Anesthetic strategy for obese patients during gastroscopy: deep sedation or conscious sedation? A prospective randomized controlled trial

Kang, Shuai; Lu, Jian; Zhou, Hongmei

doi:10.1007/s00540-021-02951-7

Cited by 7 publications

(7 citation statements)

References 30 publications

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“…Frontiers in Pharmacology frontiersin.org Dossa et al, 2021;Kang et al, 2021). However, propofol alone would likely lead to inadequate conditions for esophageal instrumentation (Cris D LaPierre et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies demonstrated that propofol is a safe and effective anesthetic for all endoscopy procedures, even for high-risk patients, including those with hepatic encephalopathy ( Wang et al, 2013 ; Yin et al, 2019 ; Edelson et al, 2020 ; Dossa et al, 2021 ; Kang et al, 2021 ). However, propofol alone would likely lead to inadequate conditions for esophageal instrumentation ( Cris D LaPierre et al, 2012 ).…”

Section: Discussionmentioning

confidence: 99%

“…RX455) was injected within 60 s. Sedation levels were assessed with the Modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) every minute during gastroscopy (score of 5: responds quickly to name spoken in normal tone; score of 4: lethargic response to name spoken in normal tone; score of 3: responds only after name is called loudly and/or repeatedly; score of 2: responds only after mild prodding or shaking; score of 1: responds only after painful trapezius squeeze; 0 score: no response after painful trapezius squeeze). Gastroscopy was performed after the patient’s MOAA/S score was ≤2 ( Patel et al, 2005 ; Kang et al, 2021 ). All anesthetic injections and management were performed by the same senior anesthesiologist, and the examination was conducted by the same group of experienced endoscopists.…”

Section: Methodsmentioning

confidence: 99%

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The median effective doses of propofol combined with two different doses of nalbuphine for adult patients during painless gastroscopy

Tang

Wang

et al. 2022

Front. Pharmacol.

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Objective: Propofol is the most widely administered intravenous anesthetic to induce deep sedation for gastroscopy procedures. Coadministration of nalbuphine can provide analgesia and sedation to patients experiencing visceral pain, thereby decreasing the amount of propofol needed and reducing the risk of propofol-induced adverse events. We carried out this study to determine the median effective dose (ED50) of propofol in combination with different dosages of nalbuphine and the optimal dosage of nalbuphine during painless gastroscopy.Methods: We recruited sixty-five patients aged 18–60 years who underwent elective painless gastroscopy. A total of sixty-one patients were allocated randomly to the N1 group (nalbuphine 0.1 mg/kg) or N2 group (nalbuphine 0.15 mg/kg). Three minutes after administration of nalbuphine, patients received a preset dose of propofol at 2.0 mg/kg with a dose gradient of 0.2 mg/kg according to Dixon’s “up-and-down” method. The primary outcome was the ED50 of propofol in combination with nalbuphine. Hemodynamic parameters, recovery time, pain score, and adverse events were recorded as secondary outcomes.Results: The ED50 of propofol in the N2 group was significantly lower than that observed in the N1 group (p < 0.01). Using probit analysis, the ED50 and ED95 of propofol were 1.632 mg/kg and 2.759 mg/kg in the N1 group and 1.111 mg/kg and 2.243 mg/kg in the N2 group, respectively. The incidence of hypotension in the N2 group was lower than that in the N1 group (p < 0.05), and the recovery time was shorter than that of the N1 group (p < 0.05).Conclusion: In adult patients, 0.15 mg/kg nalbuphine led to a significant reduction in the ED50 and ED95 of propofol during gastroscopy. This dose of nalbuphine also reduced the incidence of hypotension and shortened the recovery time. Therefore, nalbuphine (0.15 mg/kg) combined with propofol is a safe option for enhancing recovery after painless gastroscopy in adult patients.Clinical Trial Registration: [https://www.chictr.org.cn/edit.aspx?pid=126699&htm=4], identifier [ChiCTR2100053204].

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The median effective doses of propofol combined with two different doses of nalbuphine for adult patients during painless gastroscopy

Tang

Wang

et al. 2022

Front. Pharmacol.

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“…In recent article of Kang et al [1] comparing deep sedation versus conscious sedation for gastroscopy in obese patients, patients' positions during gastroscopy were not provided. Available literature indicates that positions can significantly change severity of airway obstruction and affect the occurrence of hypoxemia during gastrointestinal endoscopy with sedation [2].…”

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confidence: 99%

“…Acknowledgements All authors have no financial support and potential conflicts of interest for this work. Re: Kang et al [1].…”

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confidence: 99%