RESUMO
The aim of this study was to explore the impact of anesthetic drugs currently used to perform lower digestive endoscopy on serum concentrations of inflammation markers and catecholamines. We selected 120 patients and divided them into three lots of 40 patients each: L1, in which no anesthetics were used; L2, in which propofol was used; and L3, in which propofol combined with fentanyl was used. All patients had serum concentrations of adrenaline/epinephrine (EPI), noradrenaline/norepinephrine (NE), tumor necrosis factor alpha (TNF-α), interleukin-4 (IL-4), IL-6, IL-8, and IL-10, taken at three time points: at the beginning of the endoscopic procedure (T0), 15 min after (T1), and 2 h after the end of the endoscopic procedure (T2). The results of the research showed changes in the levels of catecholamines and interleukins (ILs) at T0, with an increased response in L1 above the mean recorded in L2 and L3 (p < 0.001). At T1, increased values were recorded in all lots; values were significantly higher in L1. At T2, the values recorded in L3 were significantly lower than the values in L2 (student T, p < 0.001) and L1, in which the level of these markers continued to increase, reaching double values compared to T0 (student T, p < 0.001). In L2 at T1, the dose of propofol correlated much better with NE, EPI, and well-known cytokines. Our results show that propofol combined with fentanyl can significantly inhibit the activation of systemic immune and neuroendocrine response during painless lower digestive endoscopy.
RESUMO
The association of sedation with analgesia in endoscopic procedures represents the ideal combination of anesthetic drugs, which allows these exploratory procedures to be carried out safely, in an outpatient setting. The aim of this study is to compare the results of the use of simple Propofol or Propofol associated with Fentanyl in order to ensure optimal sedation necessary for the detection of benign or malignant lesions of the digestive tract. In this study, 80 patients aged between 18 and 80 years were included, 40 in Group 1 who were administered Propofol alone and 40 in Group 2 in which Propofol was administered associated with Fentanyl. The onset of anesthetic sleep was 19.3±5.1 seconds in Lot 2 versus 29.6±9.1 seconds in Lot 1. The average dose of Propofol used was 203.6±82.8 mg in Lot 1 and in Lot 2 it was lower, 166.3±8.3mg. Cardio respiratory changes were more frequent in Lot 2. The wake-up time was 3.2±1.2 minutes in Lot 1 as a result of the administration of Propofol alone and 7±1.4 minutes in Lot 2. The discharge time was equal for patients in both groups. The degree of postanesthesia safisfaction was 10 for all patients from Lot 2, due to the analgesia provided by the administration of Fentanyl. The use of Propofol associated with Fentanyl in gastrointestinal endoscopic procedures is associated with a rapid recovery of cognitive function at the time of discharge and minimal adverse events, ensuring optimal conditions of analgesia and stability of vital functions.
RESUMO
Anesthesia is essential during colonoscopy because it provides patients with necessary sedation to perform the investigation safely and nonetheless to obtain the highest quality of the results. We aimed here to evaluate and establish which of the combinations of anesthetic drugs most frequently used for sedation purposes for gastrointestinal endoscopic procedures performed in the ambulatory best covers the needs of the patient and the gastroenterologist. This is a prospective, randomized, double-blind study carried out on a total of 100 patients, aged between 18 and 80 years, who meet the conditions for inclusion in the study. Patients were randomly allocated into either group A (Propofol) or group B (Midazolam plus Propofol). Evaluation of the dose of Propofol used in the 2 groups, awakening time, anesthetic induction, as well as the occurrence of episodes of bradycardia and hypotension represented the parameters followed in the study. In group A, 50 patients received on average 218.6mg of Propofol in bolus of 10-20mg. In group B, 50 patients received 0.1mg/kg Midazolam and an average of up to 129.2mg of Propofol in bolus of 10-20mg. Awakening time was shorter in group A-3.18 minutes, than in group B-15.7 minutes. Bradycardia and hypotension were met in a larger number in group B than in group A. The quality of the endoscopic evaluation was similar in both groups. The conclusion of our study was that the group to which only Propofol was administered had the best results from all aspects (rapid anesthetic induction, stability of vital functions, lower cost, awakening time much faster) compared to the combination of Propofol with Midazolam.
