Propofol <i>versus</i> midazolam for sedation during radiofrequency ablation in patients with hepatocellular carcinoma

Kanogawa, Naoya; Ogasawara, Sadahisa; Ooka, Yoshihiko; Inoue, Masatoshi; Wakamatsu, Toru; Yokoyama, Masayuki; Maruta, Susumu; Unozawa, Hidemi; Iwanaga, T.; Sakuma, Takafumi; Fujita, Naoto; Koroki, Keisuke; Kanzaki, Hiroaki; Maeda, Takahiro; Kobayashi, Kazufumi; Kiyono, Soichiro; Nakamura, Masato; Kondo, Takayuki; Saito, Tomoko; Motoyama, Tenyu; Suzuki, Eiichiro; Nakamoto, Shingo; Tawada, Akinobu; Arai, Makoto; Kanda, Tatsuo; Maruyama, Hitoshi; Kato, Jun; Takemura, Ryo; Nozaki-Taguchi, Natsuko; Isono, Shiroh; Yokosuka, Osamu; Kato, Naoya

doi:10.1002/jgh3.12483

Cited by 6 publications

(11 citation statements)

References 29 publications

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“…Therefore, researchers consider the use of propofol and midazolam to be inadequate for reducing pain and anxiety associated with RFA therapy. 16 In contrast, during our study, we were able to obtain a good sedative effect, with 95% of patients in the pentazocine-midazolam group having no memory of RFA therapy. During a previous study, sedation was often used from the time of RFA initiation subsequent to needle puncture.…”

Section: Discussioncontrasting

confidence: 63%

“…However, the rates of complete analgesia in both groups were as low as 32.5% and 35.1%, respectively. Therefore, researchers consider the use of propofol and midazolam to be inadequate for reducing pain and anxiety associated with RFA therapy 16 . In contrast, during our study, we were able to obtain a good sedative effect, with 95% of patients in the pentazocine–midazolam group having no memory of RFA therapy.…”

Section: Discussionmentioning

confidence: 57%

“…RFA is an effective treatment for eradicating early‐stage HCC using nonsurgical methods; however, patients often experience distress, such as anxiety and intense pain 25–27 . Pentazocine and morphine have been used as analgesics, 15,28,29 and benzodiazepines, such as midazolam, and systemic anesthetics, such as propofol, have been used as sedatives 16,30 . Studies have shown that propofol has a greater sedative effect than midazolam because of its smooth recovery 16 .…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, during our study, we were able to obtain a good sedative effect, with 95% of patients in the pentazocine–midazolam group having no memory of RFA therapy. During a previous study, sedation was often used from the time of RFA initiation subsequent to needle puncture 15,16 . During our study, sedatives were administered to the pentazocine–midazolam group soon after the patient was admitted to the treatment room.…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of pentazocine–midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma

et al. 2022

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Background and Aim Radiofrequency ablation (RFA) therapy is frequently used as first‐line treatment for small hepatocellular carcinoma (HCC). RFA is often associated with pain; however, no definitive solution has been established for its relief. We retrospectively analyzed the safety and efficacy of the combination of pentazocine and midazolam to relieve pain experienced by HCC patients undergoing RFA. Methods We studied 77 patients with 98 HCCs treated with RFA between January 2015 and August 2019. Patients were divided into two groups: the sedative‐free group, which included those who received pentazocine alone, and the pentazocine–midazolam group, which included those who received a combination of pentazocine and midazolam. The degrees of analgesia and sedation were evaluated using the numerical rating scale (NRS) and the Richmond Agitation‐Sedation Scale (RASS), respectively. Other parameters such as treatment time, awakening time, midazolam dosage, vital signs, local recurrence rate, and time to recurrence were also examined. Results The median NRS score and RASS score were significantly lower in the pentazocine–midazolam group. Ninety‐five percent of patients in the pentazocine–midazolam group had no memory of the RFA session. The treatment time and awakening time were prolonged for the pentazocine–midazolam group. No significant differences in oxygen saturation, recurrence rates, and time to local recurrence were observed between groups. Conclusion A combination of pentazocine and midazolam is safe and effective for pain and anxiety relief experienced by patients undergoing RFA for local treatment of HCC.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of pentazocine–midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma

et al. 2022

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“…Propofol is the standard intravenous sedative drug for short procedures in digestive and liver diseases which is mainly explained by its short time to onset of action as well as short recovery time [ 12 , 17 , 18 ]. Propofol can safely be administered by non-anesthesiologists with very low rates of sedation-associated adverse events.…”

Section: Discussionmentioning

confidence: 99%

Impact of propofol sedation on the diagnostic accuracy of hepatic venous pressure gradient measurements in patients with cirrhosis

2021

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Background Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard to evaluate the presence and severity of portal hypertension. The procedure is generally safe and well tolerated, but nevertheless, some patients demand for sedation. However, it is unknown whether propofol sedation would impair the accuracy of portal pressure measurements. Methods This is a prospective observational cohort study including cirrhotic patients with suspected portal hypertension undergoing invasive measurement of HVPG. Measurements of HVPG were performed in awake condition as well as under sedation with propofol infusion. Results In total, 37 patients were included. Mean HVPG in awake condition was 15.9 mmHg (IQR 13–19) and during sedation 14.1 mmHg (IQR 12–17). While measures of free hepatic vein pressure (FHVP) were not altered after propofol sedation (p = 0.34), wedged hepatic vein pressure values (WHVP) decreased in an average by 2.05 mmHg (95% CI − 2.46 to − 1.16; p < 0.001) which was proportional to the magnitude of HVPG. In 31 out of 37 patients (83.8%), portal hypertension with HVPG ≥ 12 mmHg was found. Under sedation with propofol, two patients (5.4%) with borderline values would have been incorrectly classified as < 12 mmHg. After adjustment for the average difference of − 10%, all patients were correctly classified. Intraclass correlation coefficient between HVPG measurement in awake condition and under propofol sedation was 0.927 (95% CI 0.594–0.975). Conclusions Propofol sedation during HVPG measurements is generally safe, however it may lead to relevant alterations of HVPG readings.

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Safety of propofol sedation administered by interventional radiologists for radiofrequency ablation in patients with hepatocellular carcinoma

Kimura,

Sone,

Sugawara

et al. 2024

Jpn J Radiol

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Purpose To evaluate the safety of propofol sedation administered by interventional radiologists during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). Materials and methods Propofol sedation was administered by interventional radiologists in 72 patients (85 procedures, 93 tumors) during RFA for HCC between August 2018 and December 2020. Interventional radiologists equipped with adequate knowledge and skills in sedation and respiratory management were responsible for sedation. Sedation was carefully assessed based on vital signs, including end-tidal carbon dioxide, consciousness status, and bispectral index. The primary endpoint was the incidence of sedation-related complications, which were evaluated separately as respiratory and cardiovascular complications. Secondary endpoints were technical success rate, ablation-related complications, and local tumor control rate. Technical success was defined as completion of ablation in the planned area. Complications were evaluated using the Clavien–Dindo classification. Sedation-related complications, technical success rate, and ablation-related complications were evaluated on a procedure basis, and local tumor control was evaluated on a tumor basis. Results Respiratory and cardiovascular complications were observed in eight (8/85, 9.4%) and two (2/85, 2.4%) patients, respectively. Four patients required the jaw thrust maneuver due to glossoptosis, whereas a decrease in oxygen saturation to < 90% was recorded in the other four patients. However, these were temporary, and none required manual ventilation or endotracheal intubation. Bradycardia (< 50 bpm) was detected in two patients; one recovered immediately without treatment, whereas the other rapidly improved after atropine sulfate administration. No severe hypotension (< 80 mmHg) was observed. The technical success rate was 100% (85/85). Grade 3 ablation-related complications were identified in three patients (3/85, 3.5%). The local tumor control rate was 95.7% (89/93). Conclusion Propofol sedation can be safely administered by interventional radiologists during RFA for HCC. Although it requires special safety considerations, it may be a sedation option during hepatic RFA.

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Propofol versus midazolam for sedation during radiofrequency ablation in patients with hepatocellular carcinoma

Cited by 6 publications

References 29 publications

Safety and efficacy of pentazocine–midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma

Safety and efficacy of pentazocine–midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma

Impact of propofol sedation on the diagnostic accuracy of hepatic venous pressure gradient measurements in patients with cirrhosis

Safety of propofol sedation administered by interventional radiologists for radiofrequency ablation in patients with hepatocellular carcinoma

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