• analgesics
• endoscopic ultrasonography
• propofol
• sedative
• sedative efficacy

• biliary and pancreatic diseases
• endoscopic cholangiopancreatography
• endoscopic ultrasound‐guided intervention
• excessive sedation
• propofol

• adverse events
• balloon-assisted ERCP
• benzodiazepine
• sedation

• 24K18948 Promotion of Science (JSPS) Grant-in-Aid for Scientific Research (KAKENHI)

• Adverse events
• Endoscopy
• Sedation

• Humans
• Italy
• Female
• Male
• Middle Aged
• Propofol/administration & dosage
• Propofol/adverse effects
• Aged
• Hypnotics and Sedatives/administration & dosage
• Hypnotics and Sedatives/adverse effects
• Endoscopy, Gastrointestinal/nursing
• Adult
• Conscious Sedation/nursing
• Conscious Sedation/methods
• Midazolam/administration & dosage
• Fentanyl/administration & dosage
• Referral and Consultation
• Deep Sedation/nursing
• Deep Sedation/methods

• Anesthesia
• Efficacy
• Endoscopic retrograde cholangiopancreatography
• Safety
• Sedation

• Humans
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Hypnotics and Sedatives/administration & dosage
• Hypnotics and Sedatives/adverse effects
• Hypnotics and Sedatives/therapeutic use
• Propofol/administration & dosage
• Propofol/adverse effects
• Propofol/therapeutic use
• Fentanyl/administration & dosage
• Fentanyl/therapeutic use
• Randomized Controlled Trials as Topic
• Oxycodone/therapeutic use
• Oxycodone/administration & dosage
• Oxycodone/adverse effects
• Dexmedetomidine/administration & dosage
• Dexmedetomidine/adverse effects
• Dexmedetomidine/therapeutic use
• Patient Satisfaction
• Meperidine/administration & dosage
• Meperidine/therapeutic use
• Midazolam/administration & dosage
• Midazolam/therapeutic use
• Midazolam/adverse effects
• Anesthetics/administration & dosage
• Anesthetics/adverse effects
• Anesthetics/therapeutic use
• Remifentanil/administration & dosage
• Remifentanil/therapeutic use
• Remifentanil/adverse effects
• Tramadol/therapeutic use
• Tramadol/administration & dosage
• Tramadol/adverse effects

• adverse reactions
• etomidate-propofol mixture
• gastroscopy
• hemodynamics
• sedation

• Adverse events
• Dexmedetomidine
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Ketamine
• Propofol
• Sedation

• Performance and complications
• Quality and logistical aspects
• Sedation and monitoring

• Balloon-assisted endoscopy
• Diazepam
• Propofol
• Sedation

• Humans
• Aged
• Propofol
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Retrospective Studies
• Hypnotics and Sedatives
• Diazepam

• 20K17050 to KM Japan Society for the Promotion of Science

• Anesthesia
• Esketamine
• Gastroscopy
• Meta-analysis
• Propofol

• adverse events
• endoscopy
• patient safety
• performance measures
• quality assessment

This study aimed to test the effect of different doses of intravenous lidocaine on the median effective dose (ED50) and 95% effective dose (ED95) of propofol-induction dose and identify the optimal dose.

Patients undergoing first-trimester uterine aspiration were screened and randomly enrolled into the following groups: saline (L₀), 0.5 mg/kg lidocaine (L_0.5), 1.0 mg/kg lidocaine (L_1.0), and 1.5 mg/kg lidocaine (L_1.5). Anesthesia was induced with 1.0 µg/kg fentanyl. Prepared lidocaine or saline solution was injected later according to allocation, followed by propofol. The dose of propofol for each patient was determined using the up-and-down sequential study design. The primary end point was the ED50 and ED95 of the propofol-induction dose. The total propofol doses, awakening time, and adverse events were recorded.

The ED50 (95% confidence interval) of propofol was significantly lower in groups L_1.0 and L_1.5 than group L₀ (1.6 [1.5–1.7] mg/kg and 1.8 [1.6–1.9] mg/kg, versus 2.4 [2.3–2.5] mg/kg, respectively; p<0.001). There was no significant difference in ED50 between groups L_1.0 and L_1.5 (p>0.05). However, surprisingly, the ED50 was significantly higher in group L_0.5 than L₀ (2.8 [2.6–3.0] mg/kg vs 2.4 [2.3–2.5] mg/kg; p<0.05). The total doses of propofol in groups L_1.0 and L_1.5 were lower than those in groups L₀ and L_0.5 (p<0.05). The systolic blood pressure (SBP) decline after anesthesia induction in group L_0.5 was greater than that in group L₀ (p<0.01). The incidence of respiratory depression in group L_0.5 was greater than that in groups L₀ and L_1.0 (p<0.05).

In patients who underwent first-trimester uterine aspiration, intravenous lidocaine 1.0 mg/kg prior to propofol injection significantly reduced the ED50 of propofol induction dose without severe side effects, equivalent to the effect of 1.5 mg/kg dose. We recommend 1.0 mg/kg as the optimal dose.

• Anesthetics, Intravenous
• Double-Blind Method
• Female
• Fentanyl
• Humans
• Lidocaine/pharmacology
• Pregnancy
• Pregnancy Trimester, First
• Propofol
• Prospective Studies
• Saline Solution

• Bispectral Index monitoring
• Endoscopic ultrasound
• Remifentanil
• Target-controlled infusion

• Alfentanil/adverse effects
• Analgesics, Opioid
• Anesthetics, Intravenous
• Humans
• Piperidines/adverse effects
• Propofol/adverse effects
• Remifentanil
• Retrospective Studies
• Ultrasonography, Interventional

• Endoscopic retrograde cholangiopancreatography
• High-flow nasal cannula
• Hypoxia
• Propofol sedation

• Aged
• Cannula
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Humans
• Hypoxia/etiology
• Hypoxia/prevention & control
• Oxygen
• Oxygen Inhalation Therapy/methods
• Prospective Studies

• CiteSpace
• VOSviewer
• bibliometric analysis
• co-citation analysis
• endoscopic sedation
• hot spots

The best candidate intravenous anesthetic agent for patients with liver cirrhosis undergoing endoscopic variceal ligation (EVL) remains unclear. Remimazolam tosilate (RT) is a new type of benzodiazepine with quick onset, rapid recovery, and no accumulation. Here, we investigated the efficacy and safety of RT for general anesthesia in cirrhotic patients undergoing EVL.

Patients undergoing EVL were randomly classified into the remimazolam tosilate (group R) and the propofol group (group P). RT was administered as a slow bolus of 0.2 mg/kg for induction and followed by 1.0–2.0 mg/kg/h for maintenance of general anesthesia. Propofol was started at 2 mg/kg, followed by 4–10 mg/kg/h until the end of surgery. Flumazenil was routinely administered to group R and the same volume of saline was given to group P immediately after surgery. The efficacy and safety of RT for general anesthesia during EVL were compared with propofol.

All patients in the two groups had satisfactory anesthetic effects and the efficacy rates were 100%. The time to loss of consciousness (LoC) was longer in group R than in group P (P > 0.05). The return of consciousness (RoC) time, extubation time, and transfer time in group R were significantly shorter than that in group P (P < 0.05). The incidence of intraoperative hypotension and postoperative low SpO₂ in group R were lower than that in the group P (P < 0.05). There were no significant differences between the two groups with respect to the satisfaction degree of patients and operators (P > 0.05).

Remimazolam tosilate can provide satisfactory anesthetic effects for surgery. Group R patients recovered faster and had a shorter PACU stay time than group P patients. Moreover, RT decreased the incidence of hypotension and low SpO₂. RT was a safer and more effective alternative for general anesthesia in cirrhotic patients undergoing EVL than propofol.

• Shandong Provincial Medical Association

The aim of the series of papers on controversies of biliopancreatic drainage procedures is to discuss the pros and cons of the varying clinical practices and techniques in ERCP and EUS for drainage of biliary and pancreatic ducts. The first part focuses on indications, clinical and imaging prerequisites before ERCP, sedation options, post-ERCP pancreatitis (PEP) prophylaxis, and other related technical topics. In the second part, specific procedural ERCP-techniques including precut techniques and its timing as well as management algorithms are discussed. In addition, controversies in EUS-guided bile duct and pancreatic drainage procedures are under preparation.

• EUS
• bile stones
• magnet resonance cholangiopancreaticography
• pancreaticolithiasis
• primary sclerosing cholangitis
• tumor

• Endoscopy
• Medium chain triglyceride
• Pain
• Propofol

• gastroenterological endoscopy
• patient monitoring
• pre-sedative assessment
• sedation
• training

Current evidence supporting the utility of electromagnetic (EM)-guided method as the preferred technique for post-pyloric feeding tube placement is limited. We conducted a meta-analysis to compare the performance of EM-guided versus endoscopic placement.

We searched several databases for all randomised controlled trials evaluating the EM-guided vs. endoscopic placement of post-pyloric feeding tubes up to 28 July 2020. Primary outcome was procedure success rate. Secondary outcomes included reinsertion rate, number of attempts, placement-related complications, tube-related complications, insertion time, total procedure time, patient discomfort, recommendation scores, length of hospital stay, mortality, and total costs.

Four trials involving 536 patients were qualified for the final analysis. There was no difference between the two groups in procedure success rate (RR 0.97; 95% CI 0.91–1.03), reinsertion rate (RR 0.84; 95% CI 0.59–1.20), number of attempts (WMD − 0.23; 95% CI − 0.99–0.53), placement-related complications (RR 0.78; 95% CI 0.41–1.49), tube-related complications (RR 1.08; 95% CI 0.82–1.44), total procedure time (WMD − 18.09 min; 95% CI − 38.66–2.47), length of hospital stay (WMD 1.57 days; 95% CI − 0.33–3.47), ICU mortality (RR 0.80; 95% CI 0.50–1.29), in-hospital mortality (RR 0.87; 95% CI 0.59–1.28), and total costs (SMD − 1.80; 95% CI − 3.96–0.36). The EM group was associated with longer insertion time (WMD 4.3 min; 95% CI 0.2–8.39), higher patient discomfort level (WMD 1.28; 95% CI 0.46–2.1), and higher recommendation scores (WMD 1.67; 95% CI 0.24–3.10).

No significant difference was found between the two groups in efficacy, safety, and costs. Further studies are needed to confirm our findings.

PROSPERO (CRD42020172427)

The online version contains supplementary material available at 10.1186/s40560-020-00506-8.

• Electromagnetic
• Endoscopy
• Enteral nutrition
• Post-pyloric feeding tube

Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine the existence of associations between these events and potentially related variables.

This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age > 18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support.

The most frequently encountered adverse event was oxygen desaturation < 95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation < 90% followed, with incidences of 19.2, 12.64, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P = 0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P = 0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, 95% confidence interval: 2.83 to 36.99) more likely to experience oxygen desaturation < 90% events.

Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with acceptable rates of adverse events and could be more widely adopted in clinical practice.

• Anaesthesia, intravenous
• Anaesthesiologists
• Deep sedation
• Endoscopy
• Gastrointestinal
• Propofol

• Gastrointestinal endoscopy
• Greece
• practice patterns
• questionnaire
• sedation

Although endoscopy is a less invasive procedure than surgery, patients can experience pain without sedation. Patients expect reduced pain during endoscopies from effective and safe sedatives. Midazolam and propofol are used for endoscopic sedation in many countries and regions. Midazolam is a widely available benzodiazepine, and many clinical trials have shown it to be an effective sedative. However, patients who are sedated with midazolam require rest in the recovery room due to its relatively long half-life, and an antagonist such as flumazenil may need to be administered in cases of deep or prolonged sedation. Propofol is a short-acting sedative with a short half-life and a quick recovery time. Therefore, the use of propofol has been increasing. However, propofol has a narrow margin of safety and often induces adverse effects such as respiratory depression. Also, propofol has no specific antagonist, and should be administered by an anesthesiologist or an endoscopist familiar with anesthesia. Remimazolam, which is a novel ultra-short-acting benzodiazepine, has recently gained attention. Remimazolam has a short half-life and an antagonist. Both effective and safe sedation is desired in accordance with the increasing need for sedative endoscopies. Therefore, in this review each sedative is summarized.

• Gastrointestinal endoscopy
• Conscious sedation
• Propofol
• Midazolam
• Remimazolam
• Benzodiazepine

Propofol is commonly used for sedation during endoscopic procedures. Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved post-procedure recovery times for patients. However, Propofol requires administration by trained healthcare providers, has a narrow therapeutic index, lacks an antidote and increases risks of cardio-pulmonary complications.

To compare, through a systematic review of the literature and meta-analysis, sedation with propofol to traditional sedatives with or without propofol during endoscopic procedures.

A literature search was performed using MEDLINE, Scopus, EMBASE, the Cochrane Library, Scopus, LILACS, BVS, Cochrane Central Register of Controlled Trials, and The Cumulative Index to Nursing and Allied Health Literature databases. The last search in the literature was performed on March, 2019 with no restriction regarding the idiom or the year of publication. Only randomized clinical trials with full texts published were included. We divided sedation therapies to the following groups: (1) Propofol versus benzodiazepines and/or opiate sedatives; (2) Propofol versus Propofol with benzodiazepine and/or opioids; and (3) Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and opioid. The following outcomes were addressed: Adverse events, patient satisfaction with type of sedation, endoscopists satisfaction with sedation administered, dose of propofol administered and time to recovery post procedure. Meta-analysis was performed using RevMan5 software version 5.39.

A total of 23 clinical trials were included (n = 3854) from the initial search of 6410 articles. For Group I (Propofol vs benzodiazepine and/or opioids): The incidence of bradycardia was not statistically different between both sedation arms (RD: -0.01, 95%CI: −0.03–+0.01, I²: 22%). In 10 studies, the incidence of hypotension was not statistically difference between sedation arms (RD: 0.01, 95%CI: −0.02–+0.04, I²: 0%). Oxygen desaturation was higher in the propofol group but not statistically different between groups (RD: −0.03, 95%CI: −0.06–+0.00, I²: 25%). Patients were more satisfied with their sedation in the benzodiazepine + opioid group compared to those with monotherapy propofol sedation (MD: +0.89, 95%CI: +0.62–+1.17, I²: 39%). The recovery time after the procedure showed high heterogeneity even after outlier withdrawal, there was no statistical difference between both arms (MD: -15.15, 95%CI: −31.85–+1.56, I²: 99%). For Group II (Propofol vs propofol with benzodiazepine and/or opioids): Bradycardia had a tendency to occur in the Propofol group with benzodiazepine and/or opioid-associated (RD: -0.08, 95%CI: −0.13–−0.02, I²: 59%). There was no statistical difference in the incidence of bradycardia (RD: -0.00, 95%CI: −0.08–+0.08, I²: 85%), desaturation (RD: −0.00, 95%CI: −0.03–+0.02, I²: 44%) or recovery time (MD: -2.04, 95%CI: −6.96–+2.88, I²: 97%) between sedation arms. The total dose of propofol was higher in the propofol group with benzodiazepine and/or opiates but with high heterogeneity. (MD: 70.36, 95%CI: +53.11–+87.60, I²: 61%). For Group III (Propofol with benzodiazepine and opioid vs benzodiazepine and opioid): Bradycardia and hypotension was not statistically significant between groups (RD: -0.00, 95%CI: −0.002–+0.02, I²: 3%; RD: 0.04, 95%CI: −0.05–+0.13, I²: 77%). Desaturation was evaluated in two articles and was higher in the propofol + benzodiazepine + opioid group, but with high heterogeneity (RD: 0.15, 95%CI: 0.08–+0.22, I²: 95%).

This meta-analysis suggests that the use of propofol alone or in combination with traditional adjunctive sedatives is safe and does not result in an increase in negative outcomes in patients undergoing endoscopic procedures.

• Sedation
• Digestive endoscopy
• Propofol
• Benzodiazepines
• Opioids
• Adverse events

• Adverse events
• Propofol
• exacerbated symptoms
• immunosuppressive medications
• systemic lupus erythematosus

• Propofol
• anesthesiology
• balanced propofol sedation
• endoscopic retrograde cholangiopancreatography
• endoscopy
• moderate sedation

• gastrointesinal endoscopy

• Consciousness Monitors
• Deep Sedation
• Endoscopy
• Humans
• Randomized Controlled Trials as Topic

• Cognitive recovery
• EncephalApp
• endoscopy
• propofol
• sedation

• Propofol
• gastrointestinal endoscopy
• sedative agents

• Grant-in-Aid for Scientific Research
• MEXT-Supported Program for the Strategic Research Foundation

• Zenker's diverticulum
• dysphagia
• pharyngeal pouch

• DBE
• advanced endoscopy
• anaesthesia
• device assisted enteroscopy
• double balloon enteroscopy
• elderly
• propofol
• safety
• sedation

• Colonoscopy
• Perforation
• Propofol sedation
• Risk

• Alcohol
• Endoscopic submucosal dissection
• Esophageal cancer
• Midazolam
• Propofol
• Sedation