Systematic review of anaesthetic medication for ERCP based on a network meta-analysis

Li, Shuangxi; Sheng, Guotao; Teng, Yishan; Sun, Min

doi:10.1016/j.ijsu.2018.01.018

Cited by 8 publications

(9 citation statements)

References 41 publications

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“…The most commonly used agent for this purpose is midazolam. This drug has a short elimination half-life and has amnestic and anxiolytic effects [1]. Propofol is a widely used sedative Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study and hypnotic agent with minimal analgesic potential.…”

Section: Introductionmentioning

confidence: 99%

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Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

Koruk¹,

Koruk²,

Arslan³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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Introduction: Interventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. The most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential. Aim: To compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP. Material and methods: Forty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 µg/kg for 10 min) in group D. Propofol was used for maintenance. The sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded. Results: The hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 ±80.0 vs. 154.5 ±66.7 mg; p = 0.011). The recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 ±2.1 vs. 6.6 ±1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups. Conclusions: We found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

Koruk¹,

Koruk²,

Arslan³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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“…8 Agents such as propofol, midazolam or dexmedetomidine can be used to achieve moderate sedation for the procedure. 17 Previously, propofol alone provided identical or superior sedation quality than combination with midazolam in regard of both the recovery time and patient tolerance. [18][19][20][21] In this survey, half of ERCP doctors in Korea preferred to use a balanced propofol sedation technique for ERCP preparation.…”

Section: Discussionmentioning

confidence: 99%

A National Survey on the Environment and Basic Techniques of Endoscopic Retrograde Cholangiopancreatography in Korea

et al. 2021

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Background/Aims: The work environment in which endoscopic retrograde cholangiopancreatography (ERCP) is conducted has influence on its efficacy and safety. We aimed to assess the current status of ERCP work environments and to investigate the trends associated with the basic techniques of ERCP in Korea. Methods:The work environment and information on the basic techniques of ERCP were acquired by the Korean Pancreatobiliary Association (KPBA) through a national survey in 2019. The survey was performed at the KPBA conference in 2019. The contents of survey comprised of the current environment of ERCP, preparation before ERCP, and the preferred basic techniques used in ERCP.Results: Completed questionnaires were returned from 84 KPBA members. The mean ERCP volume per year was approximately 500. About 60% (50/84) reported that they worked with a dedicated ERCP team with experienced nurses. Two-thirds (57/84, 68%) answered that they had a fluoroscopy room used solely for ERCP procedures. All respondents intravenously hydrated the patient to prevent post-ERCP pancreatitis (84/84, 100%). The preferred procedural sedations were balanced propofol sedation (50%) and midazolam-only sedation (47%). Wire-guided cannulation was most commonly used for selective cannulation (81%). Endoscopic retrograde biliary drainage was preferred over endoscopic nasobiliary drainage (60% vs 22%). The initial method of ampullary intervention was endoscopic sphincterotomy in 60%. Conclusions:Data from the survey involving a large number of Korean ERCP doctors revealed considerable variabilities with regard to the work environment and basic techniques of ERCP in Korea. The study provides information regarding the current trends of ERCP that can be used to establish ERCP standards in Korea.

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“…Combining propofol with an opioid is an effective approach to enhancing its sedative effects, avoiding its overuse, and consequently providing optimal sedation and analgesia without increased side effects [ 5 , 6 ]. Alfentanil, as a potent opioid analgesic with rapid onset and short action time [ 7 ], has found broad application in recent years and is widely used as supplemental analgesia to anesthetic agents in various surgical procedures [ 8 , 9 ]. Alfentanil combined with propofol has been utilized in ERCP procedures, showing low side effects and desirable safety [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Alfentanil, as a potent opioid analgesic with rapid onset and short action time [ 7 ], has found broad application in recent years and is widely used as supplemental analgesia to anesthetic agents in various surgical procedures [ 8 , 9 ]. Alfentanil combined with propofol has been utilized in ERCP procedures, showing low side effects and desirable safety [ 9 ]. Midazolam, a benzodiazepine with properties of rapid onset, short duration of action, and low toxicity [ 10 ], has proven to be a useful premedication to provide sedation, amnesia, and anxiolysis in a wide variety of procedures, including gastrointestinal endoscopy [ 11 ] and ERCP [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation of elderly patients undergoing ERCP

Zhang,

et al. 2024

BMC Gastroenterol

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Background Proper sedation of patients, particularly elderly individuals, who are more susceptible to sedation-related complications, is of significant importance in endoscopic retrograde cholangiopancreatography (ERCP). This study aims to assess the safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation in elderly patients undergoing ERCP, compared to a group of middle-aged patients. Methods The medical records of 610 patients with common bile duct stones who underwent elective ERCP under deep sedation with a three-drug regimen, including midazolam, alfentanil, and propofol at Shandong Provincial Third Hospital from January 2023 to September 2023 were retrospectively reviewed in this study. Patients were categorized into three groups: middle-aged (50–64 years, n = 202), elderly (65–79 years, n = 216), and very elderly (≥ 80 years, n = 192). Intraoperative vital signs and complications were compared among these groups. Results The three groups showed no significant difference in terms of intraoperative variation of systolic blood pressure (P = 0.291), diastolic blood pressure (P = 0.737), heart rate (P = 0.107), peripheral oxygen saturation (P = 0.188), bispectral index (P = 0.158), and the occurrence of sedation-related adverse events including hypotension (P = 0.170) and hypoxemia (P = 0.423). Conclusion The results suggest that a low-dose three-drug regimen consisting of midazolam, alfentanil, and propofol seems safe and effective for deep sedation of elderly and very elderly patients undergoing ERCP procedures. However, further studies are required to verify these findings and clarify the benefits and risks of this method.

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Systematic review of anaesthetic medication for ERCP based on a network meta-analysis

Cited by 8 publications

References 41 publications

Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

A National Survey on the Environment and Basic Techniques of Endoscopic Retrograde Cholangiopancreatography in Korea

Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation of elderly patients undergoing ERCP

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