Sedation, analgesia, and cardiorespiratory function in colonoscopy using midazolam combined with fentanyl or propofol.

BACKGROUND AND AIMS: The use of sedatives during colonoscopy remains controversial because of its safety concerns. We compared cardiorespiratory function and sedative and analgesic effects in sedative colonoscopy, using combinations of midazolam with either fentanyl or propofol. METHODS: Eligible patients (n = 480) received 1.0-2.0 mg midazolam alone (n = 160), midazolam combined with either 50-100 mg fentanyl intramuscularly (n = 160), or 0.5-2.5 mg/kg propofol intravenously, as premedication for sedative colonoscopy. Pulse rate, blood pressure, and saturation of peripheral oxygen (SpO(2)) were monitored. Levels of sedation and analgesia were semi-quantitatively scored using visual analog scales, and amnesia profiles were qualitatively evaluated. RESULTS: Combining midazolam with either fentanyl or propofol resulted in acceptable sedative and analgesic effects compared to treatment with midazolam alone (P < 0.001), with the combination with propofol giving more favorable results. More patients receiving the propofol combination became amnestic to the procedure than patients receiving the fentanyl combination. However, midazolam combined with propofol disturbed the pulse rate (P < 0.05) and blood pressure (P < 0.001) more significantly than a combination with fentanyl, or midazolam alone. CONCLUSION: The combination of midazolam with either fentanyl or propofol allowed patients to undergo colonoscopy under comparable sedative and analgesic conditions. The combination with fentanyl had a significantly lower effect on pulse rate and blood pressure. The combination with propofol produced superior amnestic effects.

[Effect of various uses of propofol on the upper gastrointestinal endoscopy].

OBJECTIVE: To investigate the efficacy and security of different uses of propofol on the sedation during the upper gastrointestinal endoscopic procedures. METHODS: Four hundred patients who underwent gastroscopy received midazolam and propofol as sedation. Patients were divided to 4 groups with different intervals between midazolam and propofol: Group A and D with the interval of 30 seconds to 1 minute, Group B and C with 3 to 5 minute interval. All patients were premedicated with midazolam and propofol at 16 approximately 25 mg/10s (Group A and B) and 6 approximately 7 mg/10s (Group C and D). RESULTS: The doses of propofol of Group A,B,C, and D were (111.90+/-22.43),(102.20+/-15.99),(73.05+/-13.08) and (80.90+/-17.36)mg respectively, with significant difference(P<0.01). The time of return to consciousness decreased markedly in Group C and D [(9+/-1), (10+/-2)min ], and that of Group A and B was [(14+/-5), (13+/-3)min ]. There was significant difference between Group C, D and Group A, B(P<0.01). CONCLUSION: The dose of propofol and the time of return to consciousness depend on the rate of administration and the interval between midazolam and propofol. Appropriate rate and interval can produce safer and more effective sedation for the upper gastrointestinal endoscopic procedure.

[Effect of prostaglandin E1 on the expression of tissue inhibitor of metalloproteinase-1 in experimental liver fibrosis rats].

OBJECTIVE: To investigate the effect of prostaglandin E1 (PGE1) on the expression of tissue inhibitor of metalloproteinase-1 (TIMP-1) in experimental liver fibrosis rats. METHODS: The liver fibrosis model was established by carbon tetrachloride. Rats were divided into a control group and PGE1-treated group. The pathological changes of the liver tissue from the two groups, the semi-quantitative analysis of hepatitic activity in HE stain sections, the pathological image quantitative analysis of the fibrosis degree, TIMP-1 positive cells, and the content of collagen were synthetically analysed. RESULTS: The mark changes of liver pathology in HE stain sections were that the degree of hepatitic activity in the PGE1-treated group was obviously lower than that in the control group (P < 0.05). The fibrosis degree, TIMP-1 positive cells and the collagenous fibers decreased in the PGE1-treated group (P <0.05). CONCLUSION: PGE1 has an anti-hepatofibrosis effect in the experimental rats, the inflammation of liver is light, and the proliferation of collagenous fibers can be restrained, whose mechanism is probably associated with the suppression of TIMP-1 expression caused by PGE1.

[Five-day rabeprazole-based triple therapy for helicobacter pylori infection].

OBJECTIVE: To evaluate the efficacy of a 5-day rabeprazole-based triple therapy regimen for helicobacter pylori infection, and to improve the eradication rates of antibiotic-resistant Helicobacter pylori with rabeprazole plus clarithromycin and furazolidone. METHODS: We selected 95 H. pylori-positive patients with gastric or duodenal ulcers or erosive gastritis and randomized them into 2 groups. The patients were given a 7-day triple standard therapy and 5-day triple standard therapy, consisting of rabeprazole 10 mg twice daily, clarithromycin 500 mg twice daily and furazolidone 100 mg twice daily. H. pylori status was checked by rapid urease test or 14C urea breath test and histology before and 4 weeks after the therapy. RESULTS: The eradication rate of H. pylori for patients under the 5-day treatment vs. 7-day treatment were 77.8% vs. 82% by per protocol and 94.4% vs. 97.6% by intention to treat analysis (no significant comparisons). The ulcer and erosion healing rate was 97.6% vs. 97.8% (no significant comparisons). No major side-effects were reported. CONCLUSION: The 5-day rabeprazole-based triple therapy( combined with clarithromycin and furazolidone) for helicobacter pylori infection is an effective regimen with excellent patient acceptability and compliance.

[Clinical observation of recombinant growth hormone therapy for liver cirrhosis with hypoproteinemia].

OBJECTIVE: To assess the effect of recombinant growth hormone (rhGH) therapy for liver cirrhosis patients with hypoproteinemia. METHODS: Fifteen patients with liver cirrhosis were treated with rhGH (4 U per day) for 7 days and 15 controls were given human albumin (10 g) for every other day (altogether 3 times). Albumin was measured one day before the treatment, and on day 1, 10, 14, and 28 after the treatment. RESULTS: After 7 days of rhGH administration, the albumin level of the patients was significantly higher and the function lasted longer than those of patients treated with human albumin (P < 0.05). CONCLUSION: Exogenous rhGH in treating hypoproteinemia in patients with liver cirrhosis is more effective than human albumin.