Effects of intravenous administration of magnesium sulfate in propofol-based sedation for ERCP in elderly patients: a randomized, double-blind, placebo-controlled study
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Abstract Background Propofol-based sedations are widely used in elderly patients for endoscopic retrograde cholangiopancreatography (ERCP) procedure, but respiratory depression and cardiovascular adverse events commonly occur. Magnesium administered intravenously can alleviate pain and decrease propofol requirements during surgery. We hypothesized that intravenous magnesium was used as adjuvant to propofol might be beneficial in elderly patients undergoing ERCP procedures. Methods Eighty patients aged from 65 to 79 years who were scheduled for ERCP were enrolled. All patients were intravenously administered 0.1 µg/kg sufentanil as premedication. The patients were randomized to receive either intravenous magnesium sulfate 40 mg/kg (group M, n = 40) or the same volume of normal saline (group N, n = 40) over 15 min before the start of sedation. Intraoperative sedation was provided by propofol. Total propofol requirement during ERCP was the primary outcome. Results The total propofol consumption were reduced by 21.4% in the group M compared with the group N (151.2 ± 53.3 mg vs. 192.3 ± 72.1 mg, P = 0.001). The incidences of respiratory depression episodes and involuntary movement were less in the group M than those in the group N (0/40 vs. 6/40, P = 0.011; 4/40 vs. 11/40, P = 0.045; respectively). In the group M, the patients experienced less pain than those in the group N at 30 min after the procedure (1 [0–1] vs. 2 [1–2], P < 0.001). Correspondingly, the patients’ satisfaction was clearly higher in the group M ( P = 0.005). There was a tendency towards lower intraoperative heart rate and mean arterial pressure in group M. Conclusions A single bolus of 40 mg/kg of intravenous magnesium can significantly reduce propofol consumption during ERCP, with higher sedation success and lower adverse events. Trial Registration ID UMIN000044737. Registered 02/07/2021.Keywords:
Sufentanil
Premedication
This study was performed to compare the pharmacological characteristics of propofol in an emulsion of both medium- and long-chain triglycerides (MCT/LCT) with those of propofol in an LCT emulsion, by measuring the sedative level and the plasma concentration of propofol during sedation using a target-controlled infusion (TCI) technique. Forty ASA 1 or 2 adult patients who required spinal anaesthesia for surgery were enrolled in this study. The patients were divided into two groups: a propofol LCT group (n=20) and a propofol MCT/LCT group (n=20). Propofol was injected intravenously at target blood concentrations of 2.0, 3.0 and 4.0 μg.ml –1 . The bispectral (BIS ® ) index was recorded, and arterial blood was drawn to measure the actual plasma concentrations of propofol at each predicted concentration. Propofol was assayed by high-performance liquid chromatography. Propofol MCT/LCT was associated with significantly less pain than propofol LCT (P<0.05). There were no significant differences between the two groups in BIS® index or in plasma concentration of propofol at each predicted concentration. Computer-generated TCI of propofol MCT/LCT during sedation is comparable with that of propofol LCT with respect to pharmacokinetics and pharmacodynamics. The formulation of MCT/LCT has a beneficial effect with respect to less pain on injection.
Bispectral index
Pharmacodynamics
Arterial blood
Lipid emulsion
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Therapeutic Endoscopy
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목적: 최근 대장 질환의 발생 빈도가 증가함에 따라 환자가 두려움 없이 편안하게 검사를 받을 수 있으면서 시술 의사가 안심하고 검사할 수 있는 수면 대장내시경이 요구되고 있다. 저자는 수면 대장내시경에서 propofol 단독요법과 midazolam, propofol 병합요법을 서로 비교하여 보다 좋은 전처치법을 개발하고자 하였다. 대상 및 방법: 2004년 8월부터 2005년 5월까지 한림대성심병원에서 수면유도법에 의한 대장내시경을 시행한 환자를 대상으로 propofol 단독요법군(108예)과 midazolam, propofol 병합요법군(102예)으로 나누어 연구를 시행하였다. 단독요법군은 propofol을 2-2.5 ml/kg/hr로 정주하였고, 병합요법군은 midazolam 3 mg을 정주 후 propofol을 2-2.5 ml/kg/hr로 정주하였다. 검사 중 지속적으로 심전도, 혈압, 맥박, 산소포화도 등을 감시하였다. 진정상태까지의 propofol 용량, 전체 propofol 용량, 수면유도시간, 내시경소요시간, 회복시간, 환자만족도, 시술자 만족도를 측정하여 두 군 간의 결과를 비교하였다. 결과: 시술 전과 시술 중의 혈압, 분당 심박수, 호흡횟수, 산소포화도 변화에 있어서 두 군간에 유의한 차이는 없었다. 진정상태까지의 propofol 용량과 전체 propofol 용량은 병합요법군에서 단독요법군에 비해 유의하게 적었다(p＜0.001). 수면유도시간은 병합요법군에서 단독요법군에 비해 유의하게 짧았다(p＜0.001). 회복시간과 환자 만족도에서 두 군간에 유의한 차이는 없었다. 시술자만족도는 병합요법군에서 유의하게 높았다(p=0.04). 두 군 모두에서 치명적인 부작용을 보인 예는 없었다. 결론: 수면 대장내시경에서 midazolam, propofol 병합요법은 propofol 단독요법에 비해 propofol 용량을 줄일 수 있었고, 부작용 발생의 증가없이 수면유도시간을 단축할 수 있었다.
Midazolam
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A controlled randomized double-blinded clinical study was undertaken to evaluate and compare the efficacy of three methods of preventing pain during injection of propofol on induction of anesthesia. Patients were randomly allocated to six groups: saline pretreatment, followed by induction with propofol at room temperature plus saline; lidocaine pretreatment, followed by induction with propofol at room temperature plus saline; saline pretreatment, followed by induction with propofol at a temperature of 4 degrees C plus saline; lidocaine pretreatment, followed by induction with propofol at a temperature of 4 degrees C plus saline; saline pretreatment, followed by induction with propofol at room temperature plus lidocaine 40 mg; saline pretreatment, followed by induction with propofol at a temperature of 4 degrees C plus lidocaine 40 mg. Pretreatment with lidocaine reduced the incidence of pain and discomfort significantly compared with unpretreated groups. Groups which received propofol mixed with lidocaine also showed a significant reduced incidence of pain. induction with cold 4 degrees C propofol showed no significant difference in reduction of injection pain.
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The extent to which epidurally administered sufentanil acts directly on spinal opioid receptors remains controversial. We tested the hypothesis that small-dose boluses of sufentanil, given epidurally or IV, provide comparable analgesia at similar plasma sufentanil concentrations. The lipophilicity of sufentanil makes it likely to be absorbed into fat surrounding the epidural space. We therefore also tested the hypothesis that more epidural than IV sufentanil is required to produce comparable analgesia. Analgesia and plasma sufentanil concentrations were evaluated in 20 postoperative patients randomly assigned to patient-controlled epidural or IV sufentanil. Pain was evaluated with visual analog scales by blinded observers. Sufentanil doses and plasma concentrations were measured. Analgesia was similar with epidural and IV sufentanil administration. Plasma sufentanil concentrations were virtually identical in the two groups. However, significantly larger sufentanil doses were required with epidural administration: 238 ± 50 μg vs 160 ± 32 μg (P < 0.01). The primary mechanism by which small-dose boluses of epidurally-administered sufentanil produce analgesia seems to be systemic absorption of the drug with subsequent recirculation to the supraspinal opioid receptors. This study demonstrates that the cumulative dose of sufentanil, when administered as a small epidural bolus, is approximately 50% more than that administered IV to provide comparable analgesia. This indicates that the bioavailability of epidurally-administered sufentanil is reduced and suggests that a large proportion of the drug may be absorbed into the epidural fat.
Sufentanil
Epidural administration
Epidural space
Bolus (digestion)
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Labor analgesia creates a safe and painless environment for labor process.Ideal medicine for analgesia labor should have obvious effect and minimum influence on mothers and neonates.Sufentanil is a synthetic opioid drug which has strong analgesic effect,long effective time and less side effect.Sufentanil is widely used in clinical application because of its unique pharmacological features.Here is to review on the sufentanil pharmacology features,clinical application in labor analgesia by intrathecal and epidural pipe and its impact on mothers and neonates,so as to understand and evaluate sufentanil in labor analgesia.
Sufentanil
Labor pain
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Background/Aims: Propofol sedation is increasingly being used when performing upper gastrointestinal endoscopy because of its rapid onset and good recovery profile. For achieving safe sedation during endoscopy, close monitoring of the vital signs is necessary because of the sedation’s potentially serious adverse effects. There are only a few studies on the induction of sedation with using propofol for endoscopy in Korea. The present study was undertaken to evaluate the adequate initial injected dose of propofol for achieving safe and effective sedation when performing upper gastrointestinal endoscopy in Koreans. Methods: From March 2008 to July 2008, 150 subjects who visited Kwangju Christian Hospital were randomized into 3 groups. An initial bolus dose of 0.5 mg/kg, 1.0 mg/kg and 1.5 mg/kg of propofol was allocated to groups A, B and C, respectively. The effectiveness and safety profiles of each injected dose of propofol were prospectively assessed by measuring various parameters of the vital signs and the adverse events. Results: Group C had a significantly shorter induction time and the patients in group C did not require additional injections of propofol without increasing adverse events, as compared to that of the other 2 groups. Conclusions: 1.5 mg/kg of propofol was found to be more appropriate than 0.5 mg/kg or 1.0 mg/kg of propofol as the initial injected dose for induction of sedation during performance of upper gastrointestinal endoscopy in Koreans.
Bolus (digestion)
Therapeutic Endoscopy
Upper endoscopy
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背景 Sufentanil 目标控制注入(TCI ) 提供稳定的痛觉缺失，更好血液动力学的控制比静脉内的麻药，期望的恢复和在 perioperative 期间的麻醉的改进质量的大丸药注射时期。这研究在中国外科的 patients.Methods 在高集中为 sufentanil 评估了 TCI 系统的精确性和可行性在一般麻醉下面经历选任的外科的 12 个低风险成年人病人在这研究被包括。Sufentanil 与合并以前报导的 sufentanil 的人口 pharmacokinetic 数据的一个特定的 TCI 系统被管理，用 sufentanil 的目标效果地点集中 4 或 6 ng/ml。Sufentanil TCI 持续时间是 30 分钟。经常的动脉的血样品被液体层析团 spectrometry/mass spectrometry 为血浆 sufentanil 集中的决心在 sufentanil TCI 以后拿在期间并且直到 24 个小时。循环系统功能的变化在 precedure，恢复侧面和不利效果期间是集中与 TCI 系统预言的值相比的 recorded.Measured 血浆 sufentanil。偏爱(中部的表演错误， MDPE ) ， procision (中部的绝对表演错误， MDAPE ) 并且摇摆(表演错误的可变性) sufentanil TCI，系统都是 determined.Results 病人们在麻醉的正式就职和维护期间有稳定的心血管的变量。眼睛开和 extubation 的时间是(5.6 ? 髼吗？？
Sufentanil
Target controlled infusion
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Regional anaesthesia has become an important anaesthetic technique. Effective sedation is an essential for regional techniques too. This study compares midazolam and propofol in terms of onset & recovery from sedation, dosage and side effects of both the drugs using Bispectral Index monitoring. Ninety eight patients were randomly divided into two groups,one group recieved midazolam infusion while the other recieved propofol infusion until BIS reached 75. We observed Time to reach desired sedation, HR, MABP, time for recovery, dose to reach sedation and for maintenance of sedation and side effects if any. The time to reach required sedation was 11 min in Midazolam group(Group I) while it was 6 min in Propofol group(Group II) (p=0.0). Fall in MABP was greater with propofol. Recovery in with midazolam was slower than with propofol (18.6 +/- 6.5 vs 10.10+/-3.65 min) (p=0.00). We concluded that both midazolam and propofol are effective sedatives, but onset and offset was quicker with propofol, while midazolam was more cardiostable.
Midazolam
Bispectral index
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