BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedation regimen by avoiding under-or oversedation.AIM To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.METHODS Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS.Patients were matched for age and endoscopic procedure.We recorded time of sedation and endoscopy,dosage of medication and adverse events.RESULTS There was a significant reduction in dose per time of propofol administered in the TCI group,compared to the NAPS group(8.2±2.7 mg/min vs 9.3±3.4 mg/min;P=0.046).The time needed to provide adequate sedation levels was slightly but significantly lower in the control group(5.3±2.7 min vs 7.7±3.3 min;P<0.001),nonetheless the total endoscopy time was similar in both groups.No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.CONCLUSION This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy.This may translate into less adverse events.However,further and randomized trials need to confirm this trend.
The effect of intravenous bolus rates on patient outcomes is a complex and crucial aspect of critical care.Fluid challenges are commonly used in critically ill patients to manage their hemodynamic status,but there is limited information available on the specifics of when,how much,and at what rate fluids should be administered during these challenges.The aim of this review is to thoroughly examine the relationship between intravenous bolus rates,fluid-electrolyte balance,and mortality and to analyze key research findings and methodologies to understand these complex dynamics better.Fluid challenges are commonly employed in managing hemodynamic status in this population,yet there is limited information on the optimal timing,volume,and rate of fluid administration.Utilizing a narrative review approach,the analysis identified nine relevant studies that investigate these variables.The findings underscore the importance of a precise and individualized approach in clinical settings,highlighting the need to tailor intravenous bolus rates to each patient's specific needs to maximize outcomes.This review provides valuable insights that can inform and optimize clinical practices in critical care,emphasizing the necessity of meticulous and exact strategies in fluid administration.
Mutaz I OthmanEmad M MustafaMoayad AlfayoumiMohamad Y KhatibAbdulqadir J Nashwan
