Pre-endoscopic tachycardia predicts increased sedation dose and lower adenoma detection rate in patients undergoing endoscopic procedures: a case control study.

BACKGROUND: Tachycardia prior to endoscopic procedures is commonly encountered which reflect patient anxiety status. Despite this frequent occurrence, it is unclear if in a patient with tachycardia sedation dose should be modified. The aim of our study was to assess the effect of pre-endoscopic tachycardia on sedation dose. METHODS: A retrospective analysis of all patients who underwent upper endoscopy and colonoscopy at EMMS Nazareth hospital were performed. We excluded patients with diseases and medications affecting the heart rate. RESULTS: A total of 2855 patients were included in the study. Two-hundred and thirty-seven patients had tachycardia before endoscopy (8.3%, group A) as compared to 2618 (group B) patients who had heart rate ≤100 beats per minute. The mean dosage of propofol in group A was significantly higher (62.6±33.2 mg vs. 57.4±29.9 mg) than in group B (P=0.01). There was no difference in the cecal intubation rate among the two groups (P=0.9). Notably, the adenoma detection rate was significantly lower among group A patients as compared to group B (13.6% vs. 22.8%, P=0.02) patients. There were no sedation related complications. CONCLUSIONS: Tachycardia prior to endoscopic procedures was associated with higher sedative dosage and lower adenoma detection rate, however no major complications were recorded. These data should be taken into consideration to optimize procedure quality.

[A different person in 2 minutes]. / Ein anderer Mensch in 2 Minuten.

I would like to describe the initial extreme physical and psychological effects of my posttraumatic stress disorder that appeared after multiple shocks from an implantable cardioverter-defibrillator, my surprise about my physical awareness, which I and apparently also the physicians could not understand, the feeling of helplessness, the lack of knowledge, the ignorance, and the unfairness of some of the physicians concerning my psychological illness, feelings of being stamped as a psychopath, not being believed, and being let down, my improvements during the course of the last 6 years, my current condition, and my appeal to physicians that better care be offered to patients with a similar illness.

[The psychological preparation of patients with a paroxysmal systolic tachyarrhythmia for helium-neon laser treatment]. / Psikhologicheskaia podgotovka bol'nykh s paroksizmal'noi takhisistolicheskoi aritmiei k lecheniiu gelievo-neonovym lazerom.

The psychological structure was studied in 120 patients with paroxysmal disorders of the cardiac rhythm. Anxiety, obsessive-phobic, neurasthenic and ergopathic syndromes were singled out. It was established that psychological aspects of personality of the patients depended on the course of paroxysmal disorders of the rhythm and influence the number of arrhythmia triggering that often reduced the grade of medicosocial adaptation. Psychological preparation of these patients to laser treatment may be achieved by rational psychotherapy. Details of such psychotherapy are discussed.