ED50 and ED95 of Remimazolam Tosilate Combined with Different Doses of Fentanyl in Elderly Patients for Painless Gastroscopy.

Background: The novel short-acting benzodiazepine drug, remimazolam tosilate, has been employed for sedation during endoscopic procedures. The optimal loading dosage of remimazolam tosilate in gastroscopy for elderly patients when co-administered with fentanyl remains unclear. Therefore, the primary objective of our research was to ascertain the median effective dose (ED50) and the 95% effective dose (ED95) of remimazolam tosilate in combination with various fentanyl dosages for elderly patients undergoing painless gastroscopy. Methods: Seventy-five patients aged ≥65 years and American Society of Anesthesiologists (ASA) class I-III were recruited to undergo elective painless gastroscopy. All patients were randomized assigned to group F1, group F2, and group F3, and were injected intravenously with different doses of fentanyl (0.5 ug/kg, 1 ug/kg, and 1.5 ug/kg) 3 minutes prior to the administration of remimazolam tosilate, respectively. The initial preset dose of remimazolam tosilate was 0.3 mg/kg in group F1, 0.2 mg/kg in group F2, 0.15 mg/kg in group F3. The dose gradient was 0.02 mg/kg per group according to the up-and-down sequential method. Probibt regression model was employed to determine the ED50 and ED95 of remimazolam tosilate. Results: The ED50 of remimazolam tosilate in group F3 was lower than that in group F1 and F2 (0.095 [0.088-0.108] mg/kg vs 0.162 [0.153-0.171] mg/kg; 0.258 [0.249-0.266] mg/kg, p < 0.05). The ED95 of remimazolam tosilate was 0.272 mg/kg (95% CI: 0.264-0.295 mg/kg) in group F1, 0.175 mg/kg (95% CI: 0.167-0.200 mg/kg) in group F2 and 0.109 mg/kg (95% CI: 0.101-0.135 mg/kg) in group F3. The total dosage of remimazolam tosilate decreased gradually with the increasing of fentanyl (p < 0.001). The frequency of injection pain was higher in group F1 compared to groups F2 and F3 (p < 0.05). The patients in group F3 had a lower incidence of hypotension than in groups F1 and F2 (p < 0.05). There was no respiratory depression, intraoperative consciousness, dizziness or delirium in the three groups. Conclusion: The concurrent use of fentanyl reduces the dosage of remimazolam tosilate required for sedative gastroscopy in elderly patients in a dose-dependent manner. Moreover, 1.5 ug/kg fentanyl combined with remimazolam tosilate may reduce the incidence of hypotension and injection pain. These findings should be confirmed in a large-scale study.

Effect of intravenous lidocaine on the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy: a prospective, randomized, double-blinded, controlled study.

BACKGROUND: Intravenous lidocaine could be a potential alternative adjuvant to propofol-based sedation for gastroscopy in elderly patients. This study aimed to evaluate the effect of intravenous lidocaine on the median effective dose (ED50) of propofol induction dose in elderly patients undergoing painless gastroscopy. METHODS: The study included 70 patients aged ≥ 60 years undergoing painless gastroscopy with 64 randomly assigned to either group L (2% lidocaine 1.5 mg/kg, n = 31) or group N (equal volume normal saline, n = 33). All patients received propofol induction following 0.1 µg/kg intravenous sufentanil. The Dixon "up-and-down" sequential method was used, with a 1.5 mg/kg initial induction dose of propofol followed by a 0.1 mg/kg sequential variable dose. The primary endpoint was the ED50 of the propofol induction dose. The total propofol dose, recovery time, adverse events, and local anesthetic intoxication reactions were also recorded. RESULTS: The ED50 of propofol induction dose was 0.670 (95% confidence interval [CI] 0.216-0.827) mg/kg in group L and 1.118 (95% CI 0.803-1.232) mg/kg in group N. There was a statistically significant difference between the two groups (p < 0.001). The incidence of hypotension and propofol injection pain were lower in group L than in group N (p < 0.05). Furthermore, the orientation recovery time in group L was shorter compared to group N (p < 0.05). None of the participants in group L observed local anesthetic intoxication reactions after receiving lidocaine. CONCLUSIONS: The administration of intravenous lidocaine to elderly patients undergoing painless gastroscopy resulted in a significant 40% reduction in the ED50 of propofol induction dose, which may be related to the decreased incidence of hypotension and injection pain, as well as the improved post-gastroscopy orientation recovery. TRIAL REGISTRATION: ChiCTR, ChiCTR2200065530. Registered on 08 November 2022.

Effect of inspiratory muscle training on hypoxemia in obese patients undergoing painless gastroscopy: protocol for a single-center, double-blind, randomized controlled trial.

Introduction: Obese patients who undergo painless gastroscopy are particularly prone to suffer from upper airway obstruction, respiratory depression, and subsequent hypoxemia. Despite adequate preoxygenation, the incidence of hypoxemia remains high. Recently, inspiratory muscle training (IMT) has been considered to be a promising strategy to increase respiratory muscle strength and endurance with the attendant improvement of pulmonary function. However, it remains unclear whether IMT is associated with a lower rate of hypoxemia in obese patients during this sedative procedure. This study aims to investigate the effectiveness of IMT used in obese patients who are scheduled for selective painless gastroscopy. Methods and analysis: This prospective, randomized controlled trial (RCT) will enroll 232 obese patients with a body mass index (BMI) of 35-39.9 kg·m-2 who undergo painless gastroscopy at the First Affiliated Hospital of Xiamen University. Subjects will be randomly assigned to two groups with a 1:1 ratio. Participants in both groups will receive IMT for 4 weeks prior to gastroscopy. The intervention group will receive IMT with a load of 30% of the maximal inspiratory pressure (Pi(max)) in the first week, with an increase of 10% per week since the following week, while the counterparts in the control group will not receive any load during the 4-week IMT. The primary outcome is the incidence of hypoxemia during painless gastroscopy. Secondary outcomes include the need for airway maneuvers, blood pressure changes, sleep quality assessment, pro-inflammatory cytokines levels, and monitoring of adverse events. Discussions: The outcomes of this study will offer invaluable guidance for the clinical implementation of IMT as a potential non-invasive preventive measure. Additionally, it stands to enrich our comprehension of anesthesia management and airway-related challenges in obese patients undergoing procedural sedation, which we anticipate will further contribute to addressing the turnaround concerns within high-volume, swiftly paced ambulatory endoscopy centers. Ethics and dissemination: This study has been approved by the Ethics Committee of the First Affiliated Hospital of Xiamen University (2022, No.091). The results will be submitted for publication in peer-reviewed journals. Trial registration number: China Clinical Trial Center (ChiCTR2200067041).

Effects of propofol combined with sufentanil on painless gastroscopy and hemodynamics in children under general anesthesia.

OBJECTIVE: To determine the effects of propofol combined with sufentanil on painless gastroscopy and hemodynamics in children under general anesthesia. METHODS: The data of 98 children who received painless gastroscopy in the Children's Hospital of Nanjing Medical University from May 2022 and November 2022 were analyzed retrospectively. Patients anesthetized with propofol (1.5-2 mg/kg) combined with sufentanil (0.03-0.05 µg/kg) were assigned to a study group (n=52), and patients anesthetized with propofol (1.5-2 mg/kg) combined with fentanyl (0.3-0.5 µg/kg) were included in a control group (n=46). The changes in hemodynamic levels (mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) at T0 (before anesthesia), T1 (1 min after anesthesia induction), T2 (start of examination), T3 (2 min after the start of examination), and T4 (end of examination) in the two groups were analyzed and compared. The Ramsay sedation score was adopted to evaluate the sedation of the two groups at the anesthesia recovery and at 1 h and 2 h after the anesthesia recovery. The anesthetic effects (time to loss of consciousness, eye opening, and recovery of orientations) of the two groups were analyzed and compared. The excellent and good anesthesia outcomes, hospitalization time and dosage of propofol were compared between the two groups, and the adverse reactions in the two groups during and after the examination were analyzed. RESULTS: At T0, the two groups were not significantly different in the levels of MAP, HR and SpO2 (P>0.05), but at T1, T2, T3, and T4, the study group showed a significantly higher MAP level than the control group (P<0.05). At T1 and T3, the study group exhibited a significantly higher HR level than the control group (P<0.05), and at T2 and T4, the HR level of the two groups was not greatly different (P>0.05). The SpO2 levels at T0, T1, T2, T3, and T4 were not greatly different between the two groups (P>0.05). There was no significant difference in Ramsay score between the two groups at anesthesia recovery and at 1 h and 2 h after the anesthesia recovery (P>0.05). Additionally, the study group experienced significantly earlier time to loss of consciousness, eye opening, and recovery of orientations than the control group (P<0.05). The number of patients with excellent anesthetic outcome in the study group was notably higher than that in the control group (P<0.05). Compared with the control group, the study group consumed less propofol, experienced shorter hospitalization time, and showed a notably lower incidence of adverse reactions (P<0.05). CONCLUSION: For children undergoing painless gastroscopy under general anesthesia, sufentanil combined with propofol can deliver better anesthetic effect than propofol combined with fentanyl, with less effect on hemodynamics and fewer gastroscopy-related adverse reactions.

Efficacy and Safety of a Subanesthetic Dose of Esketamine Combined with Propofol in Patients with Obesity Undergoing Painless Gastroscopy: A Prospective, Double-Blind, Randomized Controlled Trial.

Purpose: Patients with obesity are more susceptible to hypoxemia. Anesthetic management for patients with obesity undergoing painless gastroscopy presents a severe challenge for anesthesiologists. Esketamine is a NMDA antagonist that has been proven to be beneficial for ameliorating respiratory depression owing to its sympathomimetic effect; however, there are no relevant reports on its use in patients with obesity. We designed a randomized controlled trial to evaluate whether esketamine can be the ideal adjuvant to propofol sedation in patients with obesity undergoing painless gastroscopy. Patients and Methods: A total of 104 patients with obesity undergoing painless gastroscopy were randomly divided into group C (propofol+saline) and group S (propofol+esketamine 0.25 mg/kg). Anesthesia was induced by 2 mg/kg propofol with saline or esketamine. The consumption of propofol, hemodynamic parameters, duration of procedure, induction time, postoperative awakening time, and orientation recovery time were recorded. Adverse events and satisfaction scores were also recorded. Results: Propofol consumption was 274.4±22.6 mg and 201.3±16.6 mg in groups C and S, respectively. The induction time of groups C and S were 25.4±2.3 s and 17.8±1.9 s, respectively. The postoperative awakening times of groups C and S were 6.2±1.1 min and 4.8±1.3 min, respectively. Hemodynamic parameters were more stable in group S than in group C. The incidence of adverse events such as injection pain, hypoxemia, hypotension, bradycardia, choking, and body movement were significantly lower in group S. The satisfaction scores of the endoscopist and anesthesiologist were (4.58±0.49 vs 3.71±0.83) and (4.75±0.44 vs 3.33±0.92), respectively. Conclusion: The combination of propofol and esketamine (0.25 mg/kg) improves the safety and reduces the incidence of adverse events in patients with obesity during painless gastroscopy. Thus, this method is worthy of clinical application. Clinical Trials Registration: ChiCTR 2200062547.

Study of wrist-ankle acupuncture therapy for optimizing anaesthesia scheme of painless gastroscopy and improving painless gastroscopy related complications.

BACKGROUND: Painless gastroscopy is a widely used diagnostic and therapeutic technology in clinical practice. Propofol combined with opioids is a common drug for painless endoscopic sedation and anaesthesia. In clinical work, adverse drug reactions of anaesthesia schemes are often one of the important areas of concern for doctors and patients. With the increase in propofol dosage, the risk of serious adverse drug reactions, such as respiratory depression and hypotension, increases significantly; the use of opioids often causes gastrointestinal reactions in patients after examination, such as nausea, vomiting, delayed recovery of gastrointestinal function and other complications, which seriously affect their quality of life. AIM: To observe the effect of wrist-ankle acupuncture therapy on the anaesthesia regimen and anaesthesia-related complications during and after painless gastroscopy examination. METHODS: Two hundred patients were selected and randomly divided into a treatment group (n = 100) and a control group (n = 100). Both groups were routinely anaesthetized with the nalbuphine and propofol regimen, gastroscopy began after the patient lost consciousness, and given supportive treatment and vital sign monitoring. If the patient interrupted the surgery due to intraoperative torsion, intravenous propofol was used to relieve his or her discomfort. The treatment group received wrist-ankle acupuncture on this basis. RESULTS: The general data before treatment, American Society of Anesthesiologist (ASA) grade and operation time between the two groups was no significant difference. The Wakeup time, and the Self-ambulation time in the treatment group was significantly faster than that in the control group (P < 0.05). The total dose of propofol in the treatment group was 109 ± 8.17 mg, significantly lower than that in the control group (P < 0.05). The incidence of respiratory depression and hypotension was not significantly different, but the incidence of hiccups was significantly lower than that in the control group (P < 0.05). After the examination, the incidence of nausea, vomiting, abdominal distension, and abdominal pain was 11%, 8%, 6%, and 5%, respectively, which was significantly lower than that in the control group (P < 0.05). In addition, both the operators and the patients were more satisfied with this examination, with no significant difference between the groups (P > 0.05). CONCLUSION: Wrist-ankle acupuncture treatment can optimize the painless gastroscopy and anaesthesia scheme, reduces propofol total dose; shortens patient Wakeup time and Self-ambulation time, improves patient compliance and tolerance, is beneficial to clinical application.

Application of topical pharyngeal anesthesia to reduce adverse reactions during painless gastroscopy: A prospective randomized study.

BACKGROUND: Studies have reported that certain adverse reactions can occur during painless gastroscopy examination. Knowing how to decrease the risks and incidence of adverse reactions is of great importance. OBJECTIVE: To investigate whether topical pharyngeal anesthesia combined with intravenous anesthesia is superior to intravenous anesthesia alone in patients undergoing painless gastroscopy and to determine whether this combined approach had any additional benefits. METHODS: Three hundred patients undergoing painless gastroscopy were randomly assigned to either the control group or the experimental group. In the control group, patients were anesthetized with propofol, while patients in the experimental group received propofol combined with 2% lidocaine spray for topical pharyngeal anesthesia. Hemodynamic parameters before and after the procedure, including the heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SPO2) were recorded. Any adverse reactions experienced by the patient, including choking and respiratory depression, and the total dosage of propofol required during each procedure were also documented. RESULTS: Compared with pre-anesthetic data, the HR, MAP, and SPO2 were reduced after the completion of the painless gastroscopy procedure in both groups. However, the HR, MAP, and SPO2 measurements taken after the gastroscopy were significantly lower in the control group than those of the experimental group (P< 0.05); thus, the hemodynamic parameters of the experimental group were more stable. Compared with the control group, there was significant reduction in the total amount of propofol administered in the experimental group (P< 0.05). The incidence of adverse reactions, including choking and respiratory depression, was significantly lower in the experimental group (P< 0.05). CONCLUSION: The results demonstrated that the application of topical pharyngeal anesthesia in painless gastroscopy can significantly reduce the incidence of adverse reactions. Thus, the combination of topical pharyngeal and intravenous anesthesia is worthy of clinical application and promotion.

The effect of preoperative sleep quality on the target plasma concentration of propofol and postoperative sleep in patients undergoing painless gastroscopy.

BACKGROUND: This study aims to investigate the effect of preoperative sleep quality on the target plasma concentration of propofol and postoperative sleep in patients undergoing painless gastroscopy. METHODS: Ninety-three outpatients aged 45 to 64 years with body mass index (BMI) of 18.5-30 kg/m2 and ASA grades of I or II, who underwent painless gastroscopy, were selected. All patients were evaluated by the Athens insomnia scale (AIS) before the painless gastroscopy. The patients were divided into two groups according to the AIS score evaluated before painless gastroscopy: normal sleep group (group N, AIS score < 4 points, 47 cases) and sleep disorder group (group D, AIS score > 6 points, 46 cases). The target-controlled infusion (TCI) of propofol (Marsh model) was used for general anesthesia, the Bispectral index (BIS) was used to monitor the depth of anesthesia, and the BIS was maintained between 50 and 65 during the painless gastroscopy. The target plasma concentration (Cp) of propofol was recorded when the patient's eyelash reflex disappeared (T1), before the painless gastroscopy (T2), at the time of advancing the gastroscope (T3) and during the painless gastroscopy (T4), and the infusion rate per body surface area of propofol was calculated. The patient's AIS score was followed up by telephone at day 1, day 3, 1 week, and 1 month after the painless gastroscopy to assess the postoperative sleep of the patient. The occurrence of adverse reactions during the painless gastroscopy was recorded; the patient's satisfaction and the endoscopist's satisfaction with the anesthesia effect were compared between the two groups. RESULTS: Compared with group N, the Cp at each time point and the infusion rate per body surface area of propofol in group D was increased significantly (P < 0.05); compared with the AIS scores before the painless gastroscopy, the AIS scores of the two groups of patients were significantly increased day 1 after the painless gastroscopy (P < 0.05); there were no significant differences in the AIS scores of the two groups at day 3, 1 week, and 1 month after the painless gastroscopy (P > 0.05). There were no statistically significant differences in the occurrence of adverse reactions and the patient's satisfaction and the endoscopist's satisfaction with the anesthesia effect between the two groups (P > 0.05). CONCLUSION: The preoperative sleep disturbance will increase the Cp and the infusion rate per body surface area of propofol in patients undergoing painless gastroscopy. Propofol only affects the patients' sleep for day 1 after the painless gastroscopy. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2100045332) on 12/04/2021.

Predicting the best fit based on the synergistic interaction of remifentanil and propofol at the corrected dose in elderly patients undergoing painless gastroscopy.

OBJECTIVE: To validate a response surface model for the inhibition of somatic motor response at corrected body weight (CBW) doses of remifentanil plus propofol in elderly patients and to analyze the dose-effect relationship and optimal dosing range for total intravenous anesthesia (TIVA) induction in painless gastroscopy. METHODS: We designed a prospective, open-ended, randomized, parallel group study. A total of 300 elderly patients undergoing painless gastroscopy were randomized to receive remifentanil (0-0.5 µg/kg) and propofol (0.8-2.2 mg/kg) dosing based on CBW. Gastroscopy was performed at the drug's peak effect time. The somatic motor response to gastroscopic stimulation and the adverse reactions at different points were recorded. The somatic motor response was used as the basic element in the subsequent RSM analysis. Model parameters and 95% confidence intervals were fitted by MATLAB software. RESULTS: The CBW doses of remifentanil and propofol showed synergistic inhibitory effects on motor response to noxious stimulation and attenuated adverse reactions. The 50% effective doses of remifentanil and propofol for inhibiting the motor response were 1.754 µg/kg and 2.048 mg/kg, respectively. CONCLUSION: Remifentanil or propofol alone could not inhibit the somatic motor response at weight-adjusted doses among elderly patients. A combination of remifentanil and propofol showed a synergistic interaction in suppressing the motor response and adverse reactions in elderly patients. Preinjection of remifentanil could reduce the needed dose of propofol.

Study on painless gastroscopy and POCD of smoking patients under general anesthesia.

The number of smoking patients receiving anesthesia and surgical treatment is increasing day by day. It will be useful for medical advancement to explore whether smoking is an independent risk factor for postoperative cognitive impairment. A double-blind, parallel, and controlled study was conducted on 112 patients who fulfilled the criteria for inclusion in this study and planned to undergo painless gastroscopy under general anesthesia. The baseline mini-mental state examination (MMSE) scores and basic information were collected. The changes in the MMSE scores after waking up and 3 days after anesthesia were observed, and the adverse events (respiratory adverse reactions, circulatory fluctuations, and adverse reactions, drug use, etc.) were analyzed by logistic regression. The baseline level of each group is consistent, which is worth studying. The MMSE score of the smoking group after anesthesia was significantly different from that of the control group (p < 0.05), but there was no significant difference between the two groups 3 days after anesthesia. Among them, the differences in adverse events between the two groups were in terms of hiccup, postoperative cough, and SpO2 < 90% (p < 0.05). Regression analysis indicates that smoking after anesthesia leads to the occurrence of postoperative cough. Smoking is probably an independent risk factor for post-operative cognitive dysfunction (POCD) in early postoperative patients.

The influence of age on the safety of propofol mono-sedation gastroscopy for adult patients / 中华消化内镜杂志

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.

Effect of laryngopharyngeal reflux on sedation-related adverse events in patients undergoing painless gastroscopy / 中华麻醉学杂志

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.

Observation on the effect of body position intervention combined pronase in sifting gastroscopy / 中国实用护理杂志

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.

Application of a self designed oral-nasal double channel mask in painless gastroscopy / 中国内镜杂志

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.

The Observation of Curative Effect of Budesonide Nebulization Supplying on Post-Infection Cough Undergoing Painless Gastroscopy / 昆明医科大学学报

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.

Discussion on the application and effect of painless gastroscopy anesthesia in the sufentanil combined with propofol / 中国生化药物杂志

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.

Assessment of the clinical effect of dyclonine combined with propofol in the application of painless gastros-copy / 实用医学杂志

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.

Effects of dexmedetomidine combined with propofol on hemodynamics in elderly patients undergoing painless gastroscopy / 中国生化药物杂志

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.

Assessment of the clinical effect of dyclonine combined with propofol in the application of painless gastros-copy / 实用医学杂志

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.

Target-controlled Intravenous Analgesia with Remifentanil on Hyoxemia in Obese Patients with Painless Gastroscopy / 医学研究杂志

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.