Subject(s)
Conscious Sedation/standards , Deep Sedation/standards , Endoscopy, Gastrointestinal/standards , Hypnotics and Sedatives/administration & dosage , Propofol/administration & dosage , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/antagonists & inhibitors , Anesthesiology , Antidotes/administration & dosage , Benzodiazepines/administration & dosage , Benzodiazepines/antagonists & inhibitors , Clinical Competence , Conscious Sedation/adverse effects , Deep Sedation/adverse effects , Endoscopy, Gastrointestinal/education , Humans , Informed Consent , Monitoring, IntraoperativeABSTRACT
OBJECTIVE: to evaluate safety of continuous propofol sedation in elderly patients who undergo endoscopic procedures and investigate risk factors to develop complications in the geriatric population. MATERIAL AND METHODS: patients who received endoscopist-directed propofol sedation were classified into two groups according to age. Group I: > 80 years; Group II: < 80 years. Propofol was administered by continuous intravenous infusion to achieve deep sedation. Arterial oxygen saturation, heart rate, blood pressure, and electrocardiographic records were monitored during the procedure. Therapy and complications secondary to sedation were recorded. RESULTS: one thousand two-hundred and ninety-five endoscopic procedures (gastroscopies, colonoscopies and endoscopic ultrasonographies) were included. The dose of propofol was lower and therapy was more frequently performed in Group I. There were no differences between sedation-related complications in both groups (Group I: 15.4%, Group II: 14%; p:n.s.). Patients in Group I showed greater tendency to develop severe oxygen desaturation in the colonoscopy and endoscopic ultrasonography procedures. In the univariate analysis, a higher dose of propofol was associated with the appearance of complications (157.4 ± 84.4 vs 121.3 ± 89.6 mg) in elderly patients but it was not associated with severe oxygen desaturation. CONCLUSIONS: continuous propofol sedation during endoscopic procedures in elderly patients > 80 years is as safe as in younger patients.
Subject(s)
Conscious Sedation , Endoscopy/methods , Hypnotics and Sedatives/adverse effects , Propofol/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Bradycardia/etiology , Bradycardia/physiopathology , Colonoscopy , Electroencephalography , Endoscopy/adverse effects , Endosonography , Female , Gastroscopy , Hemodynamics/physiology , Humans , Hypotension/etiology , Hypotension/physiopathology , Male , Middle Aged , Oxygen/blood , Prospective Studies , Safety , Young AdultABSTRACT
Objetivo: evaluar la seguridad de la sedación con perfusión continua de propofol en ancianos a los que se les realizan procedimientos endoscópicos e investigar los factores de riesgo para el desarrollo de complicaciones en la población anciana. Diseño experimental: estudio observacional prospectivo de cohortes. Pacientes: pacientes sedados mediante perfusión continua administrada por el propio endoscopista divididos en dos grupos: Grupo I: ≥ 80 años; Grupo II: < 80 años. El propofol fue administrado mediante perfusión continua para conseguir sedación profunda. Durante la exploración se monitorizó: saturación arterial de oxígeno, presión arterial y registro electrocardiográfico. Se registró además si se realizó terapéutica endoscópica y las complicaciones relacionadas con la sedación que se produjeron. Resultados: se incluyeron 1.295 procedimientos endoscópicos (gastroscopias, colonoscopias y ecoendoscopias). La dosis de propofol fue inferior y la endoscopia fue terapéutica con mayor frecuencia en el Grupo I. No hubo diferencias en la aparición de complicaciones relativas a la sedación entre ambos grupos. (Grupo I: 15,4%, Grupo II: 14%; p:n.s.). Los pacientes del Grupo I tuvieron una mayor tendencia a desarrollar desaturación grave durante la colonoscopia y ecoendoscopia. En el análisis univariante, en los pacientes ancianos, el incremento en la dosis de propofol se asoció con la aparición de complicaciones (157,4 ± 84,4 vs 121,3 ± 89,6 mg) pero no con la desaturación grave. Conclusiones: la sedación con perfusión continua de propofol en procedimientos endoscópicos en pacientes >= 80 años es tan segura como en pacientes más jóvenes(AU)
Objective: to evaluate safety of continuous propofol sedation in elderly patients who undergo endoscopic procedures and investigate risk factors to develop complications in the geriatric population. Material and methods: patients who received endoscopist-directed propofol sedation were classified into two groups according to age. Group I: ≥ 80 years; Group II: < 80 years. Propofol was administered by continuous intravenous infusion to achieve deep se - dation. Arterial oxygen saturation, heart rate, blood pressure, and electrocardiographic records were monitored during the procedure. Therapy and complications secondary to sedation were recorded. Results: one thousand two-hundred and ninety-five endoscopic procedures (gastroscopies, colonoscopies and endoscopic ultrasonographies) were included. The dose of propofol was lower and therapy was more frequently performed in Group I. There were no differences between sedation-related complications in both groups (Group I: 15.4%, Group II: 14%; p:n.s.). Patients in Group I showed greater tendency to develop severe oxygen desaturation in the colonoscopy and endoscopic ultrasonography procedures. In the univariate analysis, a higher dose of propofol was associated with the appearance of complications (157.4 ± 84.4 vs 121.3 ± 89.6 mg) in elderly patients but it was not associated with severe oxygen desaturation. Conclusions: continuous propofol sedation during endoscopic procedures in elderly patients >= 80 years is as safe as in younger patients(AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Conscious Sedation/trends , Deep Sedation/methods , Deep Sedation/trends , Propofol , Endoscopy , Endoscopy, Gastrointestinal , Risk Factors , Perfusion/methods , Gastroscopy , Colonoscopy , Prospective Studies , Cohort Studies , Heart Rate/physiology , 28599ABSTRACT
Linitis plastica of the rectum is an uncommon entity that is difficult to diagnose due to the lack of mucosal lesions on endoscopy, the low diagnostic yield of biopsy and non-specific findings of barium radiology and computerized tomography. Rectal endoscopic ultrasonography has had a radical impact on the differential diagnosis of stenosing lesions of the rectum, among them linitis plastica, allowing diagnosis of this lesion even in patients with negative results of biopsy.
Subject(s)
Linitis Plastica/diagnosis , Rectal Neoplasms/diagnosis , Aged , Biopsy , Colonoscopy , Endosonography , Humans , Linitis Plastica/therapy , Male , Rectal Neoplasms/therapy , Rectum/diagnostic imaging , Rectum/pathology , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Upper gastrointestinal bleeding continues to be a severe and frequent complication in ulcerative disease. Etiologic diagnosis in these patients is highly important in order to initiate appropriate treatment and prevent bleeding recurrence. OBJECTIVE: 1. To investigate the prevalence of Helicobacter pylori infection and use of NSAIDs in patients with upper gastrointestinal hemorrhage of peptic origin. 2. To analyze the strategy used for the diagnosis of H. pylori in our previous work. PATIENTS AND MEHTODS: Seventy-three patients with endoscopically-diagnosed upper gastrointestinal bleeding of peptic origin were included in the study. The use of NSAIDs was investigated. H. pylori infection was diagnosed if one of the following tests was positive: urease test, histology, breath test. RESULTS: H. pylori infection was found in 92% of duodenal ulcers and in 88% of gastric ulcers. Fifty-six percent of the patients had taken NSAIDs. Excluding these patients resulted in an H. pylori infection rate of 96.7%. The diagnosis was based on urease test in 46%. In the remaining patients, breath test and histology were required. CONCLUSIONS: The main etiology in patients with upper gastrointestinal bleeding of peptic origin is H. pylori infection followed by the use of NSAIDs, and these two factors frequently coexist. The strategy of performing a urease test and, when this is negative, performing histological study and a breath test, is valid and allows a diagnosis of H. pylori infection to be made even if patients are receiving treatment that could make diagnosis difficult.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Helicobacter Infections/microbiology , Helicobacter pylori/isolation & purification , Peptic Ulcer Hemorrhage/chemically induced , Peptic Ulcer Hemorrhage/microbiology , Breath Tests/methods , Female , Gastric Mucosa/microbiology , Helicobacter Infections/diagnosis , Humans , Male , Middle Aged , Peptic Ulcer Hemorrhage/therapy , Predictive Value of TestsABSTRACT
BACKGROUND: Accuracy of the most frequently used tests for diagnosing Helicobacter pylori infection in patients with upper gastrointestinal bleeding of peptic origin is determined. METHODS: Seventy-eight patients with endoscopically-proven upper gastrointestinal bleeding of peptic origin were included. The presence of H. pylori was considered when observed from the histology or, if negative, when serology and breath test were both positive. Accuracy of the rapid urease test was estimated in accordance with results obtained with other diagnostic methods. RESULTS: Lesions causing gastrointestinal bleeding were 56 duodenal ulcers, 13 gastric ulcers, 7 pyloric channel ulcers, 13 acute lesions of the gastric mucosa and 16 erosive duodenitis. H. pylori infection was present in 68 patients (87.2%). Forty-four patients had received non-steroidal anti-inflammatory drugs. The sensitivity/specificity (%) of the diagnostic methods was 48.5/100 for the rapid urease test, 91/77.8 for the breath test, 89.5/80 for serology and 86.3/100 for histology. The prior consumption of proton-pump inhibitors and antibiotics induced false-negative results in the rapid urease test and breath test, with no effect on serology and histology. CONCLUSIONS: The prevalence of H. pylori infection in patients with upper gastrointestinal bleeding from peptic lesions is high. Sensitivity of the rapid urease test for diagnosing H. pylori is low in this setting. Cases with negative rapid urease test need the combination of two or more additional tests if diagnosis is to be achieved. Cases with positive rapid urease test do not need further investigation for diagnosis.
Subject(s)
Helicobacter Infections/diagnosis , Helicobacter pylori , Peptic Ulcer Hemorrhage/microbiology , Biopsy , Breath Tests , Enzyme-Linked Immunosorbent Assay , Female , Gastric Mucosa/microbiology , Humans , Male , Middle Aged , Predictive Value of Tests , Sensitivity and SpecificitySubject(s)
Accidents, Occupational , Burns, Chemical/etiology , Caustics/adverse effects , Detergents/adverse effects , Esophageal Stenosis/chemically induced , Esophagitis/chemically induced , Adult , Burns, Chemical/diagnosis , Esophageal Stenosis/diagnosis , Esophagitis/diagnosis , Female , HumansSubject(s)
Esophageal Fistula/pathology , Pleura/pathology , Sclerotherapy , Aged , Humans , Male , Sclerotherapy/adverse effectsSubject(s)
Esophagoscopy , Esophagus , Foreign Bodies/therapy , Adult , Child , Esophagoscopy/adverse effects , Female , Humans , Male , Middle AgedABSTRACT
This is the case of a 29 year-old woman, admitted because of diarrhea and incoercible vomiting; later in the course of the disease she developed signs and symptoms of encephalopathy. The diagnosis of Reye's syndrome was made after death.
