微信互动辅助全程护理模式对提高门诊儿童镇静检查依从性和安全性的价值分析

观察微信互动辅助全程护理模式对提高门诊儿童镇静检查依从性和安全性。方法 我院门诊2022年6月-2023年6月收治的58例镇静检查儿童为本次研究对象,按照检查期间是否行微信互动辅助全程护理模式均分为对照组(常规全程护理模式)与实验组(微信互动辅助全程护理模式),比较两组患者护理效果。结果 两组儿童镇静检查护理前心率、血压等生命指征数据差异不明显(P>0.05),实验组儿童检查护理后心率、血压等生命指征以及平均检查耗时镇均低于对照组,此外,实验组儿童一次性成功率以及镇静检查中Frankl依从量表中4分百分率以及儿童家长对镇静检查护理满意度(93.10%)均高于对照组,数据差异明显(P<0.05)。结论 门诊儿童镇静检查中微信互动辅助全程护理模式可有效提升儿童检查依从性和安全性。

咪唑安定在镇静性胃镜检查中的临床研究

目的探讨咪唑安定在镇静性胃镜检查中的镇静效果、安全性及可行性.方法将1 05例病人随机分为两组,1组45例,静注咪唑安定0.08mg/kg;11组60例,静注咪唑安定0.1mg/kg.观察用药前、术中及术后的血氧饱和度、心率的变化:记录病人的镇静情况及术中的不适反应:了解病人术后对胃镜检查的感受.结果两组病人用药后的血氧饱和度及心率无明显改变.咪唑安定的镇静作用有明显的剂量依赖性,用量因人而异,部分病人出现恶心、呕吐、躁动等不良反应.咪唑安定有顺行性的遗忘作用,术后遗忘率达1 00%.结论咪唑安定在胃镜检查中的镇静作用增加了病人对胃镜检查的耐受性,减轻了恐惧感,但用药前必须严格掌握其适应症.

胃镜检查前应用镇静剂的临床观察与护理

目的:比较胃镜检查前注射地西泮与未给药的不同反应。方法:将200例胃镜检查者随机分为Ⅰ组100例,静脉缓慢注射地西泮注射液10～20mg;Ⅱ组100例常规操作不给药,观察各组反应及检查前后血压、心率的变化。结果:Ⅰ组患者检查反应优于Ⅱ组,检查前后血压、心率加快。结论:检查前注射较大剂量地西泮,不仅减少患者对检查的恐具感,增加患者的依从性,减少并发症,而且为操作者带来方面,即安全又可靠,值得推广。

心理护理干预在镇静结肠镜检查术中的效果观察

目的观察心理护理干预在镇静结肠镜检查术中的临床效果。方法 100例接受镇静结肠镜检查术的患者,随机分为对照组与观察组,各50例。对照组患者实施常规护理,观察组患者在对照组基础上增加心理护理干预。比较两组患者护理前后的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分及护理满意度。结果护理前,两组患者的SAS、SDS评分比较,差异均无统计学意义(P>0.05);护理后,观察组患者的SAS、SDS评分均低于对照组,差异具有统计学意义(P<0.05)。观察组患者的护理满意度为96.00%,高于对照组的72.00%,差异具有统计学意义(P<0.05)。结论镇静结肠镜检查术患者在常规护理的基础上实施心理护理干预,能缓解患者的不良情绪,提高患者的护理满意度,值得临床推广。

PDCA护理管理在普通病房患儿检查镇静中的效果观察

分析运用PDCA护理管理模式对普通病房患儿检查镇静的效果影响。方法 将计划、实施、检查、处理(PDCA)护理管理模式运用于普通病房患儿检查镇静治疗。将2020年5月1日至2020年6月30日病房检使用镇静治疗患儿为对照组(115例)。2020年9月1日至2020年10月31日病房检查使用镇静治疗患儿为实验组(101例),通过对镇静药物使用调整、灌肠时机及方法改进、睡眠剥夺时间的延长等方式方法的改进,比较两组患儿一次性镇静失败率。结果 实施质量管理循环体系(PDCA)后镇静失败率由47.83%降低到20.97%,差异有统计学意义(P0.01)。结论 基于质量管理循环体系(PDCA)的镇静给药方式能有效提高普通病房患儿镇静检查前的镇静效果。

Superiority of split dose midazolam as conscious sedation for outpatient colonoscopy

AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A (n = 40) received a split dose of midazolam in combination with meperidine. Group B (n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. RESULTS: Group A had a lower frequency of significant hypoxemia (P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B (P = 0.043). Group B recovered from sedation slightly sooner than group A (P < 0.002). Scores for pain and memory, except insertion-related memory, were lower in group A one week after colonoscopic examination (P = 0.018 and P < 0.030, respectively). Poor patient controllability was noted by the endoscopist and nurse in group B (P = 0.038 and P = 0.032, respectively). CONCLUSION: Split dose midazolam in combination with meperidine resulted in a safer, more equable sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.

Usefulness of bispectral monitoring of conscious sedation during endoscopic mucosal dissection

AIM: To assess the usefulness of bispectral index (BIS) monitoring in order to carry out endoscopic submucosal dissection (ESD) safely and with patients' satisfaction. METHODS: Three hundred sixty-six patients with an early-stage neoplasm of the digestive tract were enrolled. The BIS monitor (A-1050: Aspect medical systems/NIHON KOHDEN, Tokyo, Japan) was used. The appropriate sedative condition was set at 55 to 75 BIS levels (BIS value) during the endoscopic procedures. RESULTS: Among 366 cases, 13 were accompanied by adverse events during and/or after ESD. All episodes occurred in cases with BIS value between 56 and 65. Hypotension was observed in four cases, and bradycardia in six. Respiratory distress was observed in two cases with chronic pulmonary obstructive disease. All patients with adverse events were able to leave the hospital without extension of the hospitalization. CONCLUSION: BIS monitoring is useful to safely perform ESD. A BIS value of 70 to 75 is suitable for ESD.

Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy

AIM:To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy;BDE) with sedation is different from those without sedation in terms of quantity,duration and typical onset time.METHODS:Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups:EGD without sedation (Group A) and BDE with sedation (Group B).The use of sedation was based on the patients' request.Anesthesiologists participated in this study by administrating sedative drugs as usual.A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients.The incidence,duration and onset time of hiccups were measured in both groups.In addition,the association between clinical variables and hiccups were analyzed.RESULTS:A total of 435 patients were enrolled in the study.The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%,respectively).The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio:8.79,P < 0.001) after adjustment.The incidence of hiccups in males under sedation was high (67.4%).The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028).The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018).CONCLUSION:Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation.Midazolam was significantly associated with an increased risk of hiccups.Furthermore,patients with GERD are prone to develop hiccups.

Safety and effectiveness of propofol sedation during and after outpatient colonoscopy

AIM:To study the safety and effectiveness of propofol sedation for outpatient colonoscopy.METHODS:Propofol was given by bolus injection with an age-adjusted standard protocol consisting of 60 mg for patients < 70 years old,40 mg for patients age 70-89 years,and 20 mg for those ≥ 90 years,and additional injections of 20 mg propofol were given up to a maximum of 200 mg.The principal parameters were the occurrence of adverse events within 24 h after colonoscopy and overall satisfaction for this procedure.Secondary parameters included successful procedure,respiratory depression,and other complications.RESULTS:Consecutive patients were entered prospectively and all 2101 entered successfully completed outpatient colonoscopy.The mean dose of propofol used was 96.4 mg(range 40-200 mg).Younger patients required higher doses of propofol than older patients(20-40 years vs ≥ 61 years:115.3 ± 32 mg vs 89.7 ± 21 mg,P < 0.001).Transient supplemental oxygen supply was needed by five patients(0.2%);no other complications occurred.The questionnaires were completed by 1820(87%) of 2101 patients and most rated their overall satisfaction as excellent(80%) or good(17%).The majority(65%) of patients drove home or to their office after their colonoscopy.Most(99%) were willing to repeat the same procedure.No incidents occurred within 24 h after colonoscopy.CONCLUSION:Propofol sedation using a dose < 200 mg proved both safe and practical for outpatient colonoscopy.

study to determine guidelines for pediatric colonoscopy

To investigated characteristics, diagnosis, bowel-cleansing preparation, sedation, and colonoscope length and diameter in Japanese pediatric patients receiving total colonoscopy. METHODSThe present study evaluated consecutive patients aged ≤ 15 years who had undergone their first colonoscopy in Kurume University between January 2007 and February 2015. Data were retrospectively analyzed. We identified 110 pediatric patients who had undergone colonoscopy that had reached the cecum, allowing the observation of the total colon. RESULTSHematochezia, abdominal pain, and diarrhea were the most common symptoms. For bowel-cleansing preparation, pediatric patients aged ≤ 12 years were treated with magnesium citrate, and patients aged 13-15 years were treated with polyethylene glycol 4000. For sedation, thiamylal with pentazocine, which has an analgesic effect, was used in patients aged ≤ 6 years, and midazolam with pentazocine was used in patients aged ≥ 7 years. Regarding the choice of endoscope, short and thin endoscopes were selected for younger patients, particularly patients aged ≤ 3 years. Positive diagnoses were made in 78 patients (70.9%). Inflammatory bowel disease (n = 49, 44.5%), including ulcerative colitis (n = 37, 33.6%) and Crohn’s disease (n = 12, 10.9%), was the most common diagnosis. CONCLUSIONColonoscopy offers a high diagnostic capability for pediatric patients with gastrointestinal symptoms. The selection of appropriate management the performance of colonoscopy is important in pediatric patients.

High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.

Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures:A three year prospective study

AIM： To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS： In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus （0.5-1.5 mg/kg）. Arterial blood pressure （BP） was monitored at 3 rain intervals and heart rate and oxygen saturation （SpO2） were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS： A statistically significant reduction in mean arterial pressure was demonstrated （P〈0.001） when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60mmHg, was noted in only 5 patients （0.5%）. Oxygen saturation decreased from 96.5% to 94.4 % （P〈0.001）. A critical decrease in oxygen saturation （〈90%） was documented in 27 patients （2.4%）. CONCLUSION： Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effelts if carefully titrated. All the patients （and especially ASA Ⅲ group） require monitoring and care of an anesthesiologist.

Conscious or unconscious:The impact of sedation choice on colon adenoma detection

AIM: To determine if anesthesiologist-monitored useof propofol results in improved detection of adenomaswhen compared with routine conscious sedation. METHODS: This retrospective study was conductedat two separate hospital-based endoscopy units whereapproximately 12 000 endoscopic procedures are permed annually, with one endoscopy unit exclusivelyusing anesthesiologist-monitored propofol. Three thousand two hundred and fifty-two patients underwent initial screening or surveillance colonoscopies. Our primaryend point was the adenoma detection rate, def ined asthe number of patients in whom at least one adenomawas found, associated with the type of sedation. RESULTS: Three thousand two hundred and fi ftytwooutpatient colonoscopies were performed by fi ve selected endoscopists. At least one adenoma was detected in 27.6% of patients (95% CI = 26.0-29.1) with no difference in the detection rate between the anesthes-ologist propofol and group and the gastroenterologist-midazolam/fentanyl group (28.1% vs 27.1%, P = 0.53). CONCLUSION: The type of sedation used during colonoscopy does not affect the number of patients in whom adenomatous polyps are detected.

How to improve patient satisfaction during midazolam sedation for gastrointestinal endoscopy?

To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODSWe prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction.RESULTSThe study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group.CONCLUSIONMidazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.

Posterior lingual lidocaine: A novel method to improve tolerance in upper gastrointestinal endoscopy

AIM: To evaluate the effect of posterior lingual lidocaine swab on patient tolerance to esophagogastro-duodenoscopy, the ease of performance of the procedure, and to determine if such use will reduce the need for intravenous sedation. METHODS: Eighty patients undergoing diagnostic esophagogastroduodenoscopy in a tertiary care medical center were randomized to either lidocaine swab or spray. Intravenous meperidine and midazolam were given as needed during the procedure. RESULTS: Patients in the lidocaine swab group (SWG) tolerated the procedure better than those in the spray group (SPG) with a median tolerability score of 2 (1, 4) compared to 4 (2, 5) (P < 0.01). The endoscopists encountered less diffi culty performing the proceduresin the SWG with lower median difficulty scores of 1 (1, 5) compared to 4 (1, 5) in the SPG (P < 0.01). In addition, the need for intravenous sedation was also lower in the SWG compared to the SPG with fewer patients requiring intravenous sedation (13/40 patients vs 38/40 patients, respectively, P < 0.01). The patients in the SWG were more satisfi ed with the mode of local anesthesia they received as compared to the SPG. In addition, the endoscopists were happier with the use of lidocaine swab. CONCLUSION: The use of a posterior lingual lidocaine swab in esophagogastroduodenoscopy improves patient comfort and tolerance and endoscopist satisfaction and decreases the need for intravenous sedation.

Listening to Turkish classical music decreases patients’anxiety,pain,dissatisfaction and the dose of sedative and analgesic drugs during colonoscopy:A prospective randomized controlled trial

AIM： To determine whether listening to music decreases the requirement for dosages of sedative drugs, patients＇ anxiety, pain and dissatisfaction feelings during colonoscopy and makes the procedure more comfortable and acceptable. METHODS： Patients undergoing elective colonoscopy between October 2005 and February 2006 were randomized into either listening to music （Group 1, n = 30） or not listening to music （Group 2, n = 30）. Anxiolytic and analgesic drugs （intravenous midazolam and meperidine） were given according to the patients＇ demand. Administered medications were monitored. We determined their levels of anxiety using the State-Trait Anxiety Inventory Test form. Patients＇ satisfaction, pain, and willingness to undergo a repeated procedure were self-assessed using a visual analog scale. RESULTS： The mean dose of sedative and analgesic drugs used in group 1 （midazolam： 2.1 ± 1.4, meperidine： 18.1 ± 11.7） was smaller than group 2 （midazolam： 2.4 ± 1.0, meperidine： 20.6 ± 11.5）, but without a significant difference （P 〉 0.05）. The mean anxiety level in group 1 was lower than group 2 （36.7 ± 2.2 vs 251.0 ± 1.9, P 〈 0.001）. The mean satisfaction score was higher in group 1 compared to group 2 （87.8 ± 3.1 vs 58.1 ± 3.4, P 〈 0.001）. The mean pain score in group i was lower than group 2 （74.1 ± 4.7 vs 39.0 ± 3.9, P 〈 0.001）. CONCLUSION： Listening to music during colonoscopy helps reduce the dose of sedative medications, as well as patients＇ anxiety, pain, dissatisfaction during the procedure. Therefore, we believe that listening to music can play an adjunctive role to sedation in colonoscopy. It is a simple, inexpensive way to improve patients＇ comfort during the procedure.

Carbon dioxide insufflation during colonoscopy in deeply sedated patients

AIM:To compare the impact of carbon dioxide(CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure.Both the colonoscopist and patient were blinded to the type of gas used.During the procedure,insertion and withdrawal times,caecal intubationrates,total sedation given and capnography readings were recorded.The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale(VAS)(0-3).Patients then graded their level of discomfort and abdominal bloating using a similar VAS.Complications during and after the procedure were recorded.RESULTS:A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm.Mean age between the two study groups were similar.Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air(P = 0.0083).The average withdrawal times were not significantly different between the two groups.Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively(P = 0.012).The level of discomfort assessed by the nurse was 0.69(air) and 0.39(CO2)(P = 0.0155) and by the patient 0.82(air) and 0.46(CO2)(P = 0.0228).The level of abdominal bloating was 0.97(air) and 0.36(CO2)(P = 0.001).Capnography readings trended to be higher in the CO2 group at the commencement,caecal intubation,and conclusion of the procedure,even though this was not significantly different when compared to readings obtained during air insufflation.There were no complications in both arms.CONCLUSION:CO2 insufflation during colonoscopy is more efficacious than air,allowing quicker and better cecal intubation rates.Abdominal discomfort and bloating were significantly less with CO2 insufflation.