Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care.

INTRODUCTION: Adequate sedation is one of the cornerstones of good quality gastrointestinal endoscopy (GIE). Propofol sedation has increased significantly but there has been much debate over whether it can be administered by endoscopists. The aim of this prospective trial was to compare nonanesthesiologist-administered propofol (NAAP) and monitored anesthesia care (MAC). METHODS: A total of 2000 outpatients undergoing GIE at Hospital Albert Einstein (São Paulo, Brazil), a tertiary-care private hospital, were divided into two matched groups: NAAP (n = 1000) and MAC (n = 1000). In NAAP, propofol doses were determined by the endoscopist. A second physician stayed in the room during the entire procedure, according to local regulations. In MAC, the anesthesiologist administered propofol. RESULTS: In total, 1427 patients (71.3 %) were ASA (American Society of Anesthesiologists) class I and 573 were ASA class II. In NAAP, patients received more propofol + fentanyl (61.1 % vs. 50.5 %; P < 0.05) and there were fewer cases of deep sedation (44.7 % vs. 66.1 %; P < 0.05). Hypoxemia rates were similar (12.8 % for NAAP and 11.2 % for MAC; P = 0.3) but these reverted more rapidly in MAC (4.22 seconds vs. 7.26 seconds; P < 0.05). Agitation was more frequent in MAC (14.0 % vs. 5.6 %; P < 0.05). No later complications were observed. Patient satisfaction was very high and similar in both groups. CONCLUSION: In this setting, NAAP was as safe and effective as MAC for healthy patients undergoing GIE. Clinical trial ref. no.: U1111-1134-4430.

Testosterone and free thyroxin blood in congenitally acallosal male BALB/cCF mice.

OBJECTIVES: Approximately 20% of BALB/cCF mice are born with partial or total absence of the corpus callosum. Here, we analyzed testosterone and free thyroxin blood levels in adult male mice of this strain in order to see if these hormones are related to the incidence of callosal defects. METHODS: Blood collected from the axillary blood vessels of 12 normal and 10 acallosal deeply anesthetized adult male mice was used in order to determine testosterone and free thyroxin levels through chemiluminescence (IMMULITE, Diagnostics Products Corporation, USA). RESULTS: No significant difference (one-way ANOVA: F = 0.11, df = 1, p > 0.10) was found between normal ((-)X= 1.95, SD = 0.62) and acallosal ((-)X= 1.86, SD = 0.62) mice for free thyroxin level. On the other hand, in those mice that had detectable testosterone levels (above 0.2 ng/ml), a significant difference was found (t = 2.8, df = 6.06, p = 0.03): normal mice (n = 7, (-)X= 8.73, SD = 7.64) had a higher level than acallosal mice (n = 4, (-)X= 0.62, SD = 0.41). CONCLUSIONS: The present results indicate that the incidence of callosal agenesis is not related to free thyroxin levels in the blood of adult BALB/cCF mice. On the other hand, in spite of the fact that low testosterone levels seems to be frequent in male mice of this strain, acallosal mice tend to have lower levels of this hormone than normal mice.