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Objective:To assess the influence of age on the safety of propofol mono-sedation for adult patients undergoing painless gastroscopy.Methods:A retrospective study was conducted on data of 321 patients scheduled for painless gastroscopy with propofol mono-sedation. According to the age, patients were divided into youth group (116 cases, 18-44 years), middle-aged group (103 cases, 45-59 years) and elderly group (102 cases, 60-80 years). The procedure time, the total dosage of propofol, the occurrence of airway obstruction or hypoxemia, the use of airway interventions including airway opening maneuvers and facemask ventilation, lowest SpO 2, adverse cardiovascular events (including hypertension, hypotension, tachycardia, and bradycardia), and the use of ephedrine during painless gastroscopy were observed. Results:There was significant difference regarding the total dosage of propofol among youth group (173.2±47.0 mg), middle-aged group (158.8±41.3 mg) and elderly group (137.8±26.3 mg) ( F=21.761, P<0.001). The total dosage of propofol was significantly lower in the elderly group compared with the middle-aged group ( P<0.017) and youth group ( P<0.017), and that in the middle-aged group was significantly lower than that in the youth group ( P<0.017). The incidence of hypoxemia was 12.9% (15/116) in the youth group, 15.5% (16/103) in the middle-aged group and 25.5% (26/102) in the elderly group, with significant difference among three groups ( χ2=5.711, P=0.017). Moreover, the incidence of hypoxemia was significantly higher in the elderly group compared with the middle-aged group ( P<0.017) and youth group ( P<0.017). The incidences of hypotension, bradycardia and total adverse cardiovascular events were 5.2% (6/116), 4.9% (5/103) and 11.8% (12/102), 1.7% (2/116), 2.9% (3/103) and 7.8% (8/102), and 11.2% (13/116), 10.7% (11/103) and 20.6% (21/102) respectively in youth, the middle-aged and the elderly group. There were no significant differences in the above indicators among the three groups ( P>0.05). However, compared with those of the young and the middle-aged patients, the occurrence of hypotension, bradycardia and total adverse cardiovascular events in the elderly patients were on the rise. There were no significant differences among the three groups in other indices( P>0.05). Conclusion:Total dosage of propofol may need to be decreased gradually with the increase of age of patients undergoing gastroscopy with propofol mono-sedation. Compared with young and middle-aged patients, elderly patients have a significantly higher incidence of hypoxemia, with a tendancy of total adverse cardiovascular events increase, so the safety of painless gastroscopy is reduced for these patients.
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Objective:To evaluate the effect of laryngopharyngeal reflux on sedation-related adverse events in the patients undergoing painless gastroscopy.Methods:Two hundred and eighty-nine American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged 18-75 yr, with body mass index 18.5-28.0 kg/m 2, scheduled for elective painless gastrocopy, were selected.Specimens of glottic secretions before and after gastroscopy were collected, and the concentration of human pepsin was measured by enzyme-linked immunosorbent assay.The patients in whom the concentration of pepsin was positive before the examination were excluded (the concentration ≥ 31.34 pg/ml was considered as positive). The patients were divided into laryngopharyngeal reflux group (R group, the concentration of pepsin was positive after gastroscopy) and non-laryngopharyngeal reflux group (N group, the concentration of pepsin was negative after gastroscopy) according to the concentration of pepsin in the secretion samples before and after gastroscopy.The occurrence of hypoxemia, hypotension, bradycardia, bucking and body movement during operation was recorded.The patients were followed up by telephone on the 1st, 3rd and 7th days after operation.The sore throat, hoarseness, nausea and vomiting, cough and expectoration and use of antibiotics were recorded. Results:Compared with group N, the incidence of bucking and hypoxemia was significantly increased, the incidence of sore throat and hoarseness was increased on the 1st day after operation, and the incidence of cough and expectoration was increased on the 1st and 3rd days after gastroscopy in group R ( P<0.05). Conclusion:Laryngopharyngeal reflux can increase the development of intraoperative and postoperative sedation-related adverse events in the patients undergoing painless gastroscopy.
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Objective To evaluate the feasibility and safety of self designed oral-nasal double channel mask in painless gastroscopy. Methods 400 patients who were given intravenous injection Sublimaze followed by Propofol were divided equally at random into two groups. The patients in control group (n = 200) were inhaled oxygen with snuffle tube (4.0 ~ 5.0 L/min) and the patients in experimental group (n = 200) were inhaled oxygen with a self designed oral-nasal double channel mask. Respiration rate, SpO2, duration of operation and dosage of anaesthetic were recorded before and during operation. Result The SpO2decreased markedly and duration of operation obviously prolonged in group I during operation (P < 0.05), there was no statistical difference between the two groups of the respiration rate and dosage of anaesthetic. Conclusion The application of oxygen inhalation with the self designed oral-nasal double channel mask in painless gastroscopy appeared safer than that of oxygen inhalation via snuffle tube. It can be safely used in painless gastroscopy.
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Objective To explore the application of body position intervention combined pronase in gastric mucosal cleaning in painless gastroscopy.Methods A total of 200 patients who underwent painless gastroscopy from July 2016 to July 2017 in the digestive endoscopy center were selected as the subjects.According to the random digital table method,the patients were randomly divided into the experimental group and the control group of 100 cases.In the experimental group,before the gastroscope was examined,pronase plus Dimethicone Powder and lidocaine mucilage was used,and then the body position intervention (right supine 5 min-supine 5 min-left lying position 5 min) was examined,and the control group was taken Dimethicone Powder and Lido before the intensive examination.The caking mortar was then placed on the left side of the examination bed 15 min for examination.The upper gastrointestinal tract visual field definition and endoscopic operation time were compared between the two groups under magnifying endoscopy under white light and narrowband imaging.Results In the experimental group,72.0％ (72/100),20.0％ (20/100),6.0％ (6/100) and 2.0％ (2/100) of A,B,C,D grade of the visual field clarity of mucosa under white light were better than 32.0％ (32/100),30.0％ (30/100),13.0％ (13/100) and 25.0％ (25/100) of the control group,respectively.The difference was statistically significant (x2=39.54,P ＜ 0.05).There were 0,6,29 and 65 cases of 1,2,3,4 scores of microvascular visual field intelligibility scores under magnifying endoscopy combined with narrow band imaging in the experimental group,which were better than those in the control group (11,31,28 and 30 cases respectively).The difference between the two groups was statistically significant (Z =-6.07,P ＜ 0.05).The examination time of the experimental group was (10.64 ± 3.83) minutes,which was lower than that of the control group (11.67 ± 4.89) minutes,and the difference was statistically significant (t=1.978,P ＜ 0.05).Conclusions The effect of pronase as an anti mucilage agent combined with body position is obvious,and the effect of dispelling the mucus and removing the mucus is comprehensive,and it can effectively shorten the time of examination.It is worthy of clinical application.
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Objective To observe and compare the incidence of cough among patients with post-infection cough undergoing painless gastroscopy.Methods Seventy-one patients with post-infection cough undergoing painless gastroscopy were enrolled and randomly divided into two groups.The observation group (34 cases) received budesonide nebulization before gastroscopy and the control group (37 cases) was performed gastroscopy directly.We observed the incidence of cough at different time point and the changes of circulationduring the operation. Results The incidence of cough between the observation group and the control group showed statistically significant differences (P＜0.01) . The changes of circulation showed statistical differences between two groups in the process of gastroscopy (P＜0.05).Conclusion Budesonide nebulization supplying can decrease the incidence of post-in-fection cough among patients undergoing painless gastroscopy.
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Objective To investigate the safety and feasibility of dyclonine combined with propofol in the application of painless gastroscopy. Methods A total of 90 patients received the painless gastroscopy in our hospi-tal were enrolled from September to December 2016. They were divided into 3 groups according to the random number table(n=30):Dyclonine+propofol(DP)group,Fentanyl+propofol(FP)group,Propofol(P)group. The hemodynamic changes,adverse reaction,propofol dosage,time of gastroscopy examination and time of conscious recovery were observed and recorded. Results Compared with P group,the incidence of hypertension,tachycardia, choking cough,body movement and the dosage of propofol in DP group and FP group were significantly decreased (P<0.05,respectively). Compared with DP group,the incidence of respiratory depression,the time of gastroscopy examination and the time of Conscious recovery in FP group and P group were significantly increased (P < 0.01 , respectively). Compared with FP group,the incidence of nausea and vomiting in DP and P group were significantly decreased (P < 0.05 ,respectively). Conclusions Dyclonine combined with propofol reduced the incidence of cardiovascular response,choking cough,body movement,respiratory depression,and nausea and vomiting,with the reduced dosage of propofol ,the shorten gastroscopy examination time and the recovery time. Therefore ,dyclo-nine combined with propofol is a safe and feasible anaesthesia management for the painless gastroscopy.
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Objective To investigate the safety and feasibility of dyclonine combined with propofol in the application of painless gastroscopy. Methods A total of 90 patients received the painless gastroscopy in our hospi-tal were enrolled from September to December 2016. They were divided into 3 groups according to the random number table(n=30):Dyclonine+propofol(DP)group,Fentanyl+propofol(FP)group,Propofol(P)group. The hemodynamic changes,adverse reaction,propofol dosage,time of gastroscopy examination and time of conscious recovery were observed and recorded. Results Compared with P group,the incidence of hypertension,tachycardia, choking cough,body movement and the dosage of propofol in DP group and FP group were significantly decreased (P<0.05,respectively). Compared with DP group,the incidence of respiratory depression,the time of gastroscopy examination and the time of Conscious recovery in FP group and P group were significantly increased (P < 0.01 , respectively). Compared with FP group,the incidence of nausea and vomiting in DP and P group were significantly decreased (P < 0.05 ,respectively). Conclusions Dyclonine combined with propofol reduced the incidence of cardiovascular response,choking cough,body movement,respiratory depression,and nausea and vomiting,with the reduced dosage of propofol ,the shorten gastroscopy examination time and the recovery time. Therefore ,dyclo-nine combined with propofol is a safe and feasible anaesthesia management for the painless gastroscopy.
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Objective To explor the safty and the effect of controlled intravenous analgesia with remifentanil on hyoxemia in obese patients with painless gastroscopy.Methods One hundred patients undergoing painless gastroscopy were randomly and equally allocated into 2 groups(50 each).In group R,anesthesia was induced with TCI(target-controlled infusion) of remifentanil,and the target plasma concentration (Cp) of propofol was set at 2ng/ml.In group N,the same volume of saline was continues infusion.MAP,RR and HR were monitored and recorded before the examination(T0),the time point of examination start(T1),gastroscopy go through glottis(T2),at the end of the operation (T3) and 5 min after examination (T4).The effect of sedation was evaluated by Ramsay.Except that,gastroscopy time,the satisfaction of patient,anesthetist and endoscopist were recored.In addition,apnea,bradycardia,hypoxemia,myoclonus,body movement,hypotension and postoperative complications were also recorded.Results Compared with group N,in group R,HR,MAP and rate of body movement were significantly decreased (P ＜ 0.05).Except that,the satisfaction of patient and endoscopist were increased (P ＜ 0.05).Conclusion TCI of remifentanil can provide satisfaction sedation for obese patients with painless gastroscopy with few adverse effects.
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Objective To observe the effects of dexmedetomidine combined with propofol on the hemodynamics level in elderly patients undergoing gastroscopy.Methods 68 patients undergoing endoscopy from January 2014 to January 2015 in our hospital were selected and randomly divided into observation group and control group, 34 cases in each group.Propofol anesthesia combined with dexmedetomidine was used in the observation group and propofol anesthesia was used in the control group.The RR ( respiratory rate) and HR ( heart rate) of the two groups were observed before the administration (T0), after the administration (T1), when the gastroscope was inserted (T2), after the examination (T3), 5 min after the examination (T4), MAP (mean arterial pressure) and SpO2(pulse oxygen saturation) were measured.The postoperative consciousness, orientation recovery time and surgical tolerance were compared between the two groups.The anesthetic adverse reactions were recorded during the operation.Results The observation group in T1, T2, T3, T4 time point HR were lower than the control group, and the data remained relatively stable level, the difference was statistically significant (P<0.05).There was no significant difference in consciousness recovery time and recovery time of orientation force between observation group and control group.The tolerance of the observation group was higher than that of the control group, the difference was statistically significant (P<0.05).The total adverse reaction rate of the observation group was 32.35% lower than that of the control group 88.24%, the difference was statistically significant ( P <0.05 ) .Conclusion Dexmedetomidine combined with propofol for the elderly patients with painless gastroscopy , analgesic effect is good, and can better maintain hemodynamic fluctuations, reduce propofol anesthesia adverse reactions, does not Affect the patient's awareness and ability to restore the direction.
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Objective To discuss the application and effect of sufentanil combined with propofol on painless gastroscopy anesthesia.Methods In the fourth people's hospital of Zhejiang in April 2014-June 2016,94 cases treated with painless gastroscopy I were randomly divided into two equal groups.Anesthesia group A were anaesthetized with fentanyl and propofol,sufentanil and propofol for anesthesia group B.The anesthetic effect,the time of consciousness disappearance,eye opening time,recovery time of orientation,the dosage of propofol in the two groups were compared.The mean arterial pressure,heart rate and adverse reaction rate in the two groups were compared.Results The anesthetic effect in the anesthesia groupB is significant better than that in the anesthesia group A(P<0.05).Compared with the anesthesia groupA,the time of consciousness disappearance,eye opening and orientation recovery is shorter in the anesthesia groupB(P<0.05),The difference of the mean arterial drug Pressure and heart rate is not significant in the two groups before medication.After medication and wake up,compared with the anesthesia group A,the mean arterial pressure,heart rate fluctuation is smaller,and the adverse reaction rate is lower in the anesthesia group B,(P<0.05).Conclusion It is effective which sufentanil combined with propofol used in anesthesia in painless gastroscopy,It can stable vital signs of patients during operation,,work quickly,restore consciousness rapidly,and contribute to reduce complications,and is worthy of promotion.
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Objective:To observe the clinical effect of the combined use of dexmedetomidine and propofol for anesthesia in the elderly patients with painless gastroscopy. Methods:Totally 70 elderly patients with painless gastroscopy were selected and randomly divided into the observation group (35 cases) and the control group (35 cases). The observation group was given dexmedetomidine and propofol for anesthesia, while the control group was given propofol for anesthesia. The anesthesia induction time, the vital signs and recovery time of the patients, intraoperative complications and postoperative adverse reactions were observed and compared between the two groups. Results:The anesthesia induction time of the observation group was shorter than that of the control group (P<0. 01). The mean arterial pressure (MAP) in T2, T3 and T4 stage in the two groups were significantly lower than that in T1 stage (P<0. 05, P<0. 01). The HR in T3 stage and RR in T2 stage in the control group were lower than those in T1 stage (P<0. 05). The RR in T2 stage in the observation group was significantly lower than that in T1 stage (P<0. 05). The MAP in T2 and T3 stage in the observation group was significantly higher than that in the control group (P<0. 01), while that in T4 stage in the observation group was significant-ly lower than that in the control group (P<0. 05). The HR in T3 stage in the observation group was significantly higher than that in the control group (P<0. 05). The incidence of intraoperative complications in the observation group was 5. 7%, while that in the con-trol group was 22. 9%, and there was significant difference between the two groups (P<0. 05). The recovery time in the observation group was shorter than that in the control group (P<0. 01). Conclusion:Dexmedetomidine combined with propofol has better anes-thesia effect and higher safety than propofol alone, which is worthy of clinical promotion.
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Objective:To investigate the effect and safety of sufentanil combined with propofol for intravenous anesthesia in chil-dren undergone painless gastroscopy. Methods:Totally 120 cases of children undergone painless gastroscopy were divided into the ob-servation group (60 cases) and the control group (60 cases) according to the random number method. The observation group was given sufentanil combined with propofol for anesthesia, and the control group was given fentanyl and propofol for anesthesia. The hemodynam-ic indices at the period of T0 (before the anesthesia), T1 (1 min after the anesthesia induction), T2 (checking), T3 (2min after the checking) and T4 ( at the end of testing) were compared between the groups, and the anesthesia situation, hospitalization time, dosage of propofol, fine/excellent rate of anesthesia and adverse reactions were also observed. Results:In T1, T2 and T3, the MAP ( mean arterial pressure) , HR ( heart rate) and RR ( respiratory rate) were declined in the two groups when compared with those in T0 ( P<0. 05), and those in the observation group were higher than those in the control group (P<0. 05). The time of consciousness disap-pearance, eyes open, orientation force recovery and hospitalization in the observation group was shorter than that in the control group, and the propofol dosage in the observation group was lower than that in the control group(P<0. 05) . The excellent number and rate of the observation group were better than those of the control group (P<0. 05), and the incidence of apnea of the observation group was lower than that of the control group (P<0. 05). Conclusion: Sufentanil combined with propofol for anesthesia in children undergone painless gastroscopy has the properties of fast onset and recovery, stable hemodynamic indices during the operation and high safety, which is worthy of promoted application.
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Objective To study the clinical anesthetic effect of butorphanol combined with propofol in painless gastroscopy. Methods 90 patientswith stomachache check were randomly divided into observation group and control group,45 cases each. The observation group was received butorphanol combined with propofol and the control group were treated with fentanyl combined with propofol. The heart rate of pa-tients before anesthesia,during checking and conscious,the change of blood pressure and oxygen saturation,respiratory depression and anes-thetic effect were analyzed. Results The heart rate,blood pressure and oxygen saturation of two groups after treatment were decreased,the difference was not statistically significant(P>0. 05). The total volume of propofol and respiratory depression between the two groups were compared,the differences were statistically significant(P<0. 05). Conclusion Butorphanol combind with propofol in painless gastroscopy with long anesthesia time and low respiratory depression,which was worthy of promotion.
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@#Objective To observe the effect of intravenous small dose of ketamine combined with continuous infusion of propofol and sufentanyl in painless gastroscopy.Methods 62 patients undergoing painless gastroscopy under intravenous anesthesia were randomly divided into the control group and ketamine group with 31 cases in each group. The cases of the control group were treated with continuous infusion of propofol (target controlled infusion rate: 3.0 μg/ml) and sufentanyl (loading dose: 0.15 μg/kg, basal rate 0.15 μg/kg/h); those of the ketamine group were treated with intravenous small dose of ketamine 0.5 mg/kg combined with continuous infusion of propofol (target controlled infusion rate: 3.0 μg/ml) and sufentanyl (loading dose: 0.1 μg/kg, basal rate 0.1 μg/kg/h). The procedure of gastroscopy was started when patients were in unconsciousness and their vital signs were stable, and the infusion of medicine was stopped when the gastroscopy was finished. The systolic blood pressure (SBP) and heart rate (HR) at the time of before anesthesia, 1 minute after anesthesia, inserting the gastroscope, 10 minutes after inserting the gastroscope, and recovering from the anesthesia were recorded. The cases needing special respiratory management (SRM), displaying body movement (BM) in gastroscopy and post-operative nausea and vomiting (PONV) were recorded. The recovery time (RT) after gastroscopy was also recorded.Results No significant difference was found in SBP, HR, BM, PONV and RT between two groups ( P>0.05). Eight cases in the control group and one case in the ketamine group needed SRM before inserting the gastroscope due to transient respiratory depression ( P<0.01).Conclusion The application of intravenous small dose of ketamine combined with continuous infusion of propofol and sufentanyl in painless gastroscopy is effective and safe.