Hypoxemia during procedural sedation in adult patients: a retrospective observational study

Schaik, Eva P. C. van; Blankman, Paul; Klei, Wilton A. van; Knape, H; Vaessen, Paul H. H. B.; Braithwaite, Sue; Wolfswinkel, Leo van; Schellekens, Willem-Jan M.

doi:10.1007/s12630-021-01992-6

Cited by 22 publications

(15 citation statements)

References 29 publications

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“…If sedative drugs can be used in some countries without restriction (4), they are not allowed in France unless an anesthesiologist is present during the bronchoscopy procedure (5). Moreover, sedative drugs could increase the risk of respiratory depression (4,6). Nonpharmacological techniques are currently being used as…”

Section: Introductionmentioning

confidence: 99%

Hypnosis associated with 3D immersive virtual reality technology during bronchoscopy under local anesthesia

Lachkar¹,

Gervereau²,

Lanquetuit³

et al. 2022

J Thorac Dis

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Background: Patients undergoing flexible bronchoscopy under local anesthesia usually experience anxiety before and during the procedure. Different non-pharmacological techniques, including music and hypnosis, are used to distract patients' attention, and to reduce anxiety. The new technique "virtual reality hypnosis (VRH)", defined as a hypnotic induction suggestion delivered by personalized virtual reality software, can generate a simulation of a lifelike environment. No study has described the use of VRH during bronchoscopy. The objective is to investigate the anxiety reducing effect and the satisfaction of patients, physicians, and nurses using VRH during bronchoscopy Methods: VRH was proposed to all patients who experienced anxiety before undergoing flexible bronchoscopy under local anesthesia. Local anesthesia was performed using 5% lidocaine spray only. No sedation was used. After the procedure, patients, physicians and nurses filled a standardized satisfaction form.Results: Twenty consecutive patients who reported pre-procedure anxiety were included. The sex ratio was 16 women/4 men, the median age was 65 years. Eight patients (40%) had undergone a previous bronchoscopy under local anesthesia. The median duration of the procedure was 10 minutes, and all procedures were completed. The median level of anxiety of patients decreased from 9/10 before the procedure to 4/10 during the procedure. The median satisfaction rate regarding the use of VRH was 10/10. All patients agreed to use VRH again in case of a new bronchoscopy procedure.Conclusions: This preliminary report has shown that VRH was useful to reduce patients' anxiety during bronchoscopy under local anesthesia. VRH was easily implemented in the routine practice.

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Section: Introductionmentioning

confidence: 99%

Hypnosis associated with 3D immersive virtual reality technology during bronchoscopy under local anesthesia

Lachkar¹,

Gervereau²,

Lanquetuit³

et al. 2022

J Thorac Dis

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“…Ризики розвитку порушення прохідності ДШ та десатурації. Ризики виникнення гіпоксемії (SpO 2 < 90%) під час ПС підвищуються при проведенні ПС не анестезіологами, а також при продовженні тривалості процедур [18]. В цьому дослідженні на вибірці близько 6 тис.…”

Section: забезпечення прохідності дш та оксигенації під час псunclassified

Justification for the Combined Use of Propofol and Dexmedetomidine in Elective Procedural Sedation

Пилипенко¹,

Михайлов²

2021

Pain Anaesth Int Care

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Procedural sedation (PS) is the technique of administering sedatives with or without analgesics to induce a condition in which the patient can tolerate unpleasant procedures while maintaining cardio-respiratory function. Planned PSs are performed with procedures of various invasiveness, painfulness and duration, but by definition, they do not reach the depth of general anesthesia and do not require the use of respiratory support or controlled mechanical ventilation, and even more – muscle relaxants. For effective PS, it is extremely important to establish verbal contact with the patient and achieve a stable emotional state of the patient and carefully explain to him the details of the PS. When choosing the depth of PS, it’s necessary to reach a compromise between the degree of anesthesia and amnesia, on the one hand, and the effectiveness of spontaneous breathing, as well as the possibility of an early recovery of consciousness, on the other. If possible, the problem of pain (when consciousness is partially preserved) or nociceptive stimuli (when the level of consciousness is reduced or absent) is solved separately through the use of local or regional anesthesia. In addition, non-steroidal anti-inflammatory drugs (NSAIDs) and some other drugs with analgesic properties are often used, and opioid analgesics are avoided or used in small or minimal doses. Unlike anesthesia, even deep sedation cannot and should not completely prevent the patient from moving during intense pain / nociceptive stimuli. If necessary, the problem of patient movements is solved not only and not so much by further deepening sedation, but precisely by improving analgesia and/or fixing the patient for the duration of short-term painful manipulations. To achieve these goals, PS is most often used propofol, or its dexmedetomidine or midazolam. This publication focuses on the advantages of using a multimodal approach for prolonged PS, which allows for a significant reduction in the dose of corresponding drugs and rate of complications in comparison with sedation with a single anaesthetic at significantly higher doses.

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“…Therefore, the application of adjuvant drugs with less side effects on respiratory and cardiac inhibition, so as to reduce the dose of propofol, is beneficial for painless GI endoscopy. For example, benzodiazepines and opioids used with propofol could significantly decrease propofol requirements [ 11 ], but hypotension and hypoxemia still occur [ 12 , 13 ]. Ketamine used with propofol reduced propofol consumption and cardiopulmonary depression events, but ketamine also produced schizophrenia and dissociative states [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of intravenous lidocaine on hypoxemia induced by propofol-based sedation for gastrointestinal endoscopy procedures: study protocol for a prospective, randomized, controlled trial

Sun

et al. 2022

Trials

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Background Oxygen-desaturation episodes, blood pressure drops, and involuntary body movement are common problems that occur in propofol-based sedation in the procedure of painless gastrointestinal (GI) endoscopy. As a widely used analgesic adjuvant, intravenous lidocaine can reduce the consumption of propofol during ERCP or colonoscopy. However, it is still unknown how lidocaine affects the incidence of oxygen-desaturation episodes and cardiovascular events, and involuntary movement during painless GI endoscopy. Therefore, we aimed to assess the effectiveness and safety of intravenous lidocaine in propofol-based sedation for GI endoscopy. Methods We will conduct a single-center, prospective, randomized, double-blind, saline-controlled trial. A total number of 300 patients undergoing painless GI procedures will be enrolled and randomly divided into the lidocaine group (Group L) and the control group (Group C). After midazolam and sufentanil intravenous injection, a bolus of 1.5 mg/kg lidocaine was immediately injected and followed by a continuous infusion of 4 mg/kg/h in the lidocaine group, whereas the same volumes of saline solution in the control group. Then, propofol was titrated to produce unconsciousness during the procedure. The primary outcome will be the incidence of oxygen-desaturation episodes. Secondary outcomes will be the incidence of involuntary body movement, discomfort symptoms, propofol consumption, endoscopist, and patient satisfaction. Discussion Propofol-based deep sedation without intubation is widely used in painless GI endoscopy. However, adverse events such as hypoxemia often occur clinically. We expect to assess the effect of lidocaine on reducing the incidence of oxygen-desaturation episodes, cardiovascular events, and involuntary body movement. We believe that the results of this trial will provide an effective and safe method for painless GI endoscopy. Trial registration Chinese Clinical Trial Registry ChiCTR2100053818. Registered on 30 November 2021.

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Hypoxemia during procedural sedation in adult patients: a retrospective observational study

Cited by 22 publications

References 29 publications

Hypnosis associated with 3D immersive virtual reality technology during bronchoscopy under local anesthesia

Hypnosis associated with 3D immersive virtual reality technology during bronchoscopy under local anesthesia

Justification for the Combined Use of Propofol and Dexmedetomidine in Elective Procedural Sedation

Effects of intravenous lidocaine on hypoxemia induced by propofol-based sedation for gastrointestinal endoscopy procedures: study protocol for a prospective, randomized, controlled trial

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