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      Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study

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          Abstract

          Background

          Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine the existence of associations between these events and potentially related variables.

          Methods

          This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age > 18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support.

          Results

          The most frequently encountered adverse event was oxygen desaturation < 95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation < 90% followed, with incidences of 19.2, 12.64, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P = 0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P = 0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, 95% confidence interval: 2.83 to 36.99) more likely to experience oxygen desaturation < 90% events.

          Conclusions

          Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with acceptable rates of adverse events and could be more widely adopted in clinical practice.

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          Most cited references17

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          Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy.

          Propofol by nonanesthesiologists is controversial because the drug is commonly used to produce deep sedation or general anesthesia. Propofol in combination with opioids and/or benzodiazepines can be titrated to moderate sedation, which might be safer. To compare recovery time, patient satisfaction, and other end points with propofol alone titrated to deep sedation versus propofol combination therapy with opioids and/or benzodiazepines. A randomized controlled clinical trial of propofol alone titrated to deep sedation versus fentanyl plus propofol versus midazolam plus propofol versus fentanyl plus midazolam plus propofol in 200 outpatients undergoing colonoscopy. Each combination regimen was titrated to moderate sedation. Patients receiving propofol alone received higher doses of propofol and had deeper sedation scores compared with combination therapy (both p < 0.001). Patients receiving combination regimens were discharged more quickly (median 13.0-14.7 versus 18.1 min) than those receiving propofol alone (p < 0.01). There were no differences in vital signs or oxygen saturations among the study arms. There were no significant differences in pain or satisfaction among the study arms in the recovery area. At a follow-up phone call, patients receiving fentanyl and propofol remembered more of the procedure than those in the other regimens (p < 0.005) and remembered more pain than those receiving propofol alone (p < 0.02). Propofol in combination with fentanyl and/or midazolam can be titrated to moderate levels of sedation without substantial loss of satisfaction and with shorter recovery times compared with propofol titrated to deep sedation throughout the procedure.
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            High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy: A prospective, randomized clinical trial

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              Propofol versus traditional sedative agents for advanced endoscopic procedures: a meta-analysis.

              The optimum method for sedation for advanced endoscopic procedures is not known. Propofol deep sedation has a faster recovery time than traditional sedative agents, but may be associated with increased complication rates. The aim of the present study was to pool data from all available studies to systematically compare the efficacy and safety of propofol with traditional sedative agents for advanced endoscopic procedures.
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                Author and article information

                Contributors
                mariae.garcia@hospitalitaliano.org.ar
                sol.fernandez@hospitalitaliano.org.ar
                delfina.sanchez@hospitalitaliano.org.ar
                sandra.salgado@hospitalitaliano.org.ar
                sergio.terrasa@hospitalitaliano.org.ar
                gonzalo.domenech@hospitalitaliano.org.ar
                carlos.teijido@hospitalitaliano.org.ar
                Journal
                BMC Anesthesiol
                BMC Anesthesiol
                BMC Anesthesiology
                BioMed Central (London )
                1471-2253
                10 August 2020
                10 August 2020
                2020
                : 20
                : 195
                Affiliations
                [1 ]GRID grid.414775.4, ISNI 0000 0001 2319 4408, Department of Anesthesiology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, ; Presidente Teniente General Juan Domingo Perón 4190, 1199 Buenos Aires, Argentina
                [2 ]GRID grid.414775.4, ISNI 0000 0001 2319 4408, Department of Research, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, ; Presidente Teniente General Juan Domingo Perón 4190, 1199 Buenos Aires, Argentina
                Article
                1103
                10.1186/s12871-020-01103-w
                7418437
                32778055
                1f09ae3d-609f-4312-98be-0b2ecffa5208
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 26 May 2020
                : 22 July 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Anesthesiology & Pain management
                propofol,anaesthesiologists,endoscopy,gastrointestinal,anaesthesia, intravenous,deep sedation

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