Background/Aims: A majority of esophagogastroduodenoscopy (EGD) and colonoscopy procedures are performed under sedation, with the intravenous administration of a hypnotic agent combined with an opioid analgesic agent. The goal of our study was to establish the quality and plausibility of target-controlled infusion (TCI) as a sedation mechanism for upper and lower gastrointestinal (GI) endoscopies. Materials and Methods: A randomized, single-blinded, controlled clinical trial was arranged in a local community hospital. In total, 100 adult outpatients scheduled for upper and lower GI endoscopies were included and randomly allocated to a control group (n=50) and a TCI group (n=50). The sedation quality was assessed using the simplified quality of an anesthesia scoring system. Categorical parameters were compared using Pearson's chi-square test. Continuous parameters that were normally distributed were further compared using Student's t-test, and the others were compared using the Mann-Whitney test. Results: The significantly lower anesthesia quality score in the TCI group (12.2 vs. 12.7) indicated that the anesthesia quality was better in this group. Conclusion: This study showed that sedation using TCI for GI endoscopy provided safe and effective sedation and was associated with a better sedation quality. We believe that TCI can be used to provide routine sedation for patients receiving GI endoscopy.

1; Taichung Veterans General Hospital; Xitun Dist.; Taichung City 407; Taiwan (R.O.C.). Abstract:We report the novel use of a Sengstaken-Blakemore tube in an 82-year-old man with severe upper gastrointestinal bleeding and subsequent hypovolemic shock. When exploratory laparotomy failed to locate the source of the bleeding, a Sengstaken-Blakemore tube was placed retrograde to the gastroesophageal junction using a previously inserted nasogastric tube for guidance. The bleeding stopped immediately after mechanical compression by the inflated gastric and esophageal balloons. Hemodynamic stability permitted a thorough evaluation of the surgical field. The balloons were deflated intermittently to allow the surgeon to address the major and other smaller bleeding vessels in a stepwise manner. The intraoperative insertion of a Sengstaken-Blakemore tube can be used to control disastrous upper gastrointestinal bleeding located at or above the gastroesophagealjunction. It helps to achieve hemodynamic stability with less transfusion required and results in fewer complications. However, the lack of experience with the direct placement of a Sengstaken-Blakemore tube and the need for the equipment-dependent confirmation of the SengstakenBlakemore tube position reduces its clinical usage. The retrograde Sengstaken-Blakemore tube insertion strategy does not require assistance by ultrasonography or endoscopy and avoids most procedure-related complications.