Risk Factor for Vital Signs Fluctuation during Colonoscopy under Conscious Sedation Consisting of Midazolam and Meperidine

Banno, Shigeo; Kato, Motohiko; Sunata, Yukie; Hirai, Yukio; Kubosawa, Yoko; Abe, Keiichiro; Takada, Yoshiaki; Hirata, Tetsu; Takatori, Yusaku; Wada, Mitsuru; Kinoshita, Satoshi; Mori, Hideki; Takabayashi, Kaoru; Kikuchi, Masahiro; Uraoka, Toshio

doi:10.1159/000481343

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…The primary outcome was all cardiopulmonary adverse events including tachycardia, bradycardia, hypertension, transient hypotension, respiratory depression, oxygen desaturation, and fatal arrhythmia. The secondary outcomes were the following: vital signs fluctuation (VSF), which was defined as transient hypotension (SBP < 90 mm Hg or at least 20 mm Hg less than the baseline value, even at least once during the procedure) and oxygen desaturation (SpO2 < 90% on room air or < 95% on 2L/min oxygen) [ 22 ] ; adverse events disturbing the procedure such as belching, severe coughing, needs for restraint, and myoclonus; and sedation-related outcomes including induction time, total procedure time, awake time, patients’ and endoscopist's satisfaction scores, and frequency of recall.…”

Section: Methodsmentioning

confidence: 99%

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Lee

Min²,

Lee³

et al. 2018

Medicine

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Background and aims:Recent studies have shown that etomidate is associated with fewer serious adverse events than propofol and has a noninferior sedative effect. We investigated whether etomidate–midazolam is associated with fewer cardiopulmonary adverse events and has noninferior efficacy compared to propofol–midazolam for screening colonoscopy in the elderly.Methods:A prospective, single-center, double-blinded, randomized controlled trial was performed. Patients aged over 65 years who were scheduled to undergo screening colonoscopy were randomized to receive either etomidate or propofol based on midazolam. The primary outcome was all cardiopulmonary adverse events. The secondary outcomes were vital sign fluctuation (VSF), adverse events disturbing the procedure, and sedation-related outcomes.Results:The incidence of cardiopulmonary adverse events was higher in the propofol group (72.6%) than in the etomidate group (54.8%) (P = .040). VSF was detected in 17 (27.4%) and 31 (50.0%) patients in the etomidate and propofol groups, respectively (P = .010). The incidence rate of adverse events disturbing the procedure was significantly higher in the etomidate group (25.8%) than in the propofol group (8.1%) (P = .008). Moreover, the incidence rate of myoclonus was significantly higher in the etomidate group (16.1%) than in the propofol group (1.6%) (P = .004). There was no statistical significance between the 2 groups with respect to sedation times and sedation-related outcomes including patients’ and endoscopist's satisfaction. In the multivariate analysis, the etomidate group had significantly low odds ratio (OR) associated with VSF (OR: 0.407, confidence interval: 0.179–0.926, P = .032).Conclusions:We recommend using etomidate–midazolam in patients with high ASA score or vulnerable to risk factors; propofol–midazolam may be used as a guideline in patients with low ASA score.

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Section: Methodsmentioning

confidence: 99%

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Lee

Min²,

Lee³

et al. 2018

Medicine

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“…Advanced age significantly increases perioperative morbidity and mortality in elderly patients 20 and has been confirmed to be an independent risk factor for anesthesia-related adverse events 21 , 22 . Studies have shown that compared with propofol, remimazolam is more effective in sedation and impacts less on the respiratory and circulatory systems 23 , and its advantages may be more prominent when used for anesthesia and sedation in the elderly 13 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy and safety of equivalent doses of remimazolam versus propofol for gastroscopy anesthesia in elderly patients

Chen,

Liao,

et al. 2024

Sci Rep

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Remimazolam, a novel intravenous anesthetic, has been proven to be safe and efficacious in the gastroscopy setting among the elderly. However, reports comparing the effectiveness and safety of using equivalent doses of remimazolam with propofol have not been seen. The aim of this study was to compare the sedation efficacy and safety of the 95% effective doses (ED95) of remimazolam versus propofol combined with sufentanil in the gastroscopy setting among the elderly. In the first step of this two-step study, a modified up-and-down method was used to calculate the ED95 of remimazolam and propofol when combined with 0.1 µg/kg sufentanil in inhibiting body movement of elderly patients undergoing gastroscopy. In the second step, ED95 of both agents calculated in the first step were administered, endpoints of efficacy, safety, and incidence of adverse events were compared. A total of 46 individuals completed the first step. The ED95 of remimazolam was 0.163 mg/kg (95% CI 0.160–0.170 mg/kg), and that of propofol was 1.042 mg/kg (95% CI 1.007–1.112 mg/kg). In the second step, 240 patients completed the trial. The anesthetic effective rates of the remimazolam group and the propofol group were 78% and 83%, respectively, with no statistical difference (P = 0.312). Patients in the remimazolam group had more stable circulatory functions (P < 0.0001) and a lower incidence of pain on injection (3.3% vs. 19.5%, P < 0.0001). The incidence of hypotension was low in the remimazolam versus propofol group (15.6% vs. 39.0%, P < 0.0001). Overall adverse event was low in the remimazolam versus propofol group (21.3% vs. 62.7%, P < 0.0001).In this study, we found that when anesthesia was administered to elderly gastroscopy patients based on 95% effective doses of remimazolam and propofol, remimazolam was as effective as propofol, but was safer with a lower incidence of adverse events.Study registration: Chinese Clinical Trial Registry, ChiCTR2000034234. Registered 29/06/2020, https://www.chictr.org.cn.

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“…This knowledge gap might be affecting PSA practice in Japan. Analgesics with a long time to peak effect, such as meperidine, are still widely used for PSA in Japan . Although there is ongoing debate over what the ideal medications for PSA are, experts generally agree that ideal pharmacological characteristics of medications for PSA should include rapid onset of action and short time to peak effect .…”

Section: Discussionmentioning

confidence: 99%

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Norii

Kimura²,

Homma³

et al. 2018

Acute Medicine & Surgery

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Aim Worldwide, health‐care providers carry out procedural sedation and analgesia (PSA) in the emergency department. However, training opportunities are limited in many Asian countries, including Japan. We formed an educational group consisting of board‐certified emergency physicians in the USA and Japanese physicians and developed a PSA training module. The aims of our study were to demonstrate the effectiveness of training and to describe PSA practice in Japan. Methods We undertook a pretest of PSA knowledge questions and a retest immediately after the training intervention. We also carried out a survey and asked about participants' PSA practice. The training module consisted of four didactic hours and three simulation and skills laboratory hours. Results of all pre‐ and post‐intervention knowledge questions were analyzed with McNemar's test, and overall scores were analyzed with a paired t‐test. Results One hundred and forty‐four health‐care providers including 123 physicians, 16 nurses, two pharmacists, and three medical students participated in the training. A total of 119 (83%) completed both the pre‐ and post‐intervention knowledge questions. Before the training, participants scored an average 66% (63%–69%) on the written knowledge test. After the intervention, participants showed significant improvement on the knowledge test (improvement 17%; 14%–20%). Among participants who answered the practice survey, 121 (88%) have undertaken PSA. Only 14 (12%) participants always or often use a continuous capnography for PSA. Only 32 (26.4%) participants undertook pre‐PSA systematic evaluation. Conclusion Our educational intervention successfully increased participants' knowledge. Only the minority of health‐care providers use capnography routinely for PSA, and pre‐PSA evaluation is not commonly carried out.

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Risk Factor for Vital Signs Fluctuation during Colonoscopy under Conscious Sedation Consisting of Midazolam and Meperidine

Cited by 7 publications

References 18 publications

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Comparison of efficacy and safety of equivalent doses of remimazolam versus propofol for gastroscopy anesthesia in elderly patients

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

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