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https://www.readbyqxmd.com/read/28205108/water-assisted-colonoscopy
#1
REVIEW
Sergio Cadoni, Felix W Leung
The current review will attempt to describe the important lessons learned from published randomized controlled trials (RCT) comparing water immersion (WI) or water exchange (WE) techniques with gas insufflation colonoscopy. Air insufflation (AI) to distend the colon to permit visualization and passage through the lumen was developed for diagnostic colonoscopy. When screening colonoscopy was adopted, the same AI method was used. Interval cancers, diagnosed within 3 to 5 years after an index screening colonoscopy, appeared to be linked to low adenoma detection rate (ADR)...
February 15, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28154379/editorial-endoscopic-sedation-who-which-when
#2
John M Inadomi
The costs of medical care are rising and media has focused attention on the costs of colonoscopy as a potential cause. A major component of procedural costs is the sedation, which is a combination of the drugs used and who administers them. An analysis of advanced endoscopic procedures revealed that the rate of sedation failure was significantly lower among patients administered sedation by anesthesia compared with patients who received moderate sedation administered by endoscopy staff. The authors argue that all endoscopic retrograde cholangiopancreatography (ERCP) should be performed with anesthesia-administered sedation...
February 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28108788/outpatient-application-of-formalin-for-chronic-rectal-bleeding-after-prostate-irradiation-a-quasi-experimental-study
#3
Gustavo Arruda Viani, Aline Sakamoto
PURPOSE: The aim of this quasi-experimental study is to evaluate a novel technique for an outpatient application of formalin for chronic rectal bleeding after prostate irradiation. METHODS: This is a quasi- experimental clinical trial developed between January 2010 and July 2015, including 35 patients with chronic radiation rectitis (CRP) due to a previous prostate radiation course. The study's eligibility was (1) completed external beam radiation therapy for prostate carcinoma >6 months previously, (2) rectal bleeding, defined as a frequency of >1× per week and/or needing of blood transfusions, and (3) diagnosis of chronic proctitis at colonoscopy...
January 20, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28106610/-opt-out-and-access-to-anesthesia-care-for-elective-and-urgent-surgeries-among-u-s-medicare-beneficiaries
#4
Eric C Sun, Franklin Dexter, Thomas R Miller, Laurence C Baker
BACKGROUND: In 2001, the Centers for Medicare and Medicaid Services issued a rule allowing U.S. states to "opt out" of the regulations requiring physician supervision of nurse anesthetists in an effort to increase access to anesthesia care. Whether "opt out" has successfully achieved this goal remains unknown. METHODS: Using Medicare administrative claims data, we examined whether "opt out" reduced the distance traveled by patients, a common measure of access, for patients undergoing total knee arthroplasty, total hip arthroplasty, cataract surgery, colonoscopy/sigmoidoscopy, esophagogastroduodenoscopy, appendectomy, or hip fracture repair...
March 2017: Anesthesiology
https://www.readbyqxmd.com/read/28057843/diphenhydramine-for-acute-extrapyramidal-symptoms-after-propofol-administration
#5
James Sherer, Tomas Salazar, Kevin B Schesing, Shannon McPartland, Jeffrey Kornitzer
Extrapyramidal symptoms are an uncommon but well-recognized side effect after the administration of general anesthesia in patients without a significant neurologic history. Several case reports implicate propofol as the likely causative agent producing these symptoms, which include ballismus, dystonia, choreoathetosis, and opisthotonus. Currently, there is no clear consensus on first-line treatment of these symptoms. In each of the published cases, anticholinergic medications and benzodiazepines were central to initial management, although the speed and extent of symptom resolution were variable...
February 2017: Pediatrics
https://www.readbyqxmd.com/read/28002204/anesthesia-service-use-and-the-uptake-of-screening-colonoscopies
#6
Samuel Hirshman, Soeren Mattke, Hangsheng Liu
BACKGROUND: The Center for Medicare & Medicaid Services recently defined "screening colonoscopy" to include separately furnished anesthesia services. OBJECTIVE: To examine the relationship between anesthesia service use and the uptake of screening colonoscopies. STUDY DESIGN: We correlated metropolitan statistical area (MSA) level anesthesia service use rates, derived from the 2008, 2010, and 2012 Medicare and MarketScan claims data, with the presence of individual level guideline concordant screening colonoscopy using the Behavioral Risk Factor Surveillance System data for the same years...
December 20, 2016: Medical Care
https://www.readbyqxmd.com/read/27988287/endoscopic-multiple-biopsy-and-rapid-diagnosis-by-in-situ-fixation-and-histopathologic-processing
#7
David S Zimmon, Fred B Smith, Forrest Manheimer, Cathy Fan, Chantel Njiwaji, Sergei Aksenov, Premtesh Chattoo
BACKGROUND AND AIMS: Endoscopic forceps biopsy and fixation are laborious and prolong the procedure and anesthesia. Multiple biopsy overcomes these shortcomings with a single endoscope pass that cuts, like a needle biopsy, up to 25 biopsy samples of uniform size and depth during endoscope withdrawal. Biopsy specimens are collected in acquisition order and stored in a perforated plastic storage chamber within the perforated metal tip. The tip is cut off, immersed in fixative, and sent to pathology...
December 15, 2016: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/27918331/growth-of-nonoperating-room-anesthesia-care-in-the-united-states-a-contemporary-trends-analysis
#8
Alexander Nagrebetsky, Rodney A Gabriel, Richard P Dutton, Richard D Urman
BACKGROUND: Although previous publications suggest an increasing demand and volume of nonoperating room anesthesia (NORA) cases in the United States, there is little factual information on either volume or characteristics of NORA cases at a national level. Our goal was to assess the available data using the National Anesthesia Clinical Outcomes Registry (NACOR). METHODS: We performed a retrospective analysis of NORA volume and case characteristics using NACOR data for the period 2010-2014...
December 1, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27779482/influence-of-premedication-with-alprazolam-on-the-occurence-of-obstructive-apneas-a-prospective-randomized-double-blind-study
#9
E Deflandre, V Bonhomme, A-C Courtois, S Degey, R Poirrier, J-F Brichant
Postoperative development or worsening of obstructive sleep apnea is a potential complication of anesthesia. The objective of this study was to study the effects of a premedication with alprazolam on the occurrence of apneas during the immediate postoperative period. Fifty ASA 1 - 2 patients undergoing a colonoscopy were recruited. Patients with a history of obstructive sleep apnea (OSA) were excluded. Recruited patients were randomly assigned to one of two groups: in Group A, they received 0.5 mg of alprazolam orally one hour before the procedure; and in Group C, they received placebo...
August 2016: Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society
https://www.readbyqxmd.com/read/27687426/noninvasive-ventilation-during-spontaneous-breathing-anesthesia-an-observational-study-using-electrical-impedance-tomography
#10
Julien Bordes, Philippe Goutorbe, Pierre Julien Cungi, Marie Caroline Boghossian, Eric Kaiser
STUDY OBJECTIVE: To assess the effects of noninvasive ventilation (NIV) during spontaneous breathing anesthesia on functional residual capacity and ventilation distribution. DESIGN: Prospective and observational study. SETTING: Operating room, military teaching hospital. PATIENTS: Eighteen adult patients submitted to digestive endoscopic procedures under spontaneous breathing anesthesia. INTERVENTIONS: Anesthetic management was standardized...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27631316/impact-of-responsive-insertion-technology-rit-on-reducing-discomfort-during-colonoscopy-randomized-clinical-trial
#11
Artur Pasternak, Miroslaw Szura, Rafal Solecki, Maciej Matyja, Antoni Szczepanik, Andrzej Matyja
BACKGROUND: In many countries, colonoscopies for colorectal cancer screening are performed without sedation due to the cost. Changes in the structure of the endoscopes are designed to facilitate the colonoscopic examination, reduce the duration of the procedure, and improve the imaging of the intestinal lumen. The variable stiffness of the endoscope and the recently introduced responsive insertion technology (RIT) are features aimed at easing colonoscope insertion and reducing the discomfort and pain during the examination...
September 8, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27493596/a-systematic-review-of-factors-associated-with-utilization-of-monitored-anesthesia-care-for-gastrointestinal-endoscopy
#12
Megan A Adams, Ashraf Saleh, Joel H Rubenstein
Utilization of monitored anesthesia care (MAC) for gastrointestinal endoscopy has increased markedly over the past decade, leading to significant additional health care expenditures. However, the extent to which certain patient-, provider-, and facility-level factors lead to MAC utilization is unclear. A systematic review of 13 studies evaluating influential factors associated with MAC utilization for colonoscopy and/or esophagogastroduodenoscopy was conducted. Multiple studies revealed significant increases in MAC utilization since the early 2000s, with substantial regional variation...
June 2016: Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27451091/similar-risk-of-cardiopulmonary-adverse-events-between-propofol-and-traditional-anesthesia-for-gastrointestinal-endoscopy-a-systematic-review-and-meta-analysis
#13
REVIEW
Vaibhav Wadhwa, Danny Issa, Sushil Garg, Rocio Lopez, Madhusudhan R Sanaka, John J Vargo
BACKGROUND & AIMS: Even though propofol use for gastrointestinal endoscopic procedures has increased over the past decade, there is a perception that it causes a higher rate of cardiopulmonary adverse events. The aim of this study was to compare the sedation-related adverse events associated with use of propofol vs nonpropofol agents for endoscopic procedures. We also wanted to determine the influence of duration or complexity of the procedures and endoscopist-directed (gastroenterologist) vs non-gastroenterologist-directed sedation on the outcomes...
July 21, 2016: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27415436/capturing-pain-in-the-cortex-during-general-anesthesia-near-infrared-spectroscopy-measures-in-patients-undergoing-catheter-ablation-of-arrhythmias
#14
Barry D Kussman, Christopher M Aasted, Meryem A Yücel, Sarah C Steele, Mark E Alexander, David A Boas, David Borsook, Lino Becerra
The predictability of pain makes surgery an ideal model for the study of pain and the development of strategies for analgesia and reduction of perioperative pain. As functional near-infrared spectroscopy reproduces the known functional magnetic resonance imaging activations in response to a painful stimulus, we evaluated the feasibility of functional near-infrared spectroscopy to measure cortical responses to noxious stimulation during general anesthesia. A multichannel continuous wave near-infrared imager was used to measure somatosensory and frontal cortical activation in patients undergoing catheter ablation of arrhythmias under general anesthesia...
2016: PloS One
https://www.readbyqxmd.com/read/27350739/clinical-study-of-anesthetization-by-dezocine-combined-with-propofol-for-indolent-colonoscopy
#15
Bin-Bin Xu, Xiao-Liang Zhao, Gui-Ping Xu
AIM: To assess the use of dezocine combined with propofol for the anesthetization of patients undergoing indolent colonoscopy. METHODS: A cross-sectional survey of patients undergoing indolent colonoscopy in the Xinjiang People's Hospital was conducted from April 1 to April 30, 2015. The survey collected patient general information and anesthesia data, including overall medical experience and pain management. Thirty minutes after colonoscopy surgery, samples of venous blood were collected and the biochemical indicators of gastrointestinal function were analyzed...
June 28, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/27348311/detection-of-anorectal-cancer-among-patients-with-crohn-s-disease-undergoing-surveillance-with-various-biopsy-methods
#16
Hiroshi Matsuno, Tsunekazu Mizushima, Riichiro Nezu, Kiyokazu Nakajima, Hidekazu Takahashi, Naotsugu Haraguchi, Junichi Nishimura, Taishi Hata, Hirofumi Yamamoto, Yuichiro Doki, Masaki Mori
BACKGROUND/AIMS: Crohn's disease (CD) is an inflammatory bowel disease. The risk of colorectal cancer (CRC) is increased in patients with CD. In Japan, anorectal cancer accounted for >60% of CRCs associated with CD. These anorectal cancers are typically diagnosed in advanced stages, because a surveillance protocol remains to be established. This study aimed to assess various biopsy methods for detecting CRC. METHODS: This study included 72 patients (113 examinations) with CD who underwent cancer surveillance between August 2008 and October 2015...
2016: Digestion
https://www.readbyqxmd.com/read/27281065/a-response-surface-model-exploration-of-dosing-strategies-in-gastrointestinal-endoscopies-using-midazolam-and-opioids
#17
Jing-Yang Liou, Chien-Kun Ting, Ming-Chih Hou, Mei-Yung Tsou
Classical midazolam-opioid combination for gastrointestinal endoscopy sedation has been adopted for decades. Dosing regimens have been studied but most require fixed dosing intervals. We intend to use a sophisticated pharmacodynamic tool, response surface model (RSM), to simulate sedation using different regimens. RSM can predict patient's response during different phases of the examination and predict patient's wake-up time with precision and without the need for fixed dosing intervals. We believe it will aid physicians in guiding their dosing strategy and timing...
June 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27227110/colonoscopy-without-sedation-patient-factors-alone-are-less-likely-to-influence-its-uptake
#18
Nusrat Iqbal, Sean Ramcharan, Samer Doughan, Irshad Shaikh
BACKGROUND AND STUDY AIMS: Conscious sedation during colonoscopy minimizes discomfort, improves polyp detection rates, and reduces technical failure, but carries medication-related risks and requires dedicated and costly recovery services. Sedation-free procedures may offer a safer alternative. We aimed to compare this group with those receiving sedation to determine differences in patient characteristics, cecal intubation rates, polyp detection rates, discomfort levels and safety in patients for whom anesthesia is high risk...
May 2016: Endoscopy International Open
https://www.readbyqxmd.com/read/27215512/-clinicopathological-characteristics-of-colorectal-carcinoma-in-the-elderly
#19
Kaixiong Tao, Jinbo Gao, Guobin Wang
Elderly patients with colorectal cancer have different clincopathological characteristics from younger patients. Colorectal cancers tend to localize in the proximal colon, from cecum to the splenic flexure in the elderly patients. Changes in the stools, rectal bleeding or black stool, abdominal pain, fatigue, weight loss and anemia are the common symptoms. Analysis showed that age is one of independent risk factors for lower completion rates of colonoscopy. Therefore, the choice of diagnosis methods in elderly patients should be careful...
May 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/27203427/residual-gastric-volume-after-bowel-preparation-with-polyethylene-glycol-for-elective-colonoscopy-a-prospective-observational-study
#20
Chi-Liang Cheng, Nai-Jen Liu, Jui-Hsiang Tang, Yen-Lin Kuo, Cheng-Hui Lin, Yi-Ning Tsui, Bai-Ping Lee, Yun-Chiu Tai, Ming-Yao Su, Cheng-Tang Chiu
GOAL: To examine the residual gastric volume (RGV) in colonoscopy after bowel preparations with 3-L polyethylene glycol (PEG). BACKGROUND: Obstacles to high-volume bowel preparation by anesthesia providers resulting from concerns over aspiration risk are common during colonoscopy. STUDY: Prospective measurements of RGV were performed in patients undergoing esophagogastroduodenoscopy (EGD) and morning colonoscopy with split-dose PEG preparation, patients undergoing EGD and afternoon colonoscopy with same-day PEG preparation, and patients undergoing EGD alone under moderate conscious sedation...
May 19, 2016: Journal of Clinical Gastroenterology
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