Clinical Application and Safety Evaluation of Sedative Demulcent Anesthesia in Therapeutic ERCP_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Xun , ZHU Xiaoliang , SHEN Yixuan , LI Yumin , ZHOU Wence , ZHANG Lei , MENG Wenbo , WANG Yongqi , HE Mingyan , LI Qiong , PU Xiaojin

The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

Keywords：

Sufentanil; Midazolam; Propofol; Sedative demulcent anesthesia; Endoscopic retrograde cholangiopancreatography; Therapy; Safety

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Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).
Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded.
Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01).
Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.

Citation： LI Xun,ZHU Xiaoliang,SHEN Yixuan,LI Yumin,ZHOU Wence,ZHANG Lei,MENG Wenbo,WANG Yongqi,HE Mingyan,LI Qiong,PU Xiaojin. Clinical Application and Safety Evaluation of Sedative Demulcent Anesthesia in Therapeutic ERCP. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(8): 645-648. doi: Copy

1.	李汛，李玉民，梁聚民，等. 端粒酶基因和DNA倍体在良恶性梗阻性黄疸中的表达 [J]. 中国普外基础与临床杂志， 2005; 12(4)： 343-345.
2.	苏进根，王建平，杨廷燕，等. 十二指肠镜技术在腹腔镜胆囊切除术前术后的应用经验 [J]. 中国普外基础与临床杂志， 2007; 14(5)： 531-532.
3.	Patterson KW， Casey PB， Murray JP， et al. Propofol sedation for outpatient upper gastrointestinal endoscopy： comparison with midazolam [J]. Br J Anaesth， 1991; 67(1)： 108- 111.
4.	Carlsson U， Grattidge P. Sedation for upper gastrointestinal endoscopy： a comparative study of propofol and midazolam [J]. Endoscopy， 1995; 27(3)： 240-243.
5.	徐福涛. 内镜术的镇静与麻醉 [J]. 中华消化内镜杂志， 2002; 19(6)： 325-326.
6.	孙涛，李欣，刘超群，等. 异丙酚静脉麻醉辅助电子胃镜、结肠镜检查术的临床观察 [J]. 中国综合临床， 2005; 21(10)： 923-925.
7.	许国铭，李兆申主编. 上消化道内镜学 [Ｍ]. 第1版. 上海：上海科学技术出版社， 2003： 98-103.
8.	Hug CC Jr， McLeskey CH， Nahrwold ML， et al. Hemodynamic effects of propofol： data from over 25 000 patients [J]. Anesth Analg， 1993; 77(4 Suppl)： S21-S29.
9.	佘守章，刘继云，许立新，等. 静脉注射不同剂量异丙酚对血流动力学及通气功能的影响 [J]. 中华麻醉学杂志， 1995; 15(1)： 31-32.
10.	Heuss LT， Schnieper P， Drewe J， et al. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients-a prospective， controlled study [J]. Am J Gastroenterol， 2003; 98(8)： 1751-1757.
11.	Heuss LT， Schnieper P， Drewe J， et al. Conscious sedation with propofol in elderly patients： a prospective evaluation [J]. Aliment Pharmacol Ther， 2003; 17(12)： 1493-1501.
12.	尹玉卿，李胜德，桑清文，等. 异丙酚用于冠心病人胃镜检查术的临床观察 [J]. 中国内镜杂志， 2002; 8(12)： 67-68.
13.	董榕，罗艳，于布为，等. 胃镜检查中泵输注与手控输注异丙酚麻醉效果的比较 [J]. 中华消化杂志， 2004; 24(9)： 530-532.
14.	徐萍，唐小阳，黄重发，等. 异丙酚、依托米酯麻醉剂辅助胃镜检查的临床观察 [J]. 临床消化病杂志， 2002; 14(5)： 228.
15.	丁进峰，张涛. 异丙酚配伍哌替啶用于胃镜检查麻醉 [J]. 现代医药卫生， 2004； 20(6)： 407.
16.	崔剑，温荟琳，陶国才，等. 利多卡因、芬太尼和曲马多在预防异丙酚静脉注射痛中的效果研究 [J]. 实用医学杂志， 2003; 19(9)： 978-979.
17.	Lazzaroni M， Porro GB. Preparation， premedication， and surveillance [J]. Endoscopy， 2005; 37(2)： 101-109.
18.	Vargo JJ， Zuccaro G Jr， Dumot JA， et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy： a prospective， randomized trial [J]. Gastroenterology， 2002; 123(1)： 8-16.
19.	Kaddu R， Bhattacharya D， Metriyakool K， et al. Propofol compared with general anesthesia for pediatric GI endoscopy： is propofol better? [J]. Gastrointest Endosc， 2002; 55(1)： 27-32.
20.	Riker RR， Picard JT， Fraser GL. Prospective evaluation of the Sedation Agitation Scale for adult critically ill patients [J]. Crit Care Med， 1999; 27(7)： 1325-1329.
21.	Devlin JW， Boleski G， Mlynarek M， et al. Motor Activity Assessment Scale： a valid and reliable sedation for use with mechanically ventilated patient in an adult surgical intensive care unit [J]. Crit Care Med， 1999; 27(7)： 1271-1275.

1. 李汛，李玉民，梁聚民，等. 端粒酶基因和DNA倍体在良恶性梗阻性黄疸中的表达 [J]. 中国普外基础与临床杂志， 2005; 12(4)： 343-345.
2. 苏进根，王建平，杨廷燕，等. 十二指肠镜技术在腹腔镜胆囊切除术前术后的应用经验 [J]. 中国普外基础与临床杂志， 2007; 14(5)： 531-532.
3. Patterson KW， Casey PB， Murray JP， et al. Propofol sedation for outpatient upper gastrointestinal endoscopy： comparison with midazolam [J]. Br J Anaesth， 1991; 67(1)： 108- 111.
4. Carlsson U， Grattidge P. Sedation for upper gastrointestinal endoscopy： a comparative study of propofol and midazolam [J]. Endoscopy， 1995; 27(3)： 240-243.
5. 徐福涛. 内镜术的镇静与麻醉 [J]. 中华消化内镜杂志， 2002; 19(6)： 325-326.
6. 孙涛，李欣，刘超群，等. 异丙酚静脉麻醉辅助电子胃镜、结肠镜检查术的临床观察 [J]. 中国综合临床， 2005; 21(10)： 923-925.
7. 许国铭，李兆申主编. 上消化道内镜学 [Ｍ]. 第1版. 上海：上海科学技术出版社， 2003： 98-103.
8. Hug CC Jr， McLeskey CH， Nahrwold ML， et al. Hemodynamic effects of propofol： data from over 25 000 patients [J]. Anesth Analg， 1993; 77(4 Suppl)： S21-S29.
9. 佘守章，刘继云，许立新，等. 静脉注射不同剂量异丙酚对血流动力学及通气功能的影响 [J]. 中华麻醉学杂志， 1995; 15(1)： 31-32.
10. Heuss LT， Schnieper P， Drewe J， et al. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients-a prospective， controlled study [J]. Am J Gastroenterol， 2003; 98(8)： 1751-1757.
11. Heuss LT， Schnieper P， Drewe J， et al. Conscious sedation with propofol in elderly patients： a prospective evaluation [J]. Aliment Pharmacol Ther， 2003; 17(12)： 1493-1501.
12. 尹玉卿，李胜德，桑清文，等. 异丙酚用于冠心病人胃镜检查术的临床观察 [J]. 中国内镜杂志， 2002; 8(12)： 67-68.
13. 董榕，罗艳，于布为，等. 胃镜检查中泵输注与手控输注异丙酚麻醉效果的比较 [J]. 中华消化杂志， 2004; 24(9)： 530-532.
14. 徐萍，唐小阳，黄重发，等. 异丙酚、依托米酯麻醉剂辅助胃镜检查的临床观察 [J]. 临床消化病杂志， 2002; 14(5)： 228.
15. 丁进峰，张涛. 异丙酚配伍哌替啶用于胃镜检查麻醉 [J]. 现代医药卫生， 2004； 20(6)： 407.
16. 崔剑，温荟琳，陶国才，等. 利多卡因、芬太尼和曲马多在预防异丙酚静脉注射痛中的效果研究 [J]. 实用医学杂志， 2003; 19(9)： 978-979.
17. Lazzaroni M， Porro GB. Preparation， premedication， and surveillance [J]. Endoscopy， 2005; 37(2)： 101-109.
18. Vargo JJ， Zuccaro G Jr， Dumot JA， et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy： a prospective， randomized trial [J]. Gastroenterology， 2002; 123(1)： 8-16.
19. Kaddu R， Bhattacharya D， Metriyakool K， et al. Propofol compared with general anesthesia for pediatric GI endoscopy： is propofol better? [J]. Gastrointest Endosc， 2002; 55(1)： 27-32.
20. Riker RR， Picard JT， Fraser GL. Prospective evaluation of the Sedation Agitation Scale for adult critically ill patients [J]. Crit Care Med， 1999; 27(7)： 1325-1329.
21. Devlin JW， Boleski G， Mlynarek M， et al. Motor Activity Assessment Scale： a valid and reliable sedation for use with mechanically ventilated patient in an adult surgical intensive care unit [J]. Crit Care Med， 1999; 27(7)： 1271-1275.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Application and Safety Evaluation of Sedative Demulcent Anesthesia in Therapeutic ERCP

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