• EUS
• midazolam
• pentazocine
• pethidine hydrochloride
• sedation

• endoscopy
• gastrointestinal
• midazolam
• propensity score
• remimazolam

• Hepatocellular carcinoma
• Interventional radiology
• Non-anesthesiologist administration of propofol
• Radiofrequency ablation
• Sedation

• Humans
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/diagnostic imaging
• Propofol/administration & dosage
• Male
• Female
• Liver Neoplasms/surgery
• Liver Neoplasms/diagnostic imaging
• Aged
• Radiofrequency Ablation/methods
• Middle Aged
• Hypnotics and Sedatives/administration & dosage
• Aged, 80 and over
• Radiology, Interventional/methods
• Adult
• Conscious Sedation/methods
• Retrospective Studies

• Humans
• Anesthetics, Intravenous/adverse effects
• Anesthetics, Intravenous/administration & dosage
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Etomidate/adverse effects
• Etomidate/administration & dosage
• Propofol/adverse effects
• Propofol/administration & dosage
• Treatment Outcome

• Colonoscopy
• Endoscopy
• Patient comfort

• 1S82223N Research Foundation Flanders
• 1SHD924N Research Foundation Flanders
• Bijzonder Onderzoeksfonds-Fonds Klinisch Onderzoek

• bis
• endoscopic retrograde cholangiopancreatography (ercp)
• monitored anesthesia care
• procedural sedation and analgesia
• tci

• Quality standards
• Sedation
• Upper gastrointestinal endoscopy

• Elderly patients
• Lidocaine
• Median effective dose
• Painless gastroscopy
• Propofol

• 4237 Project of discipline construction of "Summit Plan"

• Deep sedation
• Gastroscopy
• Moderate sedation
• Older patients

• Humans
• Aged
• Gastroscopy/methods
• Hypnotics and Sedatives
• Propofol
• Outpatients
• Deep Sedation/adverse effects
• Deep Sedation/methods
• Conscious Sedation/methods

• Hypoxemia
• anesthesia
• colonoscopy
• machine learning
• outpatient
• prediction

• Humans
• Outpatients
• Anesthesia
• Sleep Apnea, Obstructive
• Colonoscopy
• Machine Learning
• Hypoxia/etiology

• Humans
• Gastroenterology
• Endoscopy, Gastrointestinal
• Gastrointestinal Tract
• Metabolic Diseases

• endoscopy ercp
• etomidate
• haemodynamic parameters
• intravenous sedation
• monitored anaesthesia care
• propofol based sedation

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

Objective: Propofol is the most widely administered intravenous anesthetic to induce deep sedation for gastroscopy procedures. Coadministration of nalbuphine can provide analgesia and sedation to patients experiencing visceral pain, thereby decreasing the amount of propofol needed and reducing the risk of propofol-induced adverse events. We carried out this study to determine the median effective dose (ED50) of propofol in combination with different dosages of nalbuphine and the optimal dosage of nalbuphine during painless gastroscopy.

Methods: We recruited sixty-five patients aged 18–60 years who underwent elective painless gastroscopy. A total of sixty-one patients were allocated randomly to the N1 group (nalbuphine 0.1 mg/kg) or N2 group (nalbuphine 0.15 mg/kg). Three minutes after administration of nalbuphine, patients received a preset dose of propofol at 2.0 mg/kg with a dose gradient of 0.2 mg/kg according to Dixon’s “up-and-down” method. The primary outcome was the ED50 of propofol in combination with nalbuphine. Hemodynamic parameters, recovery time, pain score, and adverse events were recorded as secondary outcomes.

Results: The ED50 of propofol in the N2 group was significantly lower than that observed in the N1 group (p < 0.01). Using probit analysis, the ED50 and ED95 of propofol were 1.632 mg/kg and 2.759 mg/kg in the N1 group and 1.111 mg/kg and 2.243 mg/kg in the N2 group, respectively. The incidence of hypotension in the N2 group was lower than that in the N1 group (p < 0.05), and the recovery time was shorter than that of the N1 group (p < 0.05).

Conclusion: In adult patients, 0.15 mg/kg nalbuphine led to a significant reduction in the ED50 and ED95 of propofol during gastroscopy. This dose of nalbuphine also reduced the incidence of hypotension and shortened the recovery time. Therefore, nalbuphine (0.15 mg/kg) combined with propofol is a safe option for enhancing recovery after painless gastroscopy in adult patients.

Clinical Trial Registration: [https://www.chictr.org.cn/edit.aspx?pid=126699&htm=4], identifier [ChiCTR2100053204].

• Anesthesia/adverse effects
• Anesthesia/methods
• Anesthesiology
• Anesthetics
• Endoscopy
• Endoscopy, Gastrointestinal/adverse effects
• Gastrointestinal Tract
• Humans

• Propofol
• ambulatory
• drug combination
• gastrointestinal endoscopic procedures

• Anesthesia
• Conscious Sedation/adverse effects
• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/methods
• Female
• Hospitals
• Humans
• Hypnotics and Sedatives/adverse effects
• Male
• Midazolam
• Middle Aged
• Propofol/adverse effects

Catheter ablation for atrial fibrillation (AF) or left atrial tachycardia is well established. To avoid body movement and pain, sedative and analgesic agents are used.

The aim was to investigate safety of sedation/anti-pain protocol administered by electrophysiology (EP) staff.

A total of 3211 consecutive patients (61% male) undergoing left atrial ablation for paroxysmal AF (37.1%), persistent AF (35.3%) or left atrial tachycardia (27.6%) were included. Midazolam, fentanyl, and propofol were administered by EP staff. In case of respiratory depression, endotracheal intubation (eIT) or noninvasive ventilation (NIV) was implemented. Risk factors for eIT or NIV were analyzed.

Mean doses of propofol, midazolam, and fentanyl were 33.7 ± 16.7 mg, 3 ± 11.1 mg, and 0.16 ± 2.2 mg, respectively. Norepinephrine was administered in 396 of 3211 patients (12.3%) because of blood pressure drop (mean arterial pressure <60 mm Hg). NIV was necessary in 47 patients (1.5%) and eIT in 1 patient (0.03%). Procedure duration, high body mass index (BMI), high CHADS₂-VASC₂ score, high age, low glomerular filtration rate, diabetes mellitus, and low baseline oxygen saturation were associated with NIV or eIT. The only independent predictor for NIV/eIT was high BMI (>30.1 ± 9.0 kg/m²). Therefore, patients with a BMI of ≥30 had a 40% higher risk for the need of NIV/eIT during the procedure in our study.

Sedation/anti-pain control including midazolam, propofol, and fentanyl administered by EP staff is safe, with only 1.53% requirement of NIV/eIT. High BMI (>30 kg/m²) emerged as an independent predictor for eIT/NIV.

• Cirrhosis
• Diagnostic accuracy
• HVPG
• Portal hypertension
• Sedation

• Endoscopy
• Medium chain triglyceride
• Pain
• Propofol

• anesthesia
• dezocine
• fentanyl gastrointestinal endoscopy
• meta-analysis

• Adult
• Aged
• Analgesics, Opioid/administration & dosage
• Anesthetics, Intravenous/administration & dosage
• Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
• Drug Therapy, Combination
• Endoscopy, Gastrointestinal/adverse effects
• Female
• Fentanyl/administration & dosage
• Humans
• Male
• Middle Aged
• Pain, Postoperative/prevention & control
• Propofol/administration & dosage
• Randomized Controlled Trials as Topic
• Tetrahydronaphthalenes/administration & dosage
• Treatment Outcome

• Hypnotic
• procedural sedation
• remimazolam
• sedative
• soft drug

• adults
• effective dose
• propofol mono-sedation
• upper gastrointestinal endoscopy

Sedation in gastrointestinal endoscopy is rapidly evolving worldwide. However, this has led to significant disagreements, especially regarding the use of propofol by non-anesthesiologists. The aim of this study was to document the practices of Greek gastroenterologists regarding sedation and compare them to previous surveys.

The study was conducted in 2 periods, December 2015 and June 2018. In each period, the same online questionnaire regarding endoscopic sedation practices was sent to all registered Greek gastroenterologists (509 and 547 gastroenterologists, respectively).

The response rates were 38.3% and 47.1%, respectively. In each period, 25.1% and 16.7% of physicians did not use sedation. Most gastroenterologists (approx. 70% in both instances) answered that they “almost never” collaborate with an anesthesiologist during endoscopy. Midazolam was by far the most popular sedation agent, used by almost 90% of physicians in both periods. Propofol was used by 30.8% and 27% of physicians, respectively. Physicians using propofol were significantly more satisfied with the sedation than other physicians, while propofol was the agent selected by most physicians if they were to undergo endoscopy themselves. Most physicians cited medicolegal reasons and inadequate training as chief reasons for not using propofol.

Sedation use is widespread among Greek gastroenterologists. Although midazolam is the most commonly used agent, propofol is preferred (theoretically) by most physicians and achieves the best satisfaction. The introduction of a strict training curriculum for endoscopic sedation can effectively eliminate the barriers preventing gastroenterologists from administering propofol, while at the same time ensuring optimal patient safety during endoscopy.

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

• Conscious sedation
• Laparoscopy
• Minimally invasive surgery

• Adult
• Aged
• Anesthesia, Obstetrical
• Conscious Sedation/methods
• Female
• Gynecologic Surgical Procedures/methods
• Humans
• Laparoscopy/methods
• Middle Aged
• Retrospective Studies

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

• Apnea
• CPAP
• Non-invasive ventilation
• Respiratory depression
• Respiratory monitoring
• Sedation

• Adult
• Cannula
• Colonoscopy
• Conscious Sedation
• Humans
• Propofol
• Respiration
• Ventilators, Mechanical

• Adult
• Aged
• Cannula
• Emergence Delirium/epidemiology
• Female
• Gastroscopy/methods
• Humans
• Hypnotics and Sedatives/adverse effects
• Hypoxia/chemically induced
• Hypoxia/epidemiology
• Hypoxia/prevention & control
• Intraoperative Complications/epidemiology
• Intraoperative Complications/prevention & control
• Male
• Middle Aged
• Oxygen Inhalation Therapy/methods
• Propofol/adverse effects
• Respiratory Insufficiency/chemically induced
• Respiratory Insufficiency/epidemiology
• Severity of Illness Index

• arousal
• obstructive sleep apnea
• propofol
• sedation
• sleep-disordered breathing

• Aged
• Aged, 80 and over
• Arousal/physiology
• Dose-Response Relationship, Drug
• Female
• Humans
• Hydrocortisone/biosynthesis
• Male
• Middle Aged
• Polysomnography
• Propofol/administration & dosage
• Propofol/pharmacology
• Prospective Studies
• Respiration
• Sleep Apnea Syndromes/physiopathology

• anesthesia
• etomidate
• gastroscopy
• meta-analysis
• propofol

• Anesthetics, Combined/administration & dosage
• Anesthetics, Combined/adverse effects
• Anesthetics, Combined/therapeutic use
• Anesthetics, Intravenous/adverse effects
• Anesthetics, Intravenous/therapeutic use
• Arterial Pressure/drug effects
• China/epidemiology
• Etomidate/administration & dosage
• Etomidate/adverse effects
• Etomidate/therapeutic use
• Female
• Gastroscopy/methods
• Humans
• Hypoxia/chemically induced
• Injection Site Reaction/pathology
• Male
• Myoclonus/chemically induced
• Nausea/chemically induced
• Propofol/administration & dosage
• Propofol/adverse effects
• Propofol/therapeutic use
• Randomized Controlled Trials as Topic
• Risk
• Vomiting/chemically induced

Propofol-mediated sedation is safe and clearly associated with increased patient satisfaction. However, whether it results in a favorable effect on colonoscopy outcomes and performance compared to standard sedation with benzodiazepines/opiates remains unclear.

To determine the effect of propofol-mediated sedation on colonoscopy-quality measures compared to traditional sedation.

A large cohort of 44,794 patients who had undergone sedated colonoscopies were included. Colonoscopy-quality indicators were examined in benzodiazepine/opiate-sedated patients and compared with a propofol-mediated sedation group. Adjustment for potential confounders, such as age, sex, quality of bowel preparation, procedural setting, and indication was performed.

Patients who received propofol-mediated sedation were more likely, and in a dose-dependent manner, to have an enhanced polyp-detection rate (22.8% vs 20.9%, P<0.001), cecal intubation rate (90.4% vs 87.3%, P<0.001), and terminal ileum-intubation rate (6.4% vs 1.6%, P<0.001). On multivariate analysis, these findings were maintained, as propofol-mediated sedation use was significantly associated with improved colonoscopy indicators.

Propofol-mediated sedation during colonoscopy is associated with better examination performance and improved outcomes. Further prospective or randomized trials to support these findings are warranted.

• cecal intubation rate
• colonoscopy
• polyp-detection rate
• propofol-mediated sedation
• quality indicators

• Complications
• endoscopic submucosal dissection
• esophageal cancer
• propofol sedation
• stomach cancer

• endoscopy
• liver cirrhosis
• midazolam
• pre‐endoscopy sedation
• propofol

• Cognitive recovery
• EncephalApp
• endoscopy
• propofol
• sedation

• children
• endoscopies
• non-anesthesiologist administered propofol
• safety
• sedation

• anaesthesia, complications
• gastrointestinal endoscopy
• sedation

• Propofol
• gastrointestinal endoscopy
• sedative agents

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

• Colonoscopy
• adenoma detection rate (ADR)
• colonoscopy completion rate (CCR)
• indicators
• quality