Scandinavian Journal of Gastroenterology Factors related to paradoxical reactions during propofol-induced sedated endoscopy (original) (raw)
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Propofol sedation during gastrointestinal endoscopy arouses euphoria in a large subset of patients
United European gastroenterology journal, 2018
Propofol is recommended for sedation in gastrointestinal endoscopy (GE), but preliminary data suggest addictive potentials. The objective of this article is to evaluate the frequency of predominantly euphoric reaction after GE and patients' subsequent reminiscences. Eighty-two patients undergoing elective GE under propofol sedation were enrolled in a prospective observational study. The grade of anxiety, expectation or relief about the examination's result and affective state in terms of cheerfulness, relaxation, activation, sedation and anxiety were surveyed using a numeric rating scale (1 to 10) immediately before (t1), after GE (t2) and seven days (t3) later. Statistics: hierarchical cluster analysis, heat map, χ2 test and paired test. Mean propofol dosage was 264 ± 120 mg. Two clusters of mood changes emerged (t1 vs. t2). One ( = 46, 56.1%) was characterized by an unease reaction pattern with equal values regarding cheerfulness, relaxation and anxiety, while relaxation d...
Propofol sedation during gastrointestinal endoscopy induces euphoria in a large subset of patients
2017
Background: Propofol is recommended for sedation in gastrointestinal endoscopy (GE), but preliminary data suggest addictive potentials. Objective: The objective of this article is to evaluate the frequency of predominantly euphoric reaction after GE and patients' subsequent reminiscences. Methods: Eighty-two patients undergoing elective GE under propofol sedation were enrolled in a prospective observational study. The grade of anxiety, expectation or relief about the examination's result and affective state in terms of cheerfulness, relaxation, activation, sedation and anxiety were surveyed using a numeric rating scale (1 to 10) immediately before (t1), after GE (t2) and seven days (t3) later. Statistics: hierarchical cluster analysis, heat map, 2 test and paired t test. Results: Mean propofol dosage was 264 AE 120 mg. Two clusters of mood changes emerged (t1 vs. t2). One (n ¼ 46, 56.1%) was characterized by an unease reaction pattern with equal values regarding cheerfulness, relaxation and anxiety, while relaxation decreased; the other cluster showed a euphoric reaction pattern (n ¼ 36, 43.9%) with markedly increased cheerfulness, relaxation and decreased anxiety. These effects intensified at recall (t3). Despite similar endoscopy results, euphoric cluster patients rated these more positively. Conclusion: Propofol induces euphoria in nearly half of the patients undergoing elective GE with persisting, even enhanced reminiscence (germanctr.de, trial number DRKS00011202).
Medical Archives, 2016
Background: Anxiety is a common preprocedural problem and during processing especially in interventional medical processes. Aim: Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and coloscopy. Methods: Five hundred patients scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Beck Anxiety Inventory (BAI) was administered to each patient before brought to the endoscopy room. Demographic data of patients were collected. Results: BAI scores and anxiety levels were significantly lower in; males compared to females, patients with no comorbidity compared to patients with comorbidity (both P values < 0.001). BAI scores were significantly lower in patients educational status university and upper compared to patients educational status primary-high school (p=0.026). There were no significant difference between BAI and anxiety levels compared to procedures (Respectively, P=0.144 P=0.054). There were no significant difference between BAI scores and anxiety levels compared to age groups (Respectively, P=0.301 P=0.214). Conclusions: We think that level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonoscopy was effected by presence of comorbidities and gender but was not effected by features such as age, procedure type and educational status.
Collegium antropologicum, 2003
The aim of this study was to investigate both the efficacy and safety of sedation with propofol during urgent therapeutic gastroscopy in patients with upper gastrointestinal bleeding. This prospective study included a total of 110 patients. Propofol was administered intravenously at the starting dose of 1 mg/kg body weight and was followed by repeated doses. Oxygen saturation and heart rate were monitored by pulse oxymetry. The mean dose of propofol administered was 161 +/- 49 mg. Urgent upper GI endoscopy under propofol sedation was successful in 98% of cases. Endoscopists rated the sedation as good in 83.6%, satisfactory in 14.5%, and poor in 1.8% of patients. Potentially harmful drop in oxygen saturation below 85% was observed in 5.5% of patients, whereas a temporary drop in heart rate below 50 beats/min was observed in 11.8%, not requiring any intervention. Almost 93% of patients could not remember the beginning or the end of the intervention. This data demonstrates that sedatio...
Sedation in gastrointestinal endoscopy: Where are we at in 2014?
World Journal of Gastrointestinal Endoscopy, 2015
Gastrointestinal endoscopies are invasive and unpleasant procedures that are increasingly being used worldwide. The importance of high quality procedures (especially in colorectal cancer screening), the increasing patient awareness and the expectation of painless examination, increase the need for procedural sedation. The best single sedation agent for endoscopy is propofol which, due to its' pharmacokinetic/dynamic profile allows for a higher patient satisfaction and procedural quality and lower induction and recovery times, while maintaining the safety of traditional sedation. Propofol is an anesthetic agent when used in higher doses than those needed for endoscopy. Because of this important feature it may lead to cardiovascular and respiratory depression and, ultimately, to cardiac arrest and death. Fueled by this argument, concern over the safety of its administration by personnel without general anesthesia training has arisen. Propofol usage seems to be increasing but it's still underused. It is a safe alternative for simple endoscopic procedures in low risk patients even if administered by non-anesthesiologists. Evidence on propofol safety in complex procedures and high risk patients is less robust and in these cases, the presence of an anesthetist should be considered. We review the existing evidence on the topic and evaluate the regional differences on sedation practices.
Propofol for sedation during endoscopy: assessment of a computer-controlled infusion system
Gastrointestinal Endoscopy, 1991
Propofol can be used to provide general anesthesia or sedation. Twenty patients scheduled for upper gastrointestinal endoscopy were sedated using a computercontrolled system and endoscopy was performed by the same operator. Oxygen saturation reduced significantly (p < 0.001) during the procedure, and remained significantly lower than baseline values at the end of the procedure. Patient assessment of sedation and anxiety using linear analogue scales showed a significant increase in sedation (p < 0.00001) and decrease in anxiety (p < 0.003) compared with baseline values. There were variable positive (p < 0.001) and negative (p < 0.002) changes in blood pressure from baseline values.
Journal of Gastroenterology and Hepatology, 2014
Background and Aim: Since 2008, there exists a German S3-guideline allowing nonanesthesiological administration of propofol for gastrointestinal endoscopy. In this prospective, national, multicenter study, we evaluated the safety of endoscopist-administered propofol sedation (EDP) in German outpatient practices of Gastroenterology. Methods: In this multicenter survey of 53 ambulatory practices of Gastroenterology, we prospectively evaluated 24 441 patients that had received EDP. We recorded adverse events during the endoscopic procedure and additionally retrieved questionnaires investigating subjective parameters 24 h after the endoscopic procedure. Results: In 24 441 patients 13 793 colonoscopies, 6467 esophagogastroduodenoscopies, and 4181 double examinations were performed. In this study, 52.1% of the patients received propofol mono-sedation, and 47.9% received a combination of midazolam and propofol. Major adverse events occurred in four patients (0.016%) enrolled to this study (three mask ventilations and one laryngospasm). Minor adverse events were observed in 112 patients (0.46%) with hypoxemia being the most common minor event. All patients with adverse events recovered without persistent impairment. Minor adverse events occurred more frequently in patients sedated with propofol mono compared to propofol and midazolam (P < 0.0001) and correlated with increasing propofol dosages (P < 0.001; Pearson correlation coefficient r = 0.044). Twenty-four hours after the endoscopy, patients sedated with propofol plus midazolam stated a significantly reduced sensation of pain (P < 0.01) and improved symptoms of dizziness, nausea and vomiting (P < 0.001) compared to patients having received propofol mono-sedation. Conclusion: Four years after the implementation of a German S3-Guideline for endoscopic sedation, we demonstrated that EDP is a safe procedure.
Propofol Sedation in Diagnostic Upper Gastrointestinal Endoscopy
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy, 2020
Background: Sedation are commonly used these days in patients that having gastrointestinal endoscopy. Propofol is sedative agent that commonly used in endoscopy procedure. Method: All patients who were performed diagnostic EGD in Abdi Waluyo Hospital's Gastrointestinal Endoscopy Unit from January 1st 2017-31st December 2017, included in this study. The amount of Propofol, duration during hypnosis/sedation and adverse effects were all recorded. Results: 170 patients were performed diagnostic EGD with Propofol sedation, most of them were male (87 patients, 51,5%). The median age was 48,78 + 14. The median Body Mass Index (BMI) was 24.45. The median of duration of hynosis (sedation) during EGD was 5 minutes. The median of propofol total dose during EGD was 180 mg. Adverse effects that found during Propofol sedation are muscle twitching(10.6% patients) and pain in area of injection(80% patients). Conclusion: The duration of propofol hypnosis/sedation during Esophagogastroduodenoscopy examination was 5 minutes. Propofol total dose needed for diagnostic EGD was 180 mg. The common adverse effects of propofol are muscle twitching and pain in area of injection.