Sedation in Endoscopic Practice

Aisenberg, James; Cohen, Lawrence B.

doi:10.1016/j.giec.2006.08.004

Cited by 28 publications

(18 citation statements)

References 59 publications

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“…Western endoscopists prefer to use propofol for sedation during colonoscopy in terms of satisfying certain criteria 25 . Propofol sedation has also been identified as a factor independently associated with some quality markers of colonoscopy, including cecal intubation and polyp detection rates 26 .…”

Section: Colonoscopy Technique and Equipmentmentioning

confidence: 99%

“…Western endoscopists prefer to use propofol for sedation during colonoscopy in terms of satisfying certain criteria. 25 Propofol sedation has also been identified as a factor independently associated with some quality markers of colonoscopy, including cecal intubation and polyp detection rates. 26 In contrast, the safety and usefulness of consciousness or unsedated colonoscopy has been reported not only from Japan but also from Western countries recently, because studies from Western countries suggest that cecal intubation rates are not adversely affected by performing the examination unsedated, in addition to some advantages including cost-benefit and lower complication rates.…”

Section: Sedation During Esdmentioning

confidence: 99%

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Colorectal Endoscopic Submucosal Dissection in Japan and Western Countries

Uraoka

Parra‐Blanco

Yahagi

2012

Digestive Endoscopy

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Various studies by Japanese endoscopists have demonstrated that colorectal endoscopic submucosal dissection (ESD) can overcome technical limitations of the endoscopic mucosal resection (EMR) technique such as piecemeal resection for flat lesions larger than 20 mm, resection of lesions involving the dentate line or the ileocecal valve and lesions with the non-lifting sign, and achieve higher en bloc resection rate. However, it is infrequently performed in Western countries in comparison with Japan, despite the advantages explained above. There are some differences between Japan and Western countries in environments and clinical settings for performing ESD in the colorectum. Endoscopists who perform colorectal ESD around the world are considering that refinements in ESD techniques, devices and training will be necessary to further reduce a higher risk of complications and longer procedure times before adoption of ESD can be recommended on a widespread international scale.

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Section: Colonoscopy Technique and Equipmentmentioning

confidence: 99%

Section: Sedation During Esdmentioning

confidence: 99%

Colorectal Endoscopic Submucosal Dissection in Japan and Western Countries

Uraoka

Parra‐Blanco

Yahagi

2012

Digestive Endoscopy

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“…19,[20][21][22] The research in this area is of a low level of evidence: single-center studies including either retrospective or small numbers of prospective patients. When reviewing the literature, it is also important to take into account whether the literature matches the area of practice that is under investigation.…”

Section: Evidencementioning

confidence: 99%

Scope Creep

Davidson

Bloomberg

Burnell

2007

Critical Care Nursing Quarterly

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The finite boundaries of the scope of nursing practice are constantly changing. One could expect that with new technology and advances in science, the interventions and assessments nurses perform will change over time. The practice of nursing is governed by nursing, however, it is often challenged by our partners in medicine, and frequently driven by time constraints or reimbursement issues. This article reviews a case example in which nurses were asked to expand their practice to assume responsibility for duties that were once traditionally performed by physicians. An evaluation of a practice problem using an evidence-based approach applying the PICO (population, intervention, comparison, outcome) method is explored. Proposed steps to minimize risk and staff moral distress are also described.

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“…In general, most GI endoscopy procedures are performed under moderate sedation, a practice that was formerly referred to as “conscious sedation” . Although liver cirrhosis impairs protein synthesis, alters drug metabolism pathways, and compromises hepatic blood flow, all these factors may affect the pharmacokinetics of the sedative drugs; however, there are no current pre‐endoscopy sedation guidelines for cirrhotic patients …”

Section: Introductionmentioning

confidence: 99%

Conscious sedation using propofol versus midazolam in cirrhotic patients during upper GI endoscopy: A comparative study

Wahab¹,

Hamed²,

Ahmad³

et al. 2018

JGH Open

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Aim We aimed to assess the safety and efficacy of propofol versus midazolam in cirrhotic patients undergoing upper GI endoscopy. Methods Ninety compensated cirrhotic patients (all met class I–III criteria according to the American Society of Anesthesia) were enrolled in this comparative study. They were classified into three groups according to scheduled pre‐endoscopy sedation drugs; the midazolam group, which included 30 patients who received IV weight‐dependent midazolam (0.05 mg/kg with additional doses of 1 mg every 2 min when necessary, up to a maximum dose of 0.1 mg/kg or 10 mg); the propofol group, which included 30 patients who received a propofol bolus dose according to age and weight (0.25 mg/kg with additional doses of 20–30 mg every 30–60 s when necessary, up to a maximum dose of 400 mg); and the combined group, which included 30 patients who received half a dose of midazolam and of propofol. Results Prolonged postendoscopy recovery times were reported in the midazolam group, while shorter recovery times were reported in the propofol and combined groups. All patients in the propofol and combined groups gained consciousness shortly postendoscopy; however, only half of the midazolam group's patients gained consciousness after the standard recovery time (10–30 min). Highly significant differences were found among the three groups regarding consciousness level according to the Glasgow coma scale, as well as regarding the occurrence of hypoxia during endoscopy. Conclusion Considering safety and efficacy issues, propofol is better than midazolam in gastrointestinal endoscopy, especially in patients with liver cirrhosis.

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Sedation in Endoscopic Practice

Cited by 28 publications

References 59 publications

Colorectal Endoscopic Submucosal Dissection in Japan and Western Countries

Colorectal Endoscopic Submucosal Dissection in Japan and Western Countries

Scope Creep

Conscious sedation using propofol versus midazolam in cirrhotic patients during upper GI endoscopy: A comparative study

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