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Introduction: Throat soreness is a frequently encountered yet often underappreciated complication in patients undergoing gastroscopy. Few studies have explicitly explored the relationship between gastroscopy and throat soreness. This study aimed to review demographic data, summarize the characteristics, and investigate the influencing factors of throat soreness following gastroscopy. Methods: This cross-sectional descriptive study included inpatients who underwent painless gastroscopy at The First Affiliated Hospital of Shandong First Medical University between December 2023 and January 2024. The analysis focused on patient demographics, duration of fasting before gastroscopy, the procedure's duration, the occurrence of vomiting post-gastroscopy, sore severity, and recovery time. Results: A total of 254 patients underwent painless gastroscopy during the study period, and 123 patients experienced postoperative throat soreness (71 males, 52 females) with an average age of 57.2 years. When comparing the throat soreness and non-soreness groups, significant differences were noted in the duration of gastroscopy and fasting time before the examination. No statistically significant differences were observed in age, BMI, comorbidities, history of smoking, alcohol consumption, previous gastroesophageal surgery, reflux esophagitis, or post- procedure vomiting. Logistic regression analysis identified the duration of gastroscopy as a predictor of throat soreness post-procedure. Most of the patients reported resolution of throat soreness within 3 days. Discussion: The findings of this study confirm that throat soreness is a common issue (the incidence was 48.4%) following gastroscopy, particularly associated with longer duration of gastroscopy. Fortunately, all instances of throat soreness resolved within a few days without the need for significant medical intervention. [ABSTRACT FROM AUTHOR]

Traditional sedatives like Propofol can lead to adverse effects. This study compares the safety and efficacy of Ciprofol monotherapy versus combined Propofol for painless gastroscopy. Patients underwent painless gastroscopy at our hospital from January 2023 to December 2023 were studied. Sedation quality, adverse events, patient satisfaction, cognitive function, pain, anxiety, gastrointestinal side effects, and endoscopic quality and so on was recorded and assessed. A retrospective analysis was conducted on patients undergoing painless gastroscopy from January to December 2023. Participants (n = 200) were categorized into Ciprofol (n = 102) and Combined Propofol (n = 98) groups. The Ciprofol group exhibited longer sedation onset (4.35 ± 1.71 min) but significantly quicker recovery (12.64 ± 4.54 min) compared to the combined group. Adverse events of nausea (2.94% vs 10.20%, p = 0.037) and vomiting (1.96% vs 9.18%, p = 0.025) were less frequent in the Ciprofol group, although satisfaction scores were similar between groups. Cognitive function, pain, anxiety levels and gastrointestinal side effects was comparable. Endoscopy quality measures showed no significant differences. Cyclophenol monotherapy is a viable alternative to combine Propofol, offering a reduced incidence of adverse effects and quicker recovery without compromising procedure quality or cognitive outcomes. [ABSTRACT FROM AUTHOR]

Yanxia Guo,&ast; Zhihua Yao,&ast; Yan Feng, Dan Wang, Yizheng Wang, Jingyan Lin Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jingyan Lin, Email linjingyan@nsmc.edu.cnBackground: The novel short-acting benzodiazepine drug, remimazolam tosilate, has been employed for sedation during endoscopic procedures. The optimal loading dosage of remimazolam tosilate in gastroscopy for elderly patients when co-administered with fentanyl remains unclear. Therefore, the primary objective of our research was to ascertain the median effective dose (ED50) and the 95% effective dose (ED95) of remimazolam tosilate in combination with various fentanyl dosages for elderly patients undergoing painless gastroscopy.Methods: Seventy-five patients aged ≥ 65 years and American Society of Anesthesiologists (ASA) class I–III were recruited to undergo elective painless gastroscopy. All patients were randomized assigned to group F1, group F2, and group F3, and were injected intravenously with different doses of fentanyl (0.5 ug/kg, 1 ug/kg, and 1.5 ug/kg) 3 minutes prior to the administration of remimazolam tosilate, respectively. The initial preset dose of remimazolam tosilate was 0.3 mg/kg in group F1, 0.2 mg/kg in group F2, 0.15 mg/kg in group F3. The dose gradient was 0.02 mg/kg per group according to the up-and-down sequential method. Probibt regression model was employed to determine the ED50 and ED95 of remimazolam tosilate.Results: The ED50 of remimazolam tosilate in group F3 was lower than that in group F1 and F2 (0.095 [0.088– 0.108] mg/kg vs 0.162 [0.153– 0.171] mg/kg; 0.258 [0.249– 0.266] mg/kg, p < 0.05). The ED95 of remimazolam tosilate was 0.272 mg/kg (95% CI: 0.264– 0.295 mg/kg) in group F1, 0.175 mg/kg (95% CI: 0.167– 0.200 mg/kg) in group F2 and 0.109 mg/kg (95% CI: 0.101– 0.135 mg/kg) in group F3. The total dosage of remimazolam tosilate decreased gradually with the increasing of fentanyl (p < 0.001). The frequency of injection pain was higher in group F1 compared to groups F2 and F3 (p < 0.05). The patients in group F3 had a lower incidence of hypotension than in groups F1 and F2 (p < 0.05). There was no respiratory depression, intraoperative consciousness, dizziness or delirium in the three groups.Conclusion: The concurrent use of fentanyl reduces the dosage of remimazolam tosilate required for sedative gastroscopy in elderly patients in a dose-dependent manner. Moreover, 1.5 ug/kg fentanyl combined with remimazolam tosilate may reduce the incidence of hypotension and injection pain. These findings should be confirmed in a large-scale study.Keywords: painless gastroscopy, elderly patients, median effective dose, fentanyl, remimazolam tosilate

Objective: To explore the application effect of different doses of remifentanil combined with remifentanil in painless gastroscopy in children. Methods: 165 pediatric patients who underwent painless gastroscopy from May 2023 to November 2023 were selected as the study subjects. They were randomly divided into four groups using a random number table method, namely R1 (n=40), R2 (n=40), R3 group (n=40), and Matched group (n=45). Patients in the Matched group were intravenously injected with 2 mg/kg propofol and 7% fentany l μg/kg, R1, R2, R3 groups intravenous injection of fentanyl 7 μg/kg and Remazolam, R1 group Remazolam is 0.2 mg/kg. The R2 group is 0.3 mg/kg, and the R3 group is 0.4 mg/kg. Gastroscopy should be performed when all patients have improved alertness/calmness (MOAA/S) scores ≤ 1. Compare the success rate of sedation, onset time of sedation, awakening time, gastroscopy examination time, and number of times of remedial sedation among four groups of children. Evaluate the degree of sedation using MOAA/S scores before administration, after initial administration, before endoscopy, and immediately after examination. Record the changes in heart rate, blood pressure, oxygen saturation, heart rate (HR), and blood oxygen saturation (SpO2) of the four groups of children before anesthesia induction (T0), at entry (T1), and after anesthesia induction (T2), Finally, compare the incidence of adverse reactions among the four groups of children. Results: There was no difference in the recovery time and gastroscopy examination time among the four groups of patients(P>0.05). The success rate of sedation in the R3 group was higher than that in the R1 group, R2 group, and Matched group. The onset time of sedation and the number of times of remedial sedation were lower than those in the R1 group, R2 group, and Matched group (P<0.05); There was no difference in MOAA/S scores among the four groups of patients before administration and immediately after examination(P>0.05). After the first administration and before endoscopy, the MOAA/S scores of R3 group patients were lower than those of R1 group, R2 group, and Matched group (P<0.05); There was no change in blood oxygen saturation (SpO2) levels and heart rate (HR) levels at T0, T1, and T2 time in the four groups of patients, and there was no difference between the four groups(P>0.05). The HR levels of patients in the T2 and R3 groups were stable, but there were fluctuations between the R1 and R2 groups and the Matched group. The T1 and R3 group was lower than the R1 and R2 groups and the Matched group (P<0.05); The incidence of adverse reactions such as injection pain, laryngeal spasm, hypoxemia, hypotension, and bradycardia in patients in R1, R2, and R3 groups was lower than that in the Matched group (P<0.05), but there was no difference in the comparison of R1, R2, and R3 groups(P>0.05). Conclusion: The combination of Remazolam and Alfentanil can improve the sedative effect during gastroscopy in children, and Remazolam at a dose of 0.4 mg/kg is more effective. It can further improve the success rate of sedation, reduce the number of times of remedial sedation, and do not increase the awakening time. The sedative effect is better, and it can stabilize the heart rate level during the examination of children, with higher safety. [ABSTRACT FROM AUTHOR]

Abstract Background Intravenous lidocaine could be a potential alternative adjuvant to propofol-based sedation for gastroscopy in elderly patients. This study aimed to evaluate the effect of intravenous lidocaine on the median effective dose (ED50) of propofol induction dose in elderly patients undergoing painless gastroscopy. Methods The study included 70 patients aged ≥ 60 years undergoing painless gastroscopy with 64 randomly assigned to either group L (2% lidocaine 1.5 mg/kg, n = 31) or group N (equal volume normal saline, n = 33). All patients received propofol induction following 0.1 μg/kg intravenous sufentanil. The Dixon “up-and-down” sequential method was used, with a 1.5 mg/kg initial induction dose of propofol followed by a 0.1 mg/kg sequential variable dose. The primary endpoint was the ED50 of the propofol induction dose. The total propofol dose, recovery time, adverse events, and local anesthetic intoxication reactions were also recorded. Results The ED50 of propofol induction dose was 0.670 (95% confidence interval [CI] 0.216–0.827) mg/kg in group L and 1.118 (95% CI 0.803–1.232) mg/kg in group N. There was a statistically significant difference between the two groups (p

Background: Intravenous lidocaine could be a potential alternative adjuvant to propofol-based sedation for gastroscopy in elderly patients. This study aimed to evaluate the effect of intravenous lidocaine on the median effective dose (ED50) of propofol induction dose in elderly patients undergoing painless gastroscopy. Methods: The study included 70 patients aged ≥ 60 years undergoing painless gastroscopy with 64 randomly assigned to either group L (2% lidocaine 1.5 mg/kg, n = 31) or group N (equal volume normal saline, n = 33). All patients received propofol induction following 0.1 μg/kg intravenous sufentanil. The Dixon "up-and-down" sequential method was used, with a 1.5 mg/kg initial induction dose of propofol followed by a 0.1 mg/kg sequential variable dose. The primary endpoint was the ED50 of the propofol induction dose. The total propofol dose, recovery time, adverse events, and local anesthetic intoxication reactions were also recorded. Results: The ED50 of propofol induction dose was 0.670 (95% confidence interval [CI] 0.216–0.827) mg/kg in group L and 1.118 (95% CI 0.803–1.232) mg/kg in group N. There was a statistically significant difference between the two groups (p < 0.001). The incidence of hypotension and propofol injection pain were lower in group L than in group N (p < 0.05). Furthermore, the orientation recovery time in group L was shorter compared to group N (p < 0.05). None of the participants in group L observed local anesthetic intoxication reactions after receiving lidocaine. Conclusions: The administration of intravenous lidocaine to elderly patients undergoing painless gastroscopy resulted in a significant 40% reduction in the ED50 of propofol induction dose, which may be related to the decreased incidence of hypotension and injection pain, as well as the improved post-gastroscopy orientation recovery. Trial registration: ChiCTR, ChiCTR2200065530. Registered on 08 November 2022. [ABSTRACT FROM AUTHOR]

Objective: To compare and analyze the application effects of propofol/etomidate mixture in combination with Esketamine and sufentanil hydrochloride in painless gastroscopy. Methods: 80 patients admitted to our hospital for painless gastroscopy from January 2022 to December 2022 were selected as study subjects, and the random number table method was applied to divide all patients into observation group and control group, 40 cases in each group. The patients in the control group were anesthetized intravenously with propofol/etomidate mixture + sufentanil hydrochloride, and the patients in the observation group were anesthetized intravenously with propofol/etomidate mixture + esketamine, and the hemodynamic parameters were compared between the two groups at five different times: basal values at the time of admission (T1), at the beginning of sedation (T2), after gastroscopy insertion (T3), after enteroscopy insertion (T4), and immediately after the operation (T5). The hemodynamic parameters were compared with the onset of anesthesia, the number of additional anesthetics, the total amount of additional anesthetics, the time of recovery of consciousness, and the time of PACU stay, and the cognitive function and the incidence of adverse effects at different times. Results: There was no significant difference in the comparison of diastolic blood pressure (SBP), systolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) at T1 time between the two groups (P>0.05), and there was no significant difference in the comparison of SBP, DBP, MAP, and HR at T1, T2, T3, T4, and T5 time between the same groups of patients in the observation group (P>0.05), and the comparison of SBP, DBP, MAP, and HR at T1 to T2 time in the control group, MAP, and HR levels decreased in the control group from T1 to T2 time, increased to T3 and T4 time, and restored smoothly at T5 time, and there were significant differences in the comparison of SBP, DBP, and MAP levels in the observation group compared with the control group at T2, T3, and T4 time, and the HR in the observation group was lower than that in the control group at T3 time(P<0.05); The onset of anesthesia, the number of additional anesthetics, the total amount of additional anesthetics, the time of recovery of consciousness, and the time of PACU stay in the observation group were significantly lower than those in the control group (P<0.05); The S100B protein in the two groups increased significantly at 6 hours after examination, and the S100B protein gradually decreased at 1 days after examination, and the observation group was lower than the control group. Melatonin significantly decreased at 6 hours after examination, and the melatonin gradually increased at 1 days after examination, and the observation group was higher than the control group(P<0.05); The incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05). Conclusion: Propofol/etomidate mixture combined with Esketamine and propofol/etomidate mixture combined with sufentanil hydrochloride has a significant anesthetic effect on painless gastrointestinal endoscopy, can improve the fluctuation of hemodynamic parameters in patients, reduce the number of additional anesthetic drugs, and have a rapid onset of anesthesia, good quality of recovery, in addition, can further improve the cognitive function of patients after examination, with high safety. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of remimazolam vs propofol for children undergo⁃ ing painless gastroscopy. Methods A total of 129 children aged 4 ~ 9 years, ASAⅠ-Ⅱ, BMI 18 - 30 kg/m², scheduled for painless gastroscopy under intravenous general anesthesia were divided into two groups by random number table method: remimazolam group (R group) and propofol group (P group). Anesthesia was induced with sufentanil 0.2 µg/kg and penehyclidine hydrochloride 0.01 mg/kg. The patients in R group was given 0.5 mg/kg remimazolam and in P group was given 0.3 mg/kg propofol. The success rate of completing painless gastroscopy, heart rate, blood pressure, pulse oxygen saturation, sedation score, narcotrend index were recorded. The onset time, recovery time of orientation and adverse reactions were observed. Results The success rate of sedation in R group and P group was 82.8% and 90.8% respectively, with no statistically difference (P > 0.05). At the time of endoscopic insertion and the end of endoscopic operation, the narcotrend index value of R group was 84.7 ± 10.8, 86.4 ± 4.3, respectively, which was significantly higher than that of P group (58.9 ± 13.2 and 66.2 ± 5.0)(P < 0.05). The postoperative recovery time of R group was (14.2 ± 6.9) min, which was lower than that of P group (23.8 ± 6.7) min (P < 0.05). The incidence of injection pain in R group and P group was respectively 10.9% and 52.3%, with statisti⁃ cally significant difference(P < 0.05). And the other adverse reactions were not statistically significant (P > 0.05). Conclusion Both remimazolam and propofol could be safely and effectively used gastroscopy for children, and remimazolam made patients wake up quickly with a lower incidence of injection pain. [ABSTRACT FROM AUTHOR]

Objective: To observe the Effective dose and safety of different doses of alfentanil combined with propofol in painless gastroscopy. Method: 240 patients who underwent painless gastric examination from January 2021 to December 2021 were randomly divided into a control group and a different dose group of alfentanil (N1 group, N2 group, N3 group, N4 group, and N5 group, with injection doses of 5, 6, 7, 8, and 10ug/kg, respectively) using a number table method, with 40 patients in each group. The control group was anesthetized with propofol injection, while different dosage groups of alfentanil were anesthetized with different doses of alfentanil combined with propofol. Evaluate the anesthesia effect after the examination is completed. Compare the heart rate (HR), systolic blood pressure (SBP), apnea time, incidence of intolerance to gastroscopy insertion, and adverse reactions in each group. Result: Compared with before administration, SBP and HR in all groups decreased before gastroscopy placement (P<0.01); At 1 minute after gastroscopy insertion, both SBP and HR in the control group increased (P<0.01), while SBP in the N3 and N4 groups decreased (P<0.01), while HR remained unchanged (P>0.05). Both SBP and HR in the N5 group decreased (P<0.01). Compared with before gastroscopy insertion, SBP and HR in the control group, N1, N2, and N3 groups increased 1 minute after gastroscopy insertion (P<0.01), while there was no significant change in SBP and HR in the N4 and N5 groups (P>0.05). The apnea time of different dosage groups of alfentanil was lower than that of the control group (P<0.01), and the apnea time of N5 group was higher than that of N1 group, N2 group, N3 group, and N4 group (P<0.01). There was no significant difference in the Incidence of intolerant reactions during gastroscopy insertion, cough reaction, retching reflex, swallowing reflex and limb movement reaction rate between the six groups (P>0.05); There was no statistically significant difference in the incidence of itching, nausea, vomiting, anxiety, dizziness, drowsiness, diarrhea, and constipation after painless gastroscopy examination among the six groups (P>0.05). Conclusion: The combination of 8ug/kg alfentanil and propofol has a definite anesthesia effect, stable respiratory and circulatory system, and low incidence of adverse reactions when used for painless gastroscopy. [ABSTRACT FROM AUTHOR]

Longbin Zheng,1,&ast; Yiteng Wang,2,&ast; Qing Ma,1,&ast; Wenbo Liang,1 Xiaojing Zhang,1 Zhiqiang Ren,1 Weimin Qin,1 Fan Meng,1 Yuhong Li,1 Guoxiang Fan,1 Ning Yin1 1Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China; 2Department of Anesthesiology, Xinchang County People’s Hospital, Xinchang, Zhejiang Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ning Yin, Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, No. 109 Longmian Avenue, Nanjing, Jiangsu Province, 211112, People’s Republic of China, Email yinning882000@126.comPurpose: Patients with obesity are more susceptible to hypoxemia. Anesthetic management for patients with obesity undergoing painless gastroscopy presents a severe challenge for anesthesiologists. Esketamine is a NMDA antagonist that has been proven to be beneficial for ameliorating respiratory depression owing to its sympathomimetic effect; however, there are no relevant reports on its use in patients with obesity. We designed a randomized controlled trial to evaluate whether esketamine can be the ideal adjuvant to propofol sedation in patients with obesity undergoing painless gastroscopy.Patients and Methods: A total of 104 patients with obesity undergoing painless gastroscopy were randomly divided into group C (propofol+saline) and group S (propofol+esketamine 0.25 mg/kg). Anesthesia was induced by 2 mg/kg propofol with saline or esketamine. The consumption of propofol, hemodynamic parameters, duration of procedure, induction time, postoperative awakening time, and orientation recovery time were recorded. Adverse events and satisfaction scores were also recorded.Results: Propofol consumption was 274.4± 22.6 mg and 201.3± 16.6 mg in groups C and S, respectively. The induction time of groups C and S were 25.4± 2.3 s and 17.8± 1.9 s, respectively. The postoperative awakening times of groups C and S were 6.2± 1.1 min and 4.8± 1.3 min, respectively. Hemodynamic parameters were more stable in group S than in group C. The incidence of adverse events such as injection pain, hypoxemia, hypotension, bradycardia, choking, and body movement were significantly lower in group S. The satisfaction scores of the endoscopist and anesthesiologist were (4.58± 0.49 vs 3.71± 0.83) and (4.75± 0.44 vs 3.33± 0.92), respectively.Conclusion: The combination of propofol and esketamine (0.25 mg/kg) improves the safety and reduces the incidence of adverse events in patients with obesity during painless gastroscopy. Thus, this method is worthy of clinical application.Clinical Trials Registration: ChiCTR 2200062547.Keywords: esketamine, propofol, patients with obesity, painless gastroscopy

Abstract Background This study aims to investigate the effect of preoperative sleep quality on the target plasma concentration of propofol and postoperative sleep in patients undergoing painless gastroscopy. Methods Ninety-three outpatients aged 45 to 64 years with body mass index (BMI) of 18.5–30 kg/m2 and ASA grades of I or II, who underwent painless gastroscopy, were selected. All patients were evaluated by the Athens insomnia scale (AIS) before the painless gastroscopy. The patients were divided into two groups according to the AIS score evaluated before painless gastroscopy: normal sleep group (group N, AIS score 6 points, 46 cases). The target-controlled infusion (TCI) of propofol (Marsh model) was used for general anesthesia, the Bispectral index (BIS) was used to monitor the depth of anesthesia, and the BIS was maintained between 50 and 65 during the painless gastroscopy. The target plasma concentration (Cp) of propofol was recorded when the patient’s eyelash reflex disappeared (T1), before the painless gastroscopy (T2), at the time of advancing the gastroscope (T3) and during the painless gastroscopy (T4), and the infusion rate per body surface area of propofol was calculated. The patient’s AIS score was followed up by telephone at day 1, day 3, 1 week, and 1 month after the painless gastroscopy to assess the postoperative sleep of the patient. The occurrence of adverse reactions during the painless gastroscopy was recorded; the patient’s satisfaction and the endoscopist’s satisfaction with the anesthesia effect were compared between the two groups. Results Compared with group N, the Cp at each time point and the infusion rate per body surface area of propofol in group D was increased significantly (P 0.05). There were no statistically significant differences in the occurrence of adverse reactions and the patient’s satisfaction and the endoscopist’s satisfaction with the anesthesia effect between the two groups (P > 0.05). Conclusion The preoperative sleep disturbance will increase the Cp and the infusion rate per body surface area of propofol in patients undergoing painless gastroscopy. Propofol only affects the patients’ sleep for day 1 after the painless gastroscopy. Trial registration Chinese Clinical Trial Registry (ChiCTR2100045332) on 12/04/2021.

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BACKGROUND: Studies have reported that certain adverse reactions can occur during painless gastroscopy examination. Knowing how to decrease the risks and incidence of adverse reactions is of great importance. OBJECTIVE: To investigate whether topical pharyngeal anesthesia combined with intravenous anesthesia is superior to intravenous anesthesia alone in patients undergoing painless gastroscopy and to determine whether this combined approach had any additional benefits. METHODS: Three hundred patients undergoing painless gastroscopy were randomly assigned to either the control group or the experimental group. In the control group, patients were anesthetized with propofol, while patients in the experimental group received propofol combined with 2% lidocaine spray for topical pharyngeal anesthesia. Hemodynamic parameters before and after the procedure, including the heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SPO 2) were recorded. Any adverse reactions experienced by the patient, including choking and respiratory depression, and the total dosage of propofol required during each procedure were also documented. RESULTS: Compared with pre-anesthetic data, the HR, MAP, and SPO 2 were reduced after the completion of the painless gastroscopy procedure in both groups. However, the HR, MAP, and SPO 2 measurements taken after the gastroscopy were significantly lower in the control group than those of the experimental group (P < 0.05); thus, the hemodynamic parameters of the experimental group were more stable. Compared with the control group, there was significant reduction in the total amount of propofol administered in the experimental group (P < 0.05). The incidence of adverse reactions, including choking and respiratory depression, was significantly lower in the experimental group (P < 0.05). CONCLUSION: The results demonstrated that the application of topical pharyngeal anesthesia in painless gastroscopy can significantly reduce the incidence of adverse reactions. Thus, the combination of topical pharyngeal and intravenous anesthesia is worthy of clinical application and promotion. [ABSTRACT FROM AUTHOR]

IntroductionObese patients who undergo painless gastroscopy are particularly prone to suffer from upper airway obstruction, respiratory depression, and subsequent hypoxemia. Despite adequate preoxygenation, the incidence of hypoxemia remains high. Recently, inspiratory muscle training (IMT) has been considered to be a promising strategy to increase respiratory muscle strength and endurance with the attendant improvement of pulmonary function. However, it remains unclear whether IMT is associated with a lower rate of hypoxemia in obese patients during this sedative procedure. This study aims to investigate the effectiveness of IMT used in obese patients who are scheduled for selective painless gastroscopy.Methods and analysisThis prospective, randomized controlled trial (RCT) will enroll 232 obese patients with a body mass index (BMI) of 35–39.9 kg·m−2 who undergo painless gastroscopy at the First Affiliated Hospital of Xiamen University. Subjects will be randomly assigned to two groups with a 1:1 ratio. Participants in both groups will receive IMT for 4 weeks prior to gastroscopy. The intervention group will receive IMT with a load of 30% of the maximal inspiratory pressure (Pi(max)) in the first week, with an increase of 10% per week since the following week, while the counterparts in the control group will not receive any load during the 4-week IMT. The primary outcome is the incidence of hypoxemia during painless gastroscopy. Secondary outcomes include the need for airway maneuvers, blood pressure changes, sleep quality assessment, pro-inflammatory cytokines levels, and monitoring of adverse events.DiscussionsThe outcomes of this study will offer invaluable guidance for the clinical implementation of IMT as a potential non-invasive preventive measure. Additionally, it stands to enrich our comprehension of anesthesia management and airway-related challenges in obese patients undergoing procedural sedation, which we anticipate will further contribute to addressing the turnaround concerns within high-volume, swiftly paced ambulatory endoscopy centers.Ethics and disseminationThis study has been approved by the Ethics Committee of the First Affiliated Hospital of Xiamen University (2022, No.091). The results will be submitted for publication in peer-reviewed journals.Trial registration numberChina Clinical Trial Center (ChiCTR2200067041).

Abstract The number of smoking patients receiving anesthesia and surgical treatment is increasing day by day. It will be useful for medical advancement to explore whether smoking is an independent risk factor for postoperative cognitive impairment. A double‐blind, parallel, and controlled study was conducted on 112 patients who fulfilled the criteria for inclusion in this study and planned to undergo painless gastroscopy under general anesthesia. The baseline mini‐mental state examination (MMSE) scores and basic information were collected. The changes in the MMSE scores after waking up and 3 days after anesthesia were observed, and the adverse events (respiratory adverse reactions, circulatory fluctuations, and adverse reactions, drug use, etc.) were analyzed by logistic regression. The baseline level of each group is consistent, which is worth studying. The MMSE score of the smoking group after anesthesia was significantly different from that of the control group (p

OBJECTIVE: To probe into application effect of remazolam toluenesulfonate combined with remifentanil on painless gastroscopy in elderly patients. METHODS: A total of 90 elderly patients underwent painless gastroscopy in the endoscopy center of Taizhou People’ s Hospital from Aug. 2020 to Aug. 2022 were enrolled and divided into P group, R1 group and R2 group via random number table method. Three groups were firstly given remifentanil hydrochloride 0. 5 μg / kg intravenously; then the P group was given propofol 1. 5 mg / kg intravenously for anesthesia, the R1 group was given remazolam toluenesulfonate 0. 15 mg / kg intravenously for anesthesia, and the R2 group wasgiven remazolam toluenesulfonate 0. 2 mg / kg intravenously for anesthesia. The sedation onset time, awakening time, modified alertness/ sedation scale (MOAA/ S) score after 2 minutes of drug administration and the number of remedial sedation were compared among the three groups, the hemodynamic indicators [heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO2)], were recorded before surgery (T0), at 1 min after administration (T1), at the time of endoscopic insertion (T2), at the end of the examination (T3) and at the time of awakening from anesthesia (T4), the incidence of adverse drug reactions during and after surgery were counted. RESULTS: Compared with P group, patients in R1 group and R2 group had longer sedation onset time but shorter awakening time, with statistically significant differences (P<0. 05), while the difference between R1 group and R2 group was not statistically significant (P>0. 05). There was no statistically significant difference in the MOAA/ S sedation scores among the three groups at 2 min after drug administration (P>0. 05). The incidence of remedial sedation (additional sedative drugs ≥1 time) and the mean number of drug additions were higher in R1 group and R2 group than those in P group, with statistically significant differences (P<0. 05), while the difference between R1 group and R2 group was not statistically significant (P>0. 05). The HR and MAP from T1 to T4 and SpO2 at T1 to T2 were higher in R1 group and R2 group than those in P group, with statistically significant differences (P<0. 05), while the difference between R1 group and R2 group was not statistically significant (P>0. 05). Compared with P group, the incidences of hypotension, hypoxemia and injection pain were reduced in R1 group, and the incidence of injection pain was reduced in R2 group, with statistically significant differences (P < 0. 05). CONCLUSIONS: The 0. 15 mg / kg remazolam toluenesulfonate combined with 0. 25 μg / mg remifentanil for painless gastroscopy in elderly patients is safer while ensuring the anesthetic effect. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of low-dose esketamine on sleep quality in elderly patients undergoing painless gastroscopy. Methods: A total of 84 patients (ASA grade II - III, > 65 years old) who were to undergo painless gastroscopy in Guanggu District, Wuhan Third Hospital from June to July 2021 were enrolled. The diagnosis of sleep disorder was performed using Pittsburgh Sleep Quality Index (PSQI) before surgery. Patients with PSQI ≥ 5 were diagnosed with a sleep disorder (group E, n = 42), while those with PSQI < 5 were normal (group C, n = 42). Patients in both groups were given a single intravenous injection of esketamine 0.2 mg/kg 3 min before anesthesia induction, followed by an intravenous loading dose of propofol 1.5 mg/kg. Maintenance of anesthesia was achieved by intravenous pumping with propofol at 4 mg/kg per hour. Results: Sleep quality of patients in both groups improved after surgery, but the PSQI scores decreased more than that of group E (p < 0.05), especially on the night after surgery. Compared with group C, anesthesia induction time was longer and the number of propofol supplementation was increased in group E (p < 0.05). Groups C and E manifested no significant differences in postoperative satisfaction and occurrence of adverse reactions (p > 0.05). Conclusion: Low-dose esketamine improves the sleep quality of elderly patients with painless gastroscopy without increasing the risk of circulating breathing during surgery. However, multi-center large-scale studies will be required in further investigations in order to validate the findings of this study. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of remazolam besylate and propofol in painless gastroscopy in elderly patients. Methods A total of 80 elderly patients undergoing painless gastroscopy from January to July 2021 in this hospital were randomly divided into the observation group and the control group, with 40 cases each. Fentanyl was injected intravenously for analgesia pretreatment in both groups,propofol in-jection was given to the control group and remazolam besylate injection was given to the observation group. The changes of vital signs, time of eyelash reflex disappearing, time of recovery and leaving room, sedative effect during operation, postoperative pain score and incidence of adverse effects were compared between the two groups. Results The fluctuation of vital signs in the observation group was lower than that in the control group,the time of eyelash reflex disappearing, awakening and leaving hospital in the observation group were significantly lower than those in the control group, the sedation effect and postoperative pain score in the observation group were better than those in the control group, and the incidence of adverse reaction in the observation group was lower than that in the control group, and the differences were statistically significant (P< 0. 05). Conclusion Compared with propofol, remazolam besylate has higher efficacy and safety, and lower incidence of adverse reactions. [ABSTRACT FROM AUTHOR]

Purpose: Gastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. Remazolam besylate, a new type of ultrashort-acting benzodiazepine drug, has been less studied in gastroscopy. In this study, we studied the efficacy and safety of remazolam combined with propofol for painless gastroscopy., Design: This was a single-center, placebo-controlled randomized trial., Methods: One hundred patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups (n = 50 per group): the control group (Con group) and the remazolam group (Rem group). Sufentanil, remazolam, and propofol were used to anesthetize the patients, and then, the effects of different solutions on these patients were compared and analyzed. The patient's general condition, vital signs at different times, the dosage of propofol (mg) and additional times, complications, duration of gastroscopy (minutes), recovery time (minutes), length of stay in the recovery room (minutes), and adverse reactions were recorded., Findings: Rem group systolic blood pressure was more stable (P < .05). The amount of additional propofol in Rem group was less (P < .05). The incidence of hypotension, bradycardia, and dizziness was lower in Rem group, as well as the time of awakening and stay in the recovery room were shorter (P < .05)., Conclusions: Remazolam combined with sufentanil and propofol has less effect on hemodynamics in painless gastroscopy, and the patients have shorter awakening times., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Copyright of Nursing of Integrated Traditional Chinese & Western Medicine is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To observe and compare the incidence of cough among patients with post-infection cough undergoing painless gastroscopy．Methods Seventy-one patients with post-infection cough undergoing painless gastroscopy were enrolled and randomly divided into two groups．The observation group (34 cases) received budesonide nebulization before gastroscopy and the control group (37 cases) was performed gastroscopy directly.We observed the incidence of cough at different time point and the changes of circulationduring the operation. Results The incidence of cough between the observation group and the control group showed statistically significant differences(P<0.01) . The changes of circulation showed statistical differences between two groups in the process of gastroscopy(P<0.05)．Conclusion Budesonide nebulization supplying can decrease the incidence of post-infection cough among patients undergoing painless gastroscopy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of continuous Infusion of propofol and etomidate mixture in painless gastroscopy anesthesia. Methods: 120 patients who were treated with painless, selected gastrointestinal endoscopy were collected From September 2012 to February 2015 in our hospital and were equally divided into the treatment group of 60 patients and the control group of 60 patients. The patients in control group were received propofol auxiliary continuous infusion anesthesia, and the patients of the treatment group were received propofol and etomidate mixture assisted continuous infusion anesthesia. Results: All patients were completed the examination. The MAP and HR values at 2 min after the administration in two groups compared with before administration were statistically significant differences (P <0.05). but no difference was detectable between two groups. The above values for the remaining time in the group and between the two groups showed no significant difference (P> 0.05). The induction time and time away from the hospital in the treatment group were significantly less than that of the control group (P <0.05). while the examination time and wake time were no statistically significant between two groups (P> 0.05). After treatment, the nausea, vomiting, dizziness, skin itching and other complications in the treatment group were significantly less than those of the control group (P <0.05). Conclusions: Continuous infusion anesthesia of propofol and etomidate mixture in painless gastroscopy has less hemodynamic effect, and it can promote the effect of anesthesia and reduce the incidence of adverse reactions, worthy of promotion and applications in clinic. [ABSTRACT FROM AUTHOR]

Copyright of Nursing of Integrated Traditional Chinese & Western Medicine is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Painless gastroscopy is a widely used diagnostic and therapeutic technology in clinical practice. Propofol combined with opioids is a common drug for painless endoscopic sedation and anaesthesia. In clinical work, adverse drug reactions of anaesthesia schemes are often one of the important areas of concern for doctors and patients. With the increase in propofol dosage, the risk of serious adverse drug reactions, such as respiratory depression and hypotension, increases significantly; the use of opioids often causes gastrointestinal reactions in patients after examination, such as nausea, vomiting, delayed recovery of gastrointestinal function and other complications, which seriously affect their quality of life., Aim: To observe the effect of wrist-ankle acupuncture therapy on the anaesthesia regimen and anaesthesia-related complications during and after painless gastroscopy examination., Methods: Two hundred patients were selected and randomly divided into a treatment group ( n = 100) and a control group ( n = 100). Both groups were routinely anaesthetized with the nalbuphine and propofol regimen, gastroscopy began after the patient lost consciousness, and given supportive treatment and vital sign monitoring. If the patient interrupted the surgery due to intraoperative torsion, intravenous propofol was used to relieve his or her discomfort. The treatment group received wrist-ankle acupuncture on this basis., Results: The general data before treatment, American Society of Anesthesiologist (ASA) grade and operation time between the two groups was no significant difference. The Wakeup time, and the Self-ambulation time in the treatment group was significantly faster than that in the control group ( P < 0.05). The total dose of propofol in the treatment group was 109 ± 8.17 mg, significantly lower than that in the control group ( P < 0.05). The incidence of respiratory depression and hypotension was not significantly different, but the incidence of hiccups was significantly lower than that in the control group ( P < 0.05). After the examination, the incidence of nausea, vomiting, abdominal distension, and abdominal pain was 11%, 8%, 6%, and 5%, respectively, which was significantly lower than that in the control group ( P < 0.05). In addition, both the operators and the patients were more satisfied with this examination, with no significant difference between the groups ( P > 0.05)., Conclusion: Wrist-ankle acupuncture treatment can optimize the painless gastroscopy and anaesthesia scheme, reduces propofol total dose; shortens patient Wakeup time and Self-ambulation time, improves patient compliance and tolerance, is beneficial to clinical application., Competing Interests: Conflict-of-interest statement: All the authors declare that they have no conflict of interest with this work., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

The design and development of a functional integrated system for gastroscopy is reported in this paper. The device takes advantage of four propellers enabling locomotion in a liquid environment and generating a maximum propulsive force of 25.5 mN. The capsule has been equipped with a miniaturized wireless vision system that acquires images with a frame rate of 30 fps (frames per second). The overall size of the capsule is 32 mm in length and 22 mm in diameter, with the possibility of decreasing the diameter to swallowable dimensions. The capsule is remotely controlled by the user who can intuitively drive the device by looking at the video streaming on the graphical interface. The average speed of the device is 1.5 cm/s that allows for a fine control of the capsule motion as demonstrated in experimental tasks consisting of passing through circular targets. The video system performances have been characterized by evaluating the contrast, the focus, and the capability of acquiring and perceiving different colors. The usability of the device has been tested on bench and on explanted tissues by three users in real time target-identification tasks, in order to assess the success of the integration process. The lifetime of the capsule with active motors and vision system is 13 min, that is, a timeframe consistent with traditional gastroscopic examinations. [ABSTRACT FROM PUBLISHER]

Objective: To validate a response surface model for the inhibition of somatic motor response at corrected body weight (CBW) doses of remifentanil plus propofol in elderly patients and to analyze the dose-effect relationship and optimal dosing range for total intravenous anesthesia (TIVA) induction in painless gastroscopy., Methods: We designed a prospective, open-ended, randomized, parallel group study. A total of 300 elderly patients undergoing painless gastroscopy were randomized to receive remifentanil (0-0.5 μg/kg) and propofol (0.8-2.2 mg/kg) dosing based on CBW. Gastroscopy was performed at the drug's peak effect time. The somatic motor response to gastroscopic stimulation and the adverse reactions at different points were recorded. The somatic motor response was used as the basic element in the subsequent RSM analysis. Model parameters and 95% confidence intervals were fitted by MATLAB software., Results: The CBW doses of remifentanil and propofol showed synergistic inhibitory effects on motor response to noxious stimulation and attenuated adverse reactions. The 50% effective doses of remifentanil and propofol for inhibiting the motor response were 1.754 μg/kg and 2.048 mg/kg, respectively., Conclusion: Remifentanil or propofol alone could not inhibit the somatic motor response at weight-adjusted doses among elderly patients. A combination of remifentanil and propofol showed a synergistic interaction in suppressing the motor response and adverse reactions in elderly patients. Preinjection of remifentanil could reduce the needed dose of propofol., Competing Interests: None., (AJTR Copyright © 2022.)

Objective To investigate the clinical effect of propofol combined with fentanyl in elderly patients with painless gastroscopy. Methods A total of 180 elderly patients with painless gastroscopy in this hospital from January 2013 to De-cember 2015 were selected as the research subjects and randomly divided into two groups, 90 cases in each group. The control group was given 0.03-0.04 mg/kg midazolam and 1-2 mg/kg propofol, while the observation group received 0.5 μg/kg fentanyl and1-2 mg/kg propofol, which adopted intravenous injection. The changes of blood oxygen saturation(SpO2), blood pressure and ECG were monitored. The adverse reactions were observed. Results After drug administration, mean arterial pressure(MAP) in the observation group was(70.5±2.8)mm Hg(1 mm Hg=0.133 k Pa), which in the control group was(72.5±3.4)mm Hg; the heart rate(HR)was(70.1±2.6)bpm in the observation group and(72.6±3.2)bpm in the control group, showing that MP and HR had no statistical differences between the two groups(P 0.05); Sp O2 in the observation group was(95.5 ±2.5)%, which was higher than(91.0±3.0)% in the control group, the awake time in the observation group was(10.1±1.3)min, which was shorter than(15.3 ±1.2)min in the control group, the occurrence rates of bucking and hypoxemia in the observation group were significantly lower than those in the control group[3.3%(3/90), 0.0%(0/90)vs. 13.3%(12/90), 4.4%(4/90), P<0.05], the differences were statistically significant. Conclusion Application of propofol combined with fentanyl in elderly patients with painless gastroscopy is safe with relatively good clinical effect. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the rational dosage and clinical effects of esmolol in anesthesia and resuscitation. METHODS: 92 cases receiving painless gastroscopy admitted into our hospital from Mar.2013 to Mar.2015 were selected to be divided into group A, group B and group C via the random number table. 30 cases in group A were treated with 0.5 mg/kg esmolol, 32 cases in group B were given 1.0 mg/kg esmolol, and another 30 cases in group C received 0.9% sodium chloride injection. The heart rate (HR), changes of mean arterial pressure (MAP), the consumption amount of narcotics, length of stay in hospital for observation, awake time of anesthesia and adverse reactions at before administration (T0), after anesthesia induction (T1), gastroscope over the glottis (T2) and gastroscope over the duodenum (T3) were observed in three groups.RESULTS: The levels of HR and MAP of group C at T1,T2,T3 were significantly higher than that of group A and group B, and group A were higher than group B, with statistically significant difference (P<0.05). The length of stay in hospital for observation and awake time of anesthesia in group C were significantly higher than that in group A and group B [(50.2 ±6.4) min VS (30.3 ±6.2) min VS (30.3 ±6.0) min,(5.2 ±1.1 ) min VS (2.5 ±1.1) min VS (2.4 ±1.2 ) min ], the difference was significant (P<0.05). The dosage of propofol and remifentanil in group C were also significantly higher than that in group A and group B [(2.2 ± 0.3) μg/kg VS (2.0 ±0.2) μg/kg VS (3.4 ±0.4) μg/kg, (0.36 ±0.05) mg/kg VS (0.35 ±0.04) mg/kg VS (0.42 ±0.08) mg/kg], with statistically significant difference (P<0.05). There were no obvious adverse reactions in three group of patients. CONCLUSIONS: Different doses of esmolol in painless gastroscopy sedation anesthesia and anesthesia resuscitation has a significant, safe and effective efficacy, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Objective To observe the efficacy and safety of combination therapy with midazolam-fentanyl-propofol in painless gastroscopy for obese patients. Methods According to body mass index, 168 obese patients underwent were randomly divided into two groups: control group and Observation group, 84 cases in each group. Patients in the observation group were given intravenous midazolam 0.01 mg/kg, fentanyl 0.8 ~ 1 µg/kg, and slow injection of propofol 1.0 ~ 1.5 mg/kg after sedation. Patients in the control group were given injection of propofol 2.0 ~ 2.5 mg/kg. Then we monitored the patient's anesthesia, anesthesia induction time, respiratory and circulatory complications and the total amount of propofol and other drugs during gastroscopy. Results Compared with the control group, the observation group at the induction time, aspects of the respiratory and circulatory systems of the total incidence of complications and propofol and other drugs had statistically significant difference (P<0.05). Anesthetic effect in the observation group was better than the control group (P<0.05). Conclusion Midazolam-fentanyl-propofol combination therapy is feasible and safe in painless gastroscopy for obese patients. [ABSTRACT FROM AUTHOR]