assess embryo quality or pregnancy outcomes, which represents a limitation.ConclusionsThis exploratory study suggests that dexmedetomidine-dezocine regimens may represent a potential anesthetic option for transvaginal oocyte retrieval. However, further research is needed to validate these findings.Trial registration(TCTR20240601001) [Registered on: 01/06/2024]. This trial is registered with the Thailand Clinical Trials Registry https://www.thaiclinicaltrials.org/.

PurposeThis prospective, randomized controlled study aims to compare opioid doses in patients undergoing intracranial tumor surgery managed with Total Intravenous Anesthesia using Target Controlled Infusion (TIVA-TCI) combined with Nociception Level (NOL) monitoring. The NOL index, an artificial intelligence–driven multiparameter index, integrates physiological signals such as heart rate, skin conductance, and photoplethysmography to provide an objective measure of nociception and guide personalized opioid administration. Additionally, the study evaluates the consumption of hypnotic drugs, hemodynamic parameters, variability in the NOL index, and changes in Heart Rate (HR) in the study group patients who received NOL monitoring following severe noxious stimuli.Patients and MethodsThe study involved 50 ASA II–III patients undergoing intracranial tumor surgery, with 25 in the standard care guided group and 25 in the NOL guided group. The control group received standard monitoring while NOL monitoring added in the study group. Propofol and remifentanil were titrated to maintain hemodynamic parameters or NOL values. Hemodynamic parameters, propofol and remifentanil doses were recorded and compared between groups. NOL index changes before and after noxious stimuli were compared with HR changes.ResultsNo significant differences were found in demographic data between the two groups. The remifentanil dose administered was similar in both groups. The study group received a higher dose of propofol. However, the control group had a longer duration of operation. The NOL index showed a significantly higher change after severe noxious stimuli compared to Heart Rate, indicating greater sensitivity.ConclusionThis study compares NOL index monitoring to standard monitoring during intracranial tumor surgery. The results indicate that NOL monitoring is reliable in detecting and monitoring nociception events compared to heart rate changes. However, it does not lead to a significant reduction in opioid dose administration.

External ventricular drainage (EVD) is commonly used to manage elevated intracranial pressure (ICP) following traumatic brain injury (TBI). However, evidence supporting its effectiveness in this context remains limited. This study aimed to evaluate the effectiveness of EVD in controlling elevated ICP and to identify clinical and radiological factors associated with its success. A multicenter retrospective cohort study was conducted between January 1, 2019, and December 31, 2022, across nine regional trauma centers in France participating in the Traumabase registry. All patients with TBI with intracranial hypertension despite maximal medical therapy and treated with EVD were included. EVD success was defined as an effective control of ICP avoiding the use of any third-tier therapy or avoiding a decision to withdraw life-sustaining treatment due to both refractory intracranial hypertension and severity of brain injury lesions. A cohort of 176 patients with TBI treated with EVD was included. Among these patients, 88 (50%) achieved sustained control of ICP after EVD, with few complications reported (health care-associated ventriculitis: 3%, significant hematoma [> 1cm] on EVD path: 3%). In the multivariate analysis, sedation with a combination of sedative drugs (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.12-0.62, p = 0.002), obliterated basal cisterns on the brain computed tomography scan prior to EVD placement (OR 0.07; 95% CI 0.00-0.39, p = 0.013), and severity of chest trauma (OR 0.79; 95% CI 0.64-0.99, p = 0.039) were factors associated with poor likelihood of EVD success. Conversely, EVD placement occurring more than 24h after admission was independently associated with success (OR 3.07; 95% CI 1.41-7.01, p = 0.006). In this multicenter cohort of patients with TBI with refractory intracranial hypertension, EVD effectively controlled ICP in half of the cases. The effectiveness of EVD appears to depend on clinical and radiological markers of severity of traumatic intracranial hypertension.

BackgroundPediatric circumcision is a common yet often distressing procedure due to the associated pain and emotional response it can elicit in children. Adequate sedation and analgesia are critical to mitigate these effects and ensure the procedure’s success. The combination of propofol and opioids continues to be the most commonly utilized intravenous anesthetic regimen for pediatric circumcision procedures. However, due to its narrow therapeutic index, propofol may cause notable hemodynamic and respiratory depression. Esketamine, an S(+)-isomer of ketamine, is recognized for its analgesic potency and minimal respiratory impact. Furthermore, its sympathomimetic properties offer a counterbalance to the hemodynamic inhibition of propofol. Therefore, the aim of this study is to determine the optimal dose of esketamine combined with propofol for pediatric circumcision.MethodsThis prospective, randomized controlled, dose-finding clinical trial will enroll 100 children aged 3–9 years who undergo circumcision. Participants will be randomly assigned to five groups to receive varying doses of esketamine (0.50, 0.75, 1.00, 1.25, and 1.50 mg/kg) combined with 3 mg/kg propofol for achieving adequate sedation. An effective dose of esketamine will be defined as non-occurrence of physical movement, frowning, or Ramsay Sedation Scale (RSS) score ≥ 5 during skin incision. The values for median effective dose (ED50), 95% effective dose (ED95), and 95% confidence intervals (95% CIs) of esketamine will be determined using probit regression.DiscussionThe results of this study seek to determine the ED50 and ED95 values of esketamine combined with propofol for intravenous sedation in pediatric circumcision using probit regression analysis, which will provide further references for precise medication in pediatric circumcision.Trial registrationChinese Clinical Trial Registry ChiCTR2400090035. Registered on September 23, 2024.

BackgroundGastric cancer is a type of malignant gastrointestinal tumor that poses a serious threat to human life and ranks as the second leading cause of cancer-related mortality worldwide. Although cardia-related diseases are rarely reported in the literature on gastrointestinal disorders, cardia lesions are not uncommon in clinical practice. The development of esophageal cancer may be associated with risk factors for esophageal adenocarcinoma, such as reflux esophagitis, high-fat diet, advanced age, and obesity. During gastroscopy, it is important to note that inadequate visualization of the esophagus may result from various factors, which can affect the diagnosis of esophageal lesions and lead to misdiagnosis or missed diagnoses. Currently, intravenous sedation using a combination of fentanyl and propofol is routinely administered during gastrointestinal endoscopy. The use of propofol in gastroscopy has been shown to improve procedural quality, enhance patient tolerance, and increase the accuracy of endoscopic diagnosis. However, the differences in esophageal exposure between moderate and deep sedation still require further clinical validation.MethodsThis study was a single-center retrospective clinical study. One hundred and twenty elderly overweight patients who underwent sedation for upper gastrointestinal endoscopy at our Gastrointestinal Endoscopy Center from May 2020 to August 2023 were retrospectively collected and divided into a moderate sedation group (Group A) and a deep sedation group (Group B) according to the anesthesia method. Primary outcome index: compare the sedation success rate and cardia exposure degree between the two groups. Secondary outcome indicators: compare the incidence of hypoxia during sedation between the two groups. Comparison of sedation recovery time, pain [visual analog scale (VAS)] and patient satisfaction.ResultsA total of 120 patients aged 60–75 years with body mass index ≧ 25 kg/m2 were enrolled. The general data of the patients in the two groups were comparable (P > 0.05).The sedation success rate was comparable in Groups A and B (94.83% vs. 96.78%, P = 0.594).The degrees of cardia exposure in group A and group B were compared. The degrees of cardia exposure in Group A with scores of 1, 2, 3, and 4 were 12 cases (20.69%), 13 cases (22.41%), 19 cases (32.76%), and 14 cases (24.14%), respectively. The degrees of cardia exposure in group B were 21 cases (33.87%), 19 cases (30.65%), 18 cases (29.03%), and 4 cases (6.45%), respectively. Compared with group B, group A had a higher degree of cardia exposure, and the difference was statistically significant (p = 0.029). The total perioperative adverse reactions were relatively lower in group A compared with group B, and the difference was statistically significant (P = 0.049).The incidence of hypoxia (2%vs11%) and sedation recovery time (10.08 ± 2.18vs.15.38 ± 3.25) were significantly smaller in group A than in group B, and the differences were statistically significant (P < 0.05).The satisfaction with endoscopy was higher in both groups ( 98.28%vs.96.78%, P = 1.000), the difference was not statistically significant.The exposure of the cardia during gastroscopy was not significantly associated with patient gender, comorbidities such as diabetes, hypertension, or chronic obstructive pulmonary disease(COPD), or gastric or bile reflux, but was significantly associated with the depth of anesthesia (P < 0.05).ConclusionBoth moderate and deep sedation are applicable for upper gastrointestinal endoscopy in elderly overweight patients. However, moderate sedation is more suitable than deep sedation for those with unstable cardiopulmonary function. Compared with deep sedation, moderate sedation provides better cardia exposure, a lower incidence of hypoxia, faster recovery time, improved safety, and comparable patient satisfaction, making it worthy of clinical promotion.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12871-025-03387-2.

Comparison of pre-mortem and post-mortem blood concentrations of analgesic and sedative drugs in intensive care patients.

Effects of mPFC-rTMS in chronic Insomnia: A randomized, double-blind, placebo-controlled study.