Dexmedetomidine–Oxycodone combination for conscious sedation during colonoscopy in obese patients: A randomized controlled trial

Wang, Xinran; Zhang, Manman; Sun, Han; Zhang, Rui; Zhu, Yangzi; Zhang, Zhen; Shi, Rongxia

doi:10.1016/j.heliyon.2023.e16370

Cited by 3 publications

(1 citation statement)

References 41 publications

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“…However, this strategy does not inhibit the perioperative stress response, which may hinder functional recovery and delay discharge. 3 In order to reduce patient anxiety and discomfort, improve satisfaction and facilitate endoscopic procedures, it is crucial to select an appropriate anesthesia scheme that can achieve a good anesthetic effect while maintaining hemodynamic stability, especially for complex endoscopic gastrointestinal diagnosis and treatment procedures. 4,5 However, the sedation rate for gastrointestinal endoscopy was only approximately 50% in China, which is far below that of the United States and Europe.…”

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confidence: 99%

The Efficacy and Safety of Remimazolam Besylate Combined with Esketamine for Outpatient Colonoscopy: A Prospective, Randomized, Controlled Clinical Trial

Li,

Zhao,

Hao

et al. 2023

DDDT

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Evaluate the efficacy and safety of remimazolam besylate combined with esketamine for outpatient colonoscopy. Patients and methods: A total of 150 outpatients undergoing colonoscopy were randomized into two groups. A MOAA/S score ≤3 was maintained. The primary outcome was the rate of successful colonoscopy completion. Time indicators, hemodynamic parameters, the consumption of lidocaine, esketamine, propofol and remimazolam besylate, MOAA/S scores and bispectral index (BIS) values, the lowest SpO 2 , body movement, the use of rescue medication, endoscopist and patient satisfaction, recall of the procedure, mini-mental state examination (MMSE), fatigue level and adverse events were recorded. Results: Procedure completion was equivalent between groups (P > 0.05). Both induction and awakening times were significantly shorter in the P group (P < 0.05). There were no significant differences in colonoscopy time and discharge time (P > 0.05). The lowest SpO 2 was significantly lower in the P group, while the level of fatigue was higher (P < 0.05). Patient satisfaction was significantly higher in the R group (P < 0.05). Endoscopist satisfaction was significantly higher in the P group (P < 0.05). There were no significant differences in both systolic and diastolic blood pressure between groups except at T5 and T6 (P > 0.05). Both HR and RR were significantly lower in the P group from T3 to T5 (P < 0.05). BIS values were significantly lower in the P group from T3 to T5, while MOAA/S was significantly lower in the P group at T3 and T4 (P < 0.05). Pain on injection was significantly higher in the P group (P < 0.05). Conclusion: Remimazolam besylate has a similar efficacy to propofol when combined with subanesthetic doses of esketamine during outpatient colonoscopy. Remimazolam besylate combined with esketamine resulted in less injection pain and more stable hemodynamics, although it prolonged induction and awakening time.

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Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Remimazolam Besylate Combined with Esketamine for Outpatient Colonoscopy: A Prospective, Randomized, Controlled Clinical Trial

Li,

Zhao,

Hao

et al. 2023

DDDT

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Efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy: a prospective, randomized, double-blind controlled clinical trial

Xiao,

Zhang,

et al. 2024

BMC Anesthesiol

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Background We explored the efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy. Methods A total of 195 patients who underwent painless colonoscopy surgery were randomly divided into three groups: the propofol deep sedation group (group DS), the sufentanil combined with propofol for conscious sedation (group CS 1 ) and the esketamine combined with propofol for conscious sedation (group CS 2 ). The primary outcomes of this study included the incidence of hypoxemia, hypotension, hypertension, and bradycardia and excellent and good rates of anaesthesia during colonoscopy. The secondary outcomes included perioperative changes in vital signs (MAP, HR, and SpO 2 ), anaesthesia induction time, dischargeable time, patient and endoscopist satisfaction scores, and incidence of postoperative nausea and vomiting (PONV), drowsiness, dizziness, propofol injection pain, assisted ventilation and vasoactive medications. Results The incidence of intraoperative hypoxemia in the DS group was significantly greater than that in the CS 1 and CS 2 groups (χ2 = 7.081, P = 0.029). The incidence of hypotension in the CS 2 group was significantly lower than that in the DS and CS 1 groups (χ2 = 16.278, P < 0.001). The risk of hypoxemia was 5.727 times higher in Group DS than in Group CS 2 (OR 5.727; 95%CI 1.203–27.273), and the risk of hypotension was 9.864 times higher in Group DS than in Group CS 2 (OR 9.864; 95%CI 2.770–35.120). The risk of hypotension in Group CS 1 was 5.167 times that in Group CS 2 (OR 5.167; 95%CI 1.396–19.117). The incidence of propofol injection pain, assisted ventilation, ephedrine usage and drowsiness in the DS group was significantly greater than that in the CS 1 and CS 2 groups (χ2 = 57.618, P < 0.001; χ2 = 9.544, P = 0.008; χ2 = 14.820, P = 0.001; χ2 = 37.257, P < 0.001). The incidence of dizziness during recovery in the CS 1 group was significantly greater than that in the DS and CS 2 groups (χ2 = 6.594, P = 0.037). The dischargeable time in the DS group was significantly greater than that in the CS 1 and CS 2 groups (F = 53.039, P < 0.001). The satisfaction scores of the endoscopist and patients in the DS group were significantly lower than those in the CS 1 and CS 2 gr...

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Sedation for GI Endoscopy in the Morbidly Obese: Challenges and Possible Solutions

Sundararaman,

Goudra

2024

JCM

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With the increasing prevalence of obesity and morbid obesity, this subgroup’s contribution to patients presenting for elective procedures requiring sedation is significant. Gastrointestinal (GI) procedures clearly form the largest group of such procedures. These procedures may be intended to treat obesity such as the insertion of an intragastric balloon or one or more unrelated procedures such as a screening colonoscopy and (or) diagnostic/therapeutic endoscopy. Regardless of the procedure, these patients pose significant challenges in terms of choice of sedatives, dosing, airway management, ventilation, and oxygenation. An understanding of dissimilarity in the handling of different groups of medications used by an anesthesia provider and alterations in airway anatomy is critical for providing safe sedation. Administration of sedative medications and conduct of anesthesia requires dose modifications and airway adjuncts. In this review, we discuss the above issues in detail, with a particular focus on GI endoscopy.

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Dexmedetomidine–Oxycodone combination for conscious sedation during colonoscopy in obese patients: A randomized controlled trial

Cited by 3 publications

References 41 publications

The Efficacy and Safety of Remimazolam Besylate Combined with Esketamine for Outpatient Colonoscopy: A Prospective, Randomized, Controlled Clinical Trial

The Efficacy and Safety of Remimazolam Besylate Combined with Esketamine for Outpatient Colonoscopy: A Prospective, Randomized, Controlled Clinical Trial

Efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy: a prospective, randomized, double-blind controlled clinical trial

Sedation for GI Endoscopy in the Morbidly Obese: Challenges and Possible Solutions

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