| A prospective, randomized, comparative trial evaluating respiratory depression during patient-controlled versus anesthesiologist-administered propofol-remifentanil sedation for elective colonoscopy. | |
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MedLine Citation:
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PMID: 20493481 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Patient-controlled sedation (PCS) with propofol-remifentanil (PR) is associated with rapid sedation and recovery, but it is associated with a greater requirement for airway rescue than PCS with midazolam-fentanyl. OBJECTIVE: To demonstrate that respiratory depression associated with PR is more frequent during anesthesiologist-administered sedation (AAS) than during PCS. DESIGN: Prospective, randomized, open-label study. SETTING: Academic medical center. PATIENTS: Fifty patients undergoing elective colonoscopy. INTERVENTION: PCS or AAS using PR. All patients breathed 100% oxygen via an anesthesia mask with continuous spirometry and bispectral index (BIS). MAIN OUTCOME MEASUREMENTS: Respiratory rate and BIS. RESULTS: Colonoscopy was completed in all patients. No patient under PCS required airway rescue. Five patients under AAS required bag-mask ventilation to resolve Sao(2) (arterial oxygen saturation) less than 90% lasting longer than 30 seconds. The median BIS for the AAS group was 71.7 (range 61.06-82.34) and 88.1 (range 83.15-93.05) for the PCS group. Median respiratory rates were 5.97 (range 1.21-10.73) breaths per minute for AAS and 13.19 (range 9.54-16.84) for PCS. Respiratory rates less than 2 breaths per minute composed 28% of the procedure time for AAS, but only 5% for PCS. Patients under PCS had lower median predicted effect site concentrations for PR, but were able to achieve brief peak levels exceeding those with AAS. These differences were significant (P < .001). LIMITATIONS: Potential for bias with AAS. CONCLUSIONS: Patients undergoing colonoscopy with PR are significantly more likely to require intervention for hypoventilation compared with PCS. (Clinical trial registration number:NCT00868920.). |
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Authors:
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Jeff E Mandel; Gary R Lichtenstein; David C Metz; Gregory G Ginsberg; Michael L Kochman |
Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial Date: 2010-05-20 |
Journal Detail:
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Title: Gastrointestinal endoscopy Volume: 72 ISSN: 1097-6779 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-12 Completed Date: 2010-11-02 Revised Date: 2011-06-27 |
Medline Journal Info:
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Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: United States |
Other Details:
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Languages: eng Pagination: 112-7 Citation Subset: IM |
Copyright Information:
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Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00868920 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Academic Medical Centers Adult Aged Analgesia, Patient-Controlled* Anesthesiology* Anesthetics, Intravenous* Colonoscopy* Conscious Sedation / methods* Dose-Response Relationship, Drug Female Humans Male Middle Aged Oxygen / blood Piperidines* Propofol* Prospective Studies Respiratory Insufficiency / chemically induced* |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Intravenous; 0/Piperidines; 132875-61-7/remifentanil; 2078-54-8/Propofol; 7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
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Z Gastroenterol. 2011 May;49(5):622-3
[PMID:
21557171
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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