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Monitored anaesthesia in endoscopy

Aaron Conway, Joanna Sutherland
OBJECTIVES: Processed electroencephalogram-based depth of anaesthesia monitoring devices provide an additional method to monitor level of consciousness during procedural sedation and analgesia. The objective of this systematic review was to determine whether using a depth of anaesthesia monitoring device improves the safety and efficacy of sedation. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Electronic databases (CENTRAL; Medline; CINAHL) were searched up to May 2015...
May 24, 2016: International Journal of Nursing Studies
Patricia Duch, Camilla Haahr, Morten Hylander Møller, Steffen J Rosenstock, Nicolai B Foss, Lars Hyldborg Lundstrøm, Nicolai Lohse
OBJECTIVE: Currently, no standard approach exists to the level of monitoring or presence of staff with anaesthetic expertise required during emergency esophago-gastro-duodenoscopy (EGD) for peptic ulcer bleeding (PUB). We assess the association between anaesthesia care and mortality. We further describe the prevalence and inter-hospital variation of anaesthesia care in Denmark and identify clinical predictors for choosing anaesthesia care. MATERIAL AND METHODS: This population-based cohort study included all emergency EGDs for PUB in adults during 2012-2013...
August 2016: Scandinavian Journal of Gastroenterology
N Lohse, L H Lundstrøm, T R Vestergaard, M Risom, S J Rosenstock, N B Foss, M H Møller
BACKGROUND: Emergency upper gastrointestinal bleeding is a common condition with high mortality. Most patients undergo oesophagogastroduodenoscopy (OGD), but no universally agreed approach exists to the type of airway management required during the procedure. We aimed to compare anaesthesia care with tracheal intubation (TI group) and without airway instrumentation (monitored anaesthesia care, MAC group) during emergency OGD. METHODS: This was a prospective, nationwide, population-based cohort study during 2006-13...
June 2015: British Journal of Anaesthesia
Michaela Boström, Ola Thorsson, Ervin Toth, Daniel Agardh
BACKGROUND: Wireless pH-monitoring is an accurate method for diagnosing adults with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the use of the Bravo capsule on children investigated for GERD in terms of safety, tolerability and feasibility before and after administration of proton pump inhibitors. METHODS: A Bravo capsule was inserted during upper endoscopy under general anaesthesia or deep sedation with propofol. 48-hour pH-metry was performed in 106 children (50 males, 56 females) at the median age of 11 years (range 17 months-18 years)...
2014: BMC Gastroenterology
Marc Garnier, Francis Bonnet
PURPOSE OF REVIEW: Anesthesia outside the operating room is commonly uncomfortable and risky. In this setting, anesthetic emergencies or complications may occur. This review aims to report the most recent updates regarding the management of prehospital anesthesia, anesthesia in the trauma and emergency rooms, and anesthesia for endoscopy and interventional radiology. RECENT FINDINGS: After tracheal intubation failure, airway control of outpatients could be achieved by pharmacologically assisted laryngeal mask insertion...
August 2014: Current Opinion in Anaesthesiology
Amos Neheman, Claude Schulman, Ofer Yossepowitch
OBJECTIVE: To develop and test the safety and feasibility of a novel anti-biofilm mechanism configured for wireless capsule endoscopy (WCE) in a sheep bladder model. MATERIALS AND METHODS: A WCE mechanism, designed for long-term bladder monitoring, was developed and introduced into a sheep bladder for 5 months. The transparency of the surface was assessed by evaluating a resolution target placed inside the capsule at serial intervals using cystoscopy under general anaesthesia...
June 2013: BJU International
F J Alados-Arboledas, M P Millán-Bueno, J F Expósito-Montes, C Santiago-Gutierrez, A Arévalo-Garrido, A Pérez-Parras, L Millán-Miralles, M C Martínez-Padilla, J de la Cruz-Moreno
INTRODUCTION: The objective of this investigation is to determine whether bispectral index (BIS®) monitoring during intravenous anaesthesia with spontaneous breathing for upper gastrointestinal endoscopy (UGE) in a pediatric population is useful for: a) decreasing the amount of drug, b) decreasing the time for awakening, and c) improving patient safety. PATIENTS AND METHOD: A quasi-experimental case-control prospective study was conducted in the setting of a second level hospital pediatric intensive care unit...
August 2013: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
Jernej Brecelj, Tina Kamhi Trop, Rok Orel
OBJECTIVES: Numerous publications on sedation of and anaesthesia for diagnostic procedures in children prove that no ideal scheme is available. Therefore, we decided to study the protocol with midazolam and ketamine used by nonanaesthetists at our institution. The study aimed to establish the lowest effective starting dose of ketamine and to estimate a difference in the frequency of adverse reactions with or without the use of midazolam as premedication, with special stress on emergence reactions...
June 2012: Journal of Pediatric Gastroenterology and Nutrition
H Babar-Craig, N K Rajani, P Bailey, B T Kotecha
Bispectral index (BIS) monitor is a neurophysiological monitoring device which continually analyses a patient's electroencephalogram during sedation and general anaesthesia to assess the level of consciousness and depth of anaesthesia. BIS monitoring, whilst performing sleep nasendoscopy (using midazolam and propofol), has helped validate depth of sedation and allowed comparison with levels of sedation of control patients during natural sleep. A prospective study of 30 patients with snoring undergoing sleep nasendoscopy with BIS monitoring was conducted...
April 2012: European Archives of Oto-rhino-laryngology
J Chen, W Li, D Wang, X Hu
BACKGROUND: Excessive coughing may increase the risk of complications after sinus surgery. We hypothesized that remifentanil would decrease the incidence and severity of coughing after endoscopic sinus surgery with propofol and remifentanil anaesthesia. METHODS: Ninety patients scheduled for endoscopic sinus surgery were randomly assigned into three groups. Propofol was stopped at the completion of the surgical procedure. The remifentanil infusion was adjusted to an effect-site concentration of 1...
November 2010: Acta Anaesthesiologica Scandinavica
Neus Fàbregas, Rosemary Ann Craen
PURPOSE OF REVIEW: Endoscopic neurosurgical procedures are becoming more frequent and popular in the treatment of intracranial disease. When endoscopy involves the intraventricular structures, irrigating solutions are required and may contribute to sudden and sharp increases in intracranial pressure. More recently, nasal endoscopic approach has been used to perform skull base surgery for aneurysms and tumours. We have analysed published articles in order to detect anaesthesia management and perioperative complications...
October 2010: Current Opinion in Anaesthesiology
A R Baker, A B Baker
Endoscopic sinus surgery is commonly performed and has a low risk of major complications. Intraoperative bleeding impairs surgical conditions and increases the risk of complications. Remifentanil appears to produce better surgical conditions than other opioid analgesics, and total intravenous anaesthesia with propofol may provide superior conditions to a volatile-based technique. Moderate hypotension with intraoperative beta blockade is associated with better operating conditions than when vasodilating agents are used...
August 2010: Acta Anaesthesiologica Scandinavica
A F Kalmar, L Foubert, J F A Hendrickx, A Mottrie, A Absalom, E P Mortier, M M R F Struys
BACKGROUND: The steep (40 degrees ) Trendelenburg position optimizes surgical exposure during robotic prostatectomy. The goal of the current study was to investigate the combined effect of this position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during these procedures. METHODS: Physiological data were recorded during the whole surgical procedure in 31 consecutive patients who underwent robotic endoscopic radical prostatectomy under general anaesthesia...
April 2010: British Journal of Anaesthesia
H Y Embu, M J Misauno, E S Isamade, M G Yilkudi
BACKGROUND: To determine the incidence of oxygen desaturation and whether routine oxygen monitoring is necessary during unsedated diagnostic flexible upper gastrointestinalendoscopy. METHODS: A prospective study involving 54 consecutive in and out patients who had diagnostic upper gastrointestinal endoscopy at the endoscopy suit of the Jos University Teaching Hospital, Jos, Nigeria between March 2007 and October 2007. The patients were reviewed before the procedure and classified according to the American Society of Anesthesiologists' (ASA) classification into classes I, II, III and IV Endoscopy was carried out after topical pharyngeal anaesthesia using 10% lidocaine spray and oxygen saturation was monitored throughout the procedure...
October 2008: Nigerian Journal of Medicine: Journal of the National Association of Resident Doctors of Nigeria
Jaroslaw Regula, Elzbieta Sokol-Kobielska
Sedation for endoscopy provides comfort for the patient and better examination conditions for the endoscopist. The high costs of providing anaesthesia by specialists and the relative lack of specialist personnel in many countries have led to the wider introduction of sedation delivered by non-anaesthesiologists. Such sedation should be targeted for moderate levels of sedation; however, personnel should be able to avoid - and rescue patients from - deeper sedation levels. Several conditions have to be fulfilled to provide proper and safe non-anaesthesiologist sedation for endoscopy, especially when propofol is to be used...
2008: Best Practice & Research. Clinical Gastroenterology
Fauzia N Minai, Khalid Maudood Siddiqui, Rehan Qureshi
Sedation/analgesia is a mode of anaesthesia which facilitates an uncomfortable or painful procedure, such as gastrointestinal endoscopy, in a rousable and cooperative patient. The objective of the study was to assess the practice trends for administering sedation analgesia in non operative locations in Aga Khan Hospital, Karachi by anaesthetists. It was a descriptive study which retrospective reviewed anaesthesia records. A total of 41 ASA I-IV cases were reviewed. Non invasive cardiorespiratory monitoring and clinical sedation monitoring were applied...
February 2008: JPMA. the Journal of the Pakistan Medical Association
A Gunnarsdóttir, P Stenström, E Arnbjörnsson
BACKGROUND: Use of a catheter-free, radio telemetric, oesophageal pH-monitoring system in paediatric clinical practice allows patients to follow a more normal physiological pattern of activities and causes less discomfort. At our institution, placement of the capsule is done under general anaesthesia, which restricts the child's activity during the first day. The aim of this study was to determine whether oesophageal pH-measurements should be performed over 48 hours or whether 24-hour measurement provides sufficient and reliable results...
December 2007: European Journal of Pediatric Surgery
S Goksu, H Arik, S Demiryurek, S Mumbuc, U Oner, A T Demiryurek
BACKGROUND AND OBJECTIVES: Functional endoscopic sinus surgery can be performed under either local or general anaesthesia. The objective of this study was to investigate the haemodynamic effects of perioperatively administered dexmedetomidine, a new generation alpha-2-agonist, in patients for functional endoscopic sinus surgery. METHODS: Sixty-two patients who were planned to undergo functional endoscopic sinus surgery under local anaesthesia were included in the study...
January 2008: European Journal of Anaesthesiology
E Kottenberg-Assenmacher, M Kamler, J Peters
Minimally invasive endoscopic intracardiac surgery including one lung ventilation has been proposed to decrease surgical trauma but its impact on oxygenation and resource consumption has not been reported. We compared effects on gas exchange, induction, total anaesthesia time, staffing costs, and complications in 42 consecutive patients to a matched group undergoing similar surgery conventionally. Use of endoscopic compared to conventional surgery evoked a decrease in the P(a)o(2)/F(I)o(2) ratio (mean (SD) 24...
March 2007: Anaesthesia
Nicolas Bourdel, Sachiko Matsuzaki, Jean-Etienne Bazin, Jean-Luc Pouly, Gérard Mage, Michel Canis
BACKGROUND: Previous animal studies suggested that the peritoneal environment during a carbon dioxide (CO(2)) pneumoperitoneum is hypoxic and that this may contribute to the formation of intra-abdominal adhesions or the growth of malignant cells. There is no study, however, that investigates the relationship between anaesthesia, ventilation and the laparoscopic peritoneal environment to the development of hypoxia. The objective of this study is to monitor the peritoneal tissue-oxygen tension (PitO(2)) under various conditions including anaesthesia alone, during a CO(2) pneumoperitoneum at both low and high intraperitoneal pressure (IPP), and laparotomy, in animal models with controlled respiratory support (CRS)...
April 2007: Human Reproduction
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