Total Dose Of Propofol Research Articles

Effect of Intravenous Lidocaine Infusion on Propofol Dose and Perioperative Pain During Moderate Sedation-Analgesia for Hysteroscopy: A Randomized Controlled Trial.

In China, the majority of hysteroscopic procedures require moderate sedation and analgesia. The efficacy of intravenous lidocaine in reducing the need for sedatives and alleviating perioperative pain during hysteroscopy remains equivocal. This study aims to determine whether the intravenous administration of lidocaine can reduce the required dose of propofol and enhance perioperative pain management. We conducted a prospective, single-center, double-blind randomized controlled trial involving patients with ASA I-II undergoing hysteroscopy. Forty patients were randomly assigned in a 1:1 ratio to either receive an intravenous bolus dose of 1.5 mg/kg lidocaine, followed by a continuous intravenous infusion at 4 mg/kg/h until the conclusion of the procedure, or an equivalent volume of normal saline. Propofol was then titrated to maintain a MOAA/S score of ≤ 2. Compared with the control group, the lidocaine group showed a 13.8% decrease in the total dose of propofol (140.0[120.0, 155.0] mg vs 162.5[140.0, 197.5] mg), which was statistically significant (P = 0.014). The induction dose of propofol was 1.37 (1.29, 1.56) mg/kg in the lidocaine group and 1.61 (1.48, 1.94) mg/kg in the control group, respectively (P = 0.001). However, no significant differences were observed between the groups regarding the supplemental dose of propofol (P = 0.062), the number of involuntary movements during hysteroscopy (P = 0.384), or postoperative pain scores (T0: P = 0.628; T1: P = 0.886; T2: P = 0.711). Additionally, the incidence of intraoperative hypoxia (P = 1.000) and fatigue scores (T0: P = 0.878; T1: P = 0.401; T2: P = 0.056) between the two groups were not statistically significant. Intravenous lidocaine reduces the dose requirements of propofol during the induction phase of anesthesia. However, it does not have a significant influence on alleviating intraoperative and postoperative pain during hysteroscopic procedures.

COMPARATIVE STUDY OF PROPOFOL AUTO-COINDUCTION VERSUS KETAMINE PROPOFOL COINDUCTION USING PRIMING PRINCIPLE BY BISPECTRAL INDEX ANALYSIS FOR DAY CARE SURGERY

Aim:The aim of our study was to do the comparison of Propofol Auto-coinduction versus Ketamine Propofol coinduction using priming principle by bispectral index analysis for day care surgery. Methods:150 patients participated in our study at Govt. Medical College and Rajindra Hospital, Patiala. Patients aged above 18 years and ASA Grade I and II scheduled to undergo elective surgery were included in this prospective, randomized controlled trial. All patients were randomly assigned into 3 groups of 50 each. Group A- patients were given Propofol 0.5mg/kg body wt., Group B- patients were given Ketamine 0.5mg/kg body wt., Group C- patients were given normal saline 2.5ml 2 minutes before induction. Patients were induced with injection Propofol 1% at rate of 30mg/10 sec until BIS value reaches to 40. Induction dose requirements of Propofol, Haemodynamic parameters including HR, MAP, SBP, DBP,SPO2, ECG, RR were recorded. Incidence of post op complications / side effects were also recorded. Data was tabulated and subjected to statistical analysis. Results: Groups were comparable to each other with respect to age, weight, gender, ASA status. Significant difference was found in HR, SBP, DBP between Group A and Group B at 1 minute and 2 minute after coinduction. MAP shows statistically highly significant (p < 0.001) results after 1minute and 2 minute of coinduction. Total dose of propofol required and mean BIS value shows highly significant results when compared between groups. Conclusion: In conclusion, our study identified that overall dosage of propofol was significantly lower when modest doses of propofol and ketamine were given beforehand than when a placebo was used. When used as an induction agent, ketamine offers better haemodynamic stability.

Propofol-alone sedative efficacy in observational biliopancreatic endoscopic ultrasound.

Appropriate sedative and analgesic selection is essential to reduce patient discomfort and body movement to safely conduct endoscopic ultrasonography (EUS). However, few cases have examined sedation with propofol in EUS, and few studies the need for combined analgesia. In this study, we retrospectively evaluated the usefulness and safety of propofol without analgesics for sedation in biliopancreatic observational EUS. This single-center retrospective study included 516 observational biliopancreatic EUS procedures using propofol alone performed between April 2021 and March 2023. The primary and secondary endpoints were the observational biliopancreatic EUS results obtained with propofol alone and adverse event occurrence, respectively. The median examination time and total propofol dose were 22 (range: 10-67) min and 186.5 (range: 50-501) mg, respectively. The median starting Richmond Agitation-Sedation Scale and Visual Analog Scale scores were -5 (range: -5-1) and 0 (range: 0-10), respectively. The median recovery time was 22 (range: 5-80) min. Adverse events occurred in 60 (11.6%) patients. Trainee-performed examination (odds ratio [OR] 3.52, 95% confidence interval [CI]: 1.63-7.60, p = 0.0014) and examination length (>22 min; OR 1.67, 95% CI: 0.95-2.92, p = 0.07) were risk factors for adverse events.High body mass index (OR 1.87, 95% CI: 1.10-3.16, p = 0.02) and extended examination time (OR 4.23, 95% CI: 2.08-8. 57, p < 0.001) were risk factors for delayed recovery. During observational biliopancreatic EUS, propofol is useful as a single sedative and offers high patient satisfaction and relative safety.

Comparison of hypotension between propofol and remimazolam-propofol combinations sedation for day-surgery hysteroscopy: a prospective, randomized, controlled trial

BackgroundA combination of remimazolam and propofol could produce more stable sedation. A good medication regimen should consider not only efficacy but also safety, especially hypotension. The aim of the current study was to compare the incidence and amount of hypotension by propofol versus remimazolam-propofol combinations in day-surgery hysteroscopy.MethodsPatients were randomly assigned to receive either propofol (Group P, n = 125) or remimazolam-propofol combinations (Group RP, n = 125) at a 1:1 ratio. Intravenous injection of sufentanil 0.1ug/kg were administered before sedative medication. In group P, a bolus of 2.5 mg/kg propofol was administered. In group RP, intravenous anesthesia was commenced with 0.125 mg/kg remimazolam and 1 mg/kg propofol. After loss of consciousness, propofol was maintained at 6 mg/kg/h. The primary outcomes were the incidence and amount of hypotension during surgery. Hypotension was defined as a MAP less than 65mmHg for at least 1 min. The amount of hypotension was assessed by time-weighted average intraoperative MAP under a threshold of 65 mmHg. The secondary outcomes were various anesthesia related parameters and some adverse events.ResultsIn group P, 25 patients (20.0%) experienced hypotension during hysteroscopy compared with 9 patients (7.2%) in group RP, for a difference of 12.8% (RR 2.778, 95%CI [1.352–5.709]). The combination of remimazolam and propofol resulted in significantly lower TWA (Time Weighted Average) threshold 0.14 (0.10–0.56) mmHg in group RP compared to 0.31 (0.15–0.67) mmHg in group P. The total dose of propofol was nearly double in group P compared to group RP. A significantly higher frequency of injection pain and low oxygen saturation was observed in the group P than that of the group RP. Hiccup was observed only in group RP. The incidences of body movement, bradycardia and vomiting were no significant difference between groups.ConclusionThe incidence and amount of hypotension by remimazolam-propofol combinations was significantly less than that by propofol sedation in day-surgery hysteroscopy. The optimization of medication regimen would attenuate the harm of hypotension and contribute to patients’ rapid recovery in day surgery.Trial registration Chinese Clinical Trial Registry, ChiCTR2400079888 (date: 15/01/2024),

Comparison of effects of dexmedetomidine with ketofol and ketofol alone on quality of sedation in pediatric patients undergoing magnetic resonance imaging: A prospective randomized controlled double-blind trial.

Patient movement during magnetic resonance imaging (MRI) is the most frequent cause of artifacts and poor scan quality. Children cannot lie still. Thus, anesthesia is required to keep the child calm and immobile. This randomized double-blinded clinical trial compares the clinical effects of the addition of dexmedetomidine as premedication with ketofol on the quality of sedation. We hypothesized that the addition of dexmedetomidine would improve the quality of sedation. A total of 132 children aged 6 months to 10 years were randomized into groups DK (dexmedetomidine-ketofol) and K (ketofol). DK received an intravenous bolus of dexmedetomidine (0.5 mcg/kg) as premedication 10 minutes prior. Both the groups were induced with ketofol (0.5 mg/kg), and sedation was maintained with propfol infusion (100 mcg/kg/min). The primary objective was the quality of sedation as assessed by the University of Michigan Sedation Scale. Image quality, requirement of rescue propofol dose, recovery, and adverse events were also studied. Data are given as median [interquartile range (IQR)] or frequency. All 132 children completed MRI scans. The DK group showed significantly better quality of sedation, 71% versus 47% of children, a median difference of 1 (-0.569 to -0.0969), P < .005, a better quality of scan, a reduced number of additional doses of propofol, and a decreased total dose of propofol. Hemodynamic parameters and recovery times for the two groups were similar. There were no significant side effects in both groups. The quality of sedation and the quality of the MRI scan are greatly improved by administering dexmedetomidine (0.5 mcg/kg) 10 minutes before to induction. Additionally, this technique decreases the need of propofol and gives better hemodynamic stability without delaying the recovery time.

A Comparison of the Use of Propofol versus Midazolam for Pediatric Magnetic Resonance Imaging Sedation: Retrospective Cohort Study.

The aim of the present study was to do a comparison of the recovery profiles and airway-related adverse events of pediatric magnetic resonance imaging (MRI) sedation patients who received propofol alone to those who received midazolam alone. This retrospective cohort study was approved by the Mutah University Ethical Approval Committee (No. 2378). A search of the patients' medical records was performed between September 2021 and April 2022 to identify children aged 4 months-11 years who received propofol or midazolam for MRI sedation. The patients were subdivided into two groups: Those who had propofol alone (propofol group) and those who received midazolam (midazolam group) for pediatric MRI sedation. In propofol group, a 1-2 mg/kg of propofol bolus was given to have a deep sedation (Ramsay Sedation Scale score of 5). Patients in midazolam group received 0.05 mg/kg of midazolam. During the maintenance state of sedation, the patient received 150 µg/kg/min of propofol, and the infusion rate was adjusted in 25 μg/kg/min increments up or down at the discretion of the anesthesiologists to maintain a state of deep sedation. The major targets of this study were recovery profiles (time to awake and time to discharge) and airway-related intervention ratios in pediatric MRI sedation patients. Patient demographics, MRI sedation, and recovery data, including propofol induction dose, airway intervention, and sedation-related adverse events from the pediatric sedation recovery unit were also collected. The mean (standard deviation [SD]) propofol induction dose was higher compared to midazolam group (2.4 [0.7] mg vs. 1.3 [0.5] mg; mean difference, 1.1 mg; P < 0.001). The mean (SD) infusion rate was higher in propofol group compared to midazolam group (161.3 [37.6] μg/min/kg vs. 116.2 [25.6] μg/min/kg; mean difference 45.1 μg/min/kg; P < 0.001). The mean (SD) propofol total dose was higher in propofol group compared to midazolam group (236.3 [102.4] mg vs. 180.7 [80.9] mg; mean difference, 155.4 mg; P < 0.001). The mean (SD) time to awake was longer in midazolam group compared to propofol group (21.2 [5.6] min vs. 23.0 [7.1] min; mean difference, 1.8 min; P < 0.001). The mean (SD) time to discharge was longer in midazolam group compared to propofol group (34.5 [6.9] min vs. 38.6 [9.4] min; mean difference, 4.1 min; 95% confidence interval, 3.0-5.1; P < 0.001). The administration of midazolam during pediatric MRI sedation can decrease the frequency of airway complications without prolonging the clinically significant recovery profile.

Comparison of bispectral index-guided endoscopic ultrasonography with continuous vs. intermittent infusion of propofol: a retrospective study in Japan.

This study aimed to evaluate the safety and efficacy of continuous propofol infusion for anesthesia during endoscopic ultrasonography (EUS). A total of 427 consecutive patients who underwent EUS between May 2018 and February 2019 were enrolled in this study. The patients were divided into two propofol infusion groups: continuous (n=207) and intermittent (n=220). The following parameters were compared: (1) propofol dose, (2) respiratory and circulatory depression, (3) body movement requiring discontinuation of the examination, (4) awakening score, and (5) patient satisfaction. The median total maintenance dose of propofol was significantly higher in the continuous group than in the intermittent group (160.0 mg vs. 130.0 mg, respectively); however, the reduction in SpO2 was significantly lower in the continuous group (2.9% vs. 13.2%). Body movements occurred less frequently in the continuous group than in the intermittent group (40.1% vs. 49.5%, respectively). The rate of complete awakening was significantly higher in the continuous group than in the intermittent group. Finally, there was a significant difference in the percentage of patients who answered "absolutely yes" when asked about receiving EUS again: 52.7% in the continuous group vs. 34.3% in the intermittent group. Continuous infusion resulted in stable sedation and reduced propofol-associated risks.

Comparison of propofol-esketamine versus propofol-sufentanil for deep sedation and analgesia in children with autism: A randomized double-blind clinical trial.

Propofol sedation, routinely used for endoscopic procedures, is safe and acceptable for children. Adjuvants, such as esketamine or sufentanil, are commonly added to improve the efficacy and safety of propofol sedation. This study aimed to compare the clinical efficacy and safety of propofol-esketamine (PE) versus propofol-sufentanil (PS) for deep sedation and analgesia in children with autism undergoing colonoscopy procedure. One hundred and twenty-four children with autism undergoing colonoscopy procedure were included in the study. Patients were randomly assigned to receive one of the two adjuvants: esketamine (0.3 mg/kg) or sufentanil (0.2 μg/kg), subsequently administered propofol 2.0 mg/kg to induce anesthesia. Additional doses of propofol (0.5-1.0 mg/kg) were administered as needed to ensure patient tolerance for the remaining duration of the procedure. Movement during the procedure, hemodynamic variables, the total dose of propofol, recovery time, and adverse events were recorded. The PE group exhibited a significantly lower incidence of severe movement during the procedure compared with the PS group (14.52% vs. 32.26%, p = 0.020). The PE group showed significantly lower incidence of respiratory depression, hypotension, and severe injection pain of propofol than the PS group during the procedure (all p < 0.05). The mean arterial pressure (MAP) decreased significantly after anesthesia induction in the PS group and remained lower than baseline (all p < 0.05). Compared with the combination of low-dose sufentanil (0.2 μg/mg) with propofol, the low-dose esketamine (0.3 mg/kg) combined with propofol provided more stable hemodynamics, higher quality of sedation, and fewer adverse events in children with autism undergoing colonoscopy procedure.

EFFECT OF VARYING TIME INTERVALS BETWEEN FENTANYL AND PROPOFOL ADMINISTRATION ON PROPOFOL REQUIREMENT FOR INDUCTION OF ANESTHESIA - AN OBSERVATIONAL STUDY

Objective: The objective of the study is to determine the dose of propofol required for induction when fentanyl was administered just before, 3 min, and 5 min before propofol administration. Furthermore, to determine changes in heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), when fentanyl was given at varying time intervals. Methods: A prospective observational study was conducted in a tertiary care teaching hospital for 12 months. A total of 150 patients belonging to ASA 1 and 2 in the age group of 18–60 years scheduled for elective surgery under general anesthesia were allocated into three groups. Group 1 received propofol immediately after a 2 mcg/kg fentanyl injection and Group 2 and Group 3 received propofol 3 and 5 min, respectively, after the administration of fentanyl. The total dose of propofol required for induction is noted. Heart rate, systolic, diastolic, and MAPs after induction were also noted. Data analysis was done using SPSS version 25. Results: All three groups were comparable concerning demographic variables. The total dose of propofol required for induction was highest in Group 1, where propofol was given immediately after fentanyl, followed by Group 2, and lowest in Group 3 where propofol was given 5 min after fentanyl. Fall in heart rate, SBP, DBP, and MAP after propofol administration was highest in Group 1, followed by Group 2, and least in Group 3 where fentanyl was administered 5 min before propofol. The results were statistically significant. Conclusion: Administering fentanyl 5 min before propofol causes a marked reduction in the dose requirement of propofol along with a significantly decreased incidence of hypotension after induction.

The impact of erector spinae plane (ESP) block on neurophysiological monitoring in patients undergoing scoliosis repair

ABSTRACT Background Preventive analgesia is designed to ensure perioperative pain control. The erector spinae plane (ESP) block may abolish the neuroendocrine stress response and augments controlled hypotensive anesthesia. But to what extent does it interfere with spinal cord function. Methods The patient’s population is divided into Group N (control) and Group E (ESP Group). A baseline for the amplitude and/or latency of either somatosensory evoked potentials (SSEPs) or motor evoked potentials (MEPs) were collected (30 min after induction of anesthesia and after full reverse of muscle relaxant before performing ESP block) in group E, the change from the baseline was recorded as a percent decrease. The total dose of anesthetics, the adjuvant analgesics and the postoperative complications were recorded. Results The change in the latency and the amplitude of SSEPs and MEPs among the two groups showed a non-significant change from the baseline. The intra-operative fentanyl consumption was significantly lower in group E than in C. The mean was 21.5 ± 25 vs 178.2 ± 46 mg respectively. The total doses of propofol and dexmedetomidine were lower in group E than in C. 18% of the patients in group E requested a rescue analgesic at a median of 70 (65) min postoperatively vs 55% of those in group C that requested analgesics earlier at a median 16(6) min. Conclusion The ESP block can be safely used without interfering with the monitoring of the somatosensory and MEPs during complex spinal surgery.

Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea.

Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation. This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm. Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79-0.86) and displayed a moderate discriminatory power. High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.

Do Patients With Mental Illness Undergoing Office-Based Sedation Require an Increased Propofol Dosage?

Providers report needing higher sedative doses to achieve adequate sedation in patients with mental illnesses. These claims, however, have not been thoroughly assessed. The purpose of the study was to measure the association between mental illness and the propofol dosage necessary to achieve a satisfactory level of anesthesia. The study consisted of a single-center, retrospective cohort consisting of patients treated by oral and maxillofacial surgery at the University of Cincinnati Medical Center in 2020. The study was comprised of subjects 15 or older who were American Society of Anesthesiologists (ASA) classification I or II. Subjects under 15 or ASA III or higher were excluded from the study. The predictor variable was the presence or absence of mental illness. The primary outcome was the total dose of propofol, measured as the total amount of propofol administered divided by the patient's weight in kilograms divided by the length of the procedure in minutes (mg/kg/min). The secondary outcome was the Richmond Agitation-Sedation Scale (RASS) score achieved during sedation. Sex, race, ethnicity, age, weight, body mass index, ASA score, prior tobacco use, marijuana use, use of adjunct midazolam, fentanyl, and ketamine during the procedure, and type of procedure served as covariates. Test statistics were calculated using the Wilcoxon rank-sum test, Kruskal-Wallis test, Spearman rank correlation test, and χ2 test for bivariate analyses. Linear and logistic regression models were used to estimate association while controlling for confounding. P values ≤ .05 were considered statistically significant. The study sample was 409 subjects (36.92% male, mean age 28.27±12.20years). In bivariate analysis, mental illness did not show any association with propofol dose (mean dose with mental illness 150.85±143.97mg/kg/min, mean dose without mental illness 116.54±104.16, P=.08) or RASS score (sufficiently sedated with mental illness 63.38%, sufficiently sedated without mental illness 58.80%, P=.36). After adjusting for all previously mentioned covariates, mental illness was statistically associated with propofol dose (P<.01). Adjusting for covariates, only sex had a statistically significant association with the RASS score (P<.05). The findings suggest that a patient's mental illness may influence the amount of sedative required to achieve satisfactory anesthesia.

Effect of intravenous lidocaine on the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy: a prospective, randomized, double-blinded, controlled study

BackgroundIntravenous lidocaine could be a potential alternative adjuvant to propofol-based sedation for gastroscopy in elderly patients. This study aimed to evaluate the effect of intravenous lidocaine on the median effective dose (ED50) of propofol induction dose in elderly patients undergoing painless gastroscopy.MethodsThe study included 70 patients aged ≥ 60 years undergoing painless gastroscopy with 64 randomly assigned to either group L (2% lidocaine 1.5 mg/kg, n = 31) or group N (equal volume normal saline, n = 33). All patients received propofol induction following 0.1 μg/kg intravenous sufentanil. The Dixon “up-and-down” sequential method was used, with a 1.5 mg/kg initial induction dose of propofol followed by a 0.1 mg/kg sequential variable dose. The primary endpoint was the ED50 of the propofol induction dose. The total propofol dose, recovery time, adverse events, and local anesthetic intoxication reactions were also recorded.ResultsThe ED50 of propofol induction dose was 0.670 (95% confidence interval [CI] 0.216–0.827) mg/kg in group L and 1.118 (95% CI 0.803–1.232) mg/kg in group N. There was a statistically significant difference between the two groups (p < 0.001). The incidence of hypotension and propofol injection pain were lower in group L than in group N (p < 0.05). Furthermore, the orientation recovery time in group L was shorter compared to group N (p < 0.05). None of the participants in group L observed local anesthetic intoxication reactions after receiving lidocaine.ConclusionsThe administration of intravenous lidocaine to elderly patients undergoing painless gastroscopy resulted in a significant 40% reduction in the ED50 of propofol induction dose, which may be related to the decreased incidence of hypotension and injection pain, as well as the improved post-gastroscopy orientation recovery.Trial registrationChiCTR, ChiCTR2200065530. Registered on 08 November 2022.

Monitoring of general anesthesia by qCON and qNOX indices versus conventional clinical parameters in urological surgery: A randomized controlled clinical trial

Background: Awareness during anesthesia is a major anesthetic concern. Depth of anesthesia is commonly assessed in clinical practice by the patient’s clinical signs and symptoms such as blood pressure, heart rate variability, and body movement. At present, many studies have focused on qCON monitoring for sedative depth, but only a few studies have focused on qNOX monitoring for analgesic depth. Aims and Objectives: The aim of the present study was to evaluate the relative efficacy of qCON and qNOX versus commonly used vital signs such as blood pressure and heart rate in monitoring the anesthetic depth and analgesia. Materials and Methods: A total of 100 patients of either sex and of ASA Physical status I &amp; II, scheduled for urogenital surgeries, were selected and randomly placed into two groups. Group A was monitored by conventional clinical technique and Group B was monitored by qCON and qNOX indices. The primary outcome was the total dose of propofol and fentanyl required to maintain the depth of anesthesia and analgesia. The secondary outcomes were propofol and fentanyl adjustment frequency, infusion duration, and quality of recovery from anesthesia. Results: Results showed statistically significant differences between the two groups in mean dose of both propofol (P=0.000) and fentanyl (P=0.006), adjustment frequency of both propofol (P=0.000) and fentanyl (P=0.010), time required to voluntary eye-opening (P=0.000) and extubation time (P=0.000) and visual analog scale score (P=0.000). There was no statistically significant difference found in infusion duration (P=0.317) and Ramsay Sedation Score (P=0.709) between the groups. Conclusion: Using the qCON and qNOX indices, an anesthesiologist can monitor the depth of anesthesia and analgesia more effectively and can adjust the anesthetic or analgesic drug dosing in a better possible way with lesser requirement of drugs than with conventional clinical monitoring.

Comparing sedation protocols for endoscopic retrograde cholangiopancreatography (ERCP): A retrospective study

BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) is a widely used diagnostic and therapeutic procedure. Effective sedation is crucial to enhance patient comfort and optimize endoscopist performance. Various sedation protocols, including Propofol and Dexmedetomidine (Pro-Dex), Ketamine and Propofol (Keto-Fol), Propofol and Midazolam (Pro-Mid), and Propofol alone, have been utilized during ERCP. This retrospective study aims to compare the safety and efficacy of these four sedation protocols. MethodsA retrospective analysis was conducted on data from 600 patients who underwent ERCP between 2018 and 2021, with each patient receiving one of the four sedation protocols. Protocol assignment was based on the endoscopist's preference. Data on hemodynamic parameters, sedation level, recovery time, and procedure-related complications were collected. ResultsBaseline data showed no significant differences among the groups pre-procedure. The Pro-Dex group exhibited significantly lower mean total propofol dose, shorter recovery time, and faster achievement of Ramsay Sedation Scale (RSS) score 3–4 compared to the other groups. The Pro-group demonstrated significantly longer hospital stay than the other three groups (median, 4.19 ± 1.1 vs. 3.48 ± 1.2 days in the KP groups, p = 0.042). There were no significant variations in the incidence of respiratory depression, hypotension, or bradycardia among the four groups. Additionally, notable trends were found for hemodynamic measures, total propofol dosage, time to reach the desired level of sedation (as measured by the Ramsay Sedation Scale), and hospital stay based on BMI categories, indicating that higher BMI is linked to more serious outcomes. ConclusionOur retrospective study demonstrates that the Pro-Dex protocol offers superior sedation quality, faster recovery, and fewer complications compared to the other protocols during ERCP. However, the incidence of ERCP-related adverse events did not significantly differ among the four sedation protocols. These findings can aid clinicians in selecting the most appropriate sedation protocol for ERCP, considering patient and endoscopist preferences.

Dexmedetomidine as an Adjunct to Propofol in Patients Undergoing Elective Endoscopic Retrograde Cholangio-Pancreaticography - A Double-blind Randomized Controlled Study.

Propofol is the drug of choice for procedural sedation. The addition of α2 agonist dexmedetomidine may improve the safety profile of the procedure by providing stable hemodynamics, better sedation quality, and decreasing the side effects of each drug during elective endoscopic retrograde cholangio-pancreaticography (ERCP). Eighty patients aged between 18 and 60 years were distributed randomly into two groups. The dexmedetomidine + propofol group (group DP) received an injection of dexmedetomidine at the dose of 1 mcg/kg in 100 mLsaline, and the propofol group (group P) received plain 100 mL normal saline over 10 min. Subsequently, both groups received a bolus dose of injection propofol 1 mg/kg as sedation, and a modified observer's assessment of alertness/sedation score (MOASS) score was assessed, followed by infusion at the rate of 50 mcg/kg/min during the procedure. A rescue bolus dose (20 mg) of propofol was administered when the patient showed signs of inadequate sedation or analgesia in both groups. Cardiovascular and respiratory parameters were recorded every 10 min throughout the procedure. Post-procedure modified Aldrete score was evaluated for 30 min, and the endoscopist's score was noted at the end of the procedure. There was a significant difference (P = 0.001) in the additional number of rescue doses of propofol administered in group DP (3.47 ± 0.77) as compared to group P (8.78 ± 1.11). The total dose of propofol was lower in group DP (316.59 ± 43.29 mg) than in group P (443 ± 41.1 mg) with P value = 0.001. Statistically significant differences in the hemodynamic values were observed in group DP during infusion (P value < 0.05) of dexmedetomidine and throughout the procedure (P < 0.05) when compared with group P. Endoscopists graded the satisfaction score as very high (3.477 ± 0.77) in group DP. The addition of dexmedetomidine to propofol during ERCP provided better and safer sedation.

Risk Factors for Intraoperative Instability in Sedated Patients Undergoing Pulmonary Vein Isolation Ablation.

Persistent or paroxysmal atrial fibrillation is typically treated with pulmonary vein isolation (PVI) ablation under deep sedation with propofol. Intraoperative hemodynamic or respiratory instability often interferes with the surgical procedure. We retrospectively investigated risk factors in 80 patients who underwent their first PVI ablation for atrial fibrillation at our hospital. Background and echocardiography findings were collected from their electronic charts and the questionnaires they completed during hospitalization. Total intraoperative propofol dose and bolus injections (total number and volume) were defined as surrogate measures of patient instability. Single and stepwise multiple regression were performed using each measure as the dependent variable. When total propofol dose was employed as the dependent variable, significant associations were observed with drinking status (P < 0.05) and body mass index (BMI) (P < 0.05). When total number or volume of intravenous propofol boluses were each used as the dependent variable, significant associations were noted with age (P < 0.05) and BMI (P < 0.05). Separately, statistical analyses were conducted using total propofol dose or total number of bolus injections as the dependent variable and echocardiography parameters as independent variables. A significant association was detected between total dose and left atrial dimension (P < 0.05). These results suggested that younger age, higher BMI (obesity), and current drinking status adversely affect patient stability under deep sedation. To ensure safe ablation, physicians should pay attention to these risk factors when administering deep sedation for PVI.

Comparison between Bispectral Index-guided Propofol Induction and Clinically-guided Induction in Adult Hypertensive Patients Undergoing Elective Laparoscopic Surgery: A Randomised Controlled Study

Introduction: Traditional clinical endpoints for propofol induction often led to unintentional overdose, leading to haemodynamic instability, delayed recovery, and other complications. Bispectral Index monitoring could potentially prevent undesired haemodynamic changes like hypotension. Aim: To compare BIS-guided propofol induction with clinically guided propofol induction. Materials and Methods: A randomised controlled study was conducted in the Department of Anaesthesiology at Apollo Hospitals, Guwahati, Assam, India, between December 7, 2020 and December 6, 2021, on adult hypertensive patients undergoing elective laparoscopic surgeries. The Clinical Group (n=30) received propofol induction based on clinical guidance, and the Bispectral index group (n=30) underwent Bispectral Index (BIS) guided induction. Demographic variables, the dose of drug required for BIS 50, and the total amount of drug consumed were recorded. After the administration of each dose, Systolic BP (SBP), Diastolic BP (DBP), Mean Arterial BP (MAP), Heart Rate (HR), and SpO2 were recorded. Frequencies and percentages were used to describe qualitative data, whereas the mean and standard deviation were used to express quantitative data. Parametric tests included unpaired t-tests for comparison between groups. A p-value of &lt;0.05 was considered statistically significant. Results: Total 60 patients with 30 in each group, were studied. There was a steady fall in SBP, DBP, and MAP with successive incremental doses of 0.5 mg in both groups. Mean SBP was comparable between the two groups at dosages of 1 mg/ kg, 1.5 mg/kg, and 2 mg/kg. At 2.5 mg/kg, the clinical group had a significantly lower SBP (p=0.0001). Mean DBP was comparable in both groups at doses of 2 mg/kg and 2.5 mg/ kg but significantly lower in the BIS group at 1 mg/kg and at 1.5 mg/kg (p=0.003, p=0.01). Mean MAP was comparable at doses of 2 and 2.5 mg/kg but significantly lower in the BIS group at doses of 1 mg/kg and 1.5 mg/kg (p=0.007, p=0.02). Mean HR was comparable between the two groups at doses of 1 and 1.5 mg/kg. HR showed an increase in group CL and a gradual drop in group BIS with incremental doses. Mean HR was significantly lower in the group BIS at doses of 2 mg/kg and 2.5 mg/kg (p=0.001, p=0.001). The BIS group required a substantially lower total dose of propofol compared to the CL group (158.63±30.57 mg vs. 118.23±28.53 mg, p=0.0001). Conclusion: BIS-guided propofol induction leads to more stable haemodynamics during induction. It helps to titrate propofol administration, which, in turn, reduces the frequency of propofol overdose and its subsequent adverse effects on haemodynamic stability. The total dose of propofol consumed is also reduced.

Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy.

The aim of this study was to observe the effect of nasal high-flow humidification oxygen therapy on choking reactions and related respiratory and hemodynamic effects in elderly patients undergoing fiberoptic bronchoscopy. A total of 126 elderly patients aged 65-80 years who underwent painless fiberoptic bronchoscopy from March 2021 to December 2021 were randomly divided into two groups. The pulse oxygen saturation at T1 and T2 time points in the experimental group was higher than that in the control group (P < 0.05), and the average arterial pressure was slightly lower than that in the control group, but there was no statistical significance. In the experimental group, the total dosage of propofol and sufentanil increased, the microscopic examination time shortened, the choking reaction decreased significantly(P < 0.05), and the total incidence of hypoxemia decreased (P < 0.05). The application of nasal high-flow humidification oxygen therapy in elderly painless fiberoptic bronchoscopy improves the oxygenation ability of patients increases the use of narcotic drugs, does not have a great impact on hemodynamics, reduces choking reaction, and is more conducive to the operation of endoscopy doctors.

Dexmedetomidine Pretreatment Confers Myocardial Protection and Reduces Mechanical Ventilation Duration for Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass.

The study aims to assess the effects of dexmedetomidine (Dex) pretreatment on patients during cardiac valve replacement under cardiopulmonary bypass. For patients in the Dex group (n = 52), 0.5 μg/kg Dex was given before anesthesia induction, followed by 0.5 μg/kg/h pumping injection before aortic occlusion. For patients in the control group (n = 52), 0.125 ml/kg normal saline was given instead of Dex. The patients in the Dex group had longer time to first dose of rescue propofol than the control group (P = 0.003). The Dex group required less total dosage of propofol than the control group (P = 0.0001). The levels of cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), malondialdehyde (MDA), and tumor necrosis factor-α (TNF-α) were lower in the Dex group than the control group at T4, 8 h after the operation (T5), and 24 h after the operation (T6) (P <0.01). The Dex group required less time for mechanical ventilation than the control group (P = 0.003). The study suggests that 0.50 µg/kg Dex pretreatment could reduce propofol use and the duration of mechanical ventilation, and confer myocardial protection without increased adverse events during cardiac valve replacement.