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Introduction Procedural sedation during dental treatment has been reported to have a high incidence of respiratory depression. Nasal high flow (NHF) therapy uses a mild positive pressure load that improves carbon dioxide washout and reduces rebreathing to improve respiratory function and therefore is widely used to prevent hypoxemia and hypercapnia. We will investigate the efficacy of respiratory support with NHF during dental treatment under procedural sedation. Methods/design In a multicenter randomized controlled study, adult patients undergoing dental treatment under procedural sedation were allocated to either a nasal high-flow (NHF) group or a low-flow oxygen group. For sedation, midazolam plus propofol were used according to the guidelines to obtain a moderate sedation level. The primary endpoint is the incidence of hypoxemia, defined as SpO 2  ≤ 90% during intravenous anesthesia. As a secondary evaluation item, the percutaneous CO 2 concentration is evaluated to examine whether it is effective in preventing hypercapnia. Furthermore, we will evaluate sedative and analgesic doses, and examine whether the use of equipment is effective in preventing the occurrence of hypercapnia and hypoxemia. Discussion The purpose of this study was to obtain evidence for the utility of NHF as respiratory support for dental treatment under procedural sedation, assessed by determining if the incidence rates of hypercapnia and hypoxemia can be decreased by NHF. Trial status The protocol version number and date: Version 1.2 (approved on January 14, 2025). The date recruitment began: Patient recruitment began on August 1, 2025. The approximate date when recruitment will be completed: The patient recruitment will be completed on March 31, 2026.

Sedation during endoscopic gastrointestinal procedures is now a routine practise that can improve patient outcomes. Propofol is one of the most commonly used intravenous anaesthetics. However, despite its popularity, it has been associated with various side effects, particularly haemodynamic and respiratory complications, especially in frail patient populations. Intravenous (IV) lidocaine, used as an adjuvant, has already demonstrated its efficacy in improving certain outcomes during sedation with propofol. However, the emergence of further studies requires an update to enhance the quality of existing data and refine this anaesthetic practise. The aim of this systematic review and meta-analysis is to evaluate the efficacy of intravenous lidocaine in reducing propofol consumption, decreasing episodes of desaturation and involuntary movements during the procedure, improving awakening time, relieving post-procedure pain, and increasing endoscopist satisfaction during propofol sedation in gastrointestinal endoscopic procedures (PROSPERO registration: CRD420250651511). We included randomised controlled trials conducted in adult patients undergoing propofol sedation with IV lidocaine administered as an adjunct during gastrointestinal endoscopic procedures. A comprehensive systematic search was conducted in PubMed/MEDLINE, Scopus and Web of Science from January to February 2025 without language or time restrictions. Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB2). Seventeen randomised controlled trials (1698 patients) were selected based on full text and included in the study. Lower propofol consumption was observed with intravenous lidocaine compared with the control group (SMD: –1.36, 95 % CI: −1.67 to −1.05; p < 0.001), with consistent results in all subgroups. Awakening time was significantly shorter in the IV lidocaine group (SMD = −0.92 [95 % CI: −1.18 to −0.66]; p < 0.001), while no significant difference was observed in full recovery time. Lidocaine administration was associated with a 59 % reduction in desaturation events, 36 % reduction in hypotension events and a 57 % reduction in involuntary movements. Continuous infusion after bolus administration was required to achieve these effects. Infusion rates of 2 mg/kg/h and 4 mg/kg/h were equally effective. Intravenous lidocaine is a safe and effective adjunct to propofol sedation in gastrointestinal endoscopy, reducing anaesthetic requirements and sedation-related complications. Routine use of lidocaine may increase the safety of the procedure, especially in high-risk populations and complex procedures. •IV lidocaine reduces propofol use in adult GI procedures, with consistent effects across procedures and age groups.•Lidocaine shortens awakening, lowers desaturation risk, and improves sedation quality with fewer involuntary movements.•Clinical benefits require continuous lidocaine infusion; both 2 and 4 mg/kg/h rates are equally effective.•Older patients benefit from lidocaine like younger ones, supporting routine use to improve sedation safety in high-risk populations.

Background and Aims Remimazolam, a new ultra‐short‐acting benzodiazepine, is a safe and effective option for procedural sedation. Nevertheless, to date, no study has directly compared remimazolam and midazolam in diagnostic upper gastrointestinal endoscopy. This study aimed to evaluate the efficacy and safety of remimazolam compared with those of midazolam in this setting. Methods This multicenter, single‐blind, randomized, positive‐control, superiority, investigator‐initiated phase III trial enrolled patients who were scheduled to undergo diagnostic upper gastrointestinal endoscopy at seven academic teaching hospitals from April 2023 to January 2024. Participants were randomly assigned to receive remimazolam or midazolam (1:1 ratio). The primary endpoint was total procedure time, defined as the duration from the first sedative administration to discharge. Results Of 133 randomized patients, 132 (remimazolam group, n = 66; midazolam group, n = 66) underwent upper endoscopy with sedation. The total procedure time was significantly shorter in the remimazolam group (30.3 vs. 48.5 min, p < 0.001). Sedation‐related times (i.e., induction, sedation, recovery, and discharge times) were also significantly shorter in the remimazolam group (all p < 0.001). The incidence of adverse events did not significantly differ between the groups; however, the incidence rates of hypotension, bradycardia, and paradoxical reactions were lower in the remimazolam group. When compared to previous sedation experiences, patient satisfaction was higher in the remimazolam group (p < 0.001). Conclusions Compared with midazolam, the use of remimazolam in diagnostic upper gastrointestinal endoscopy allows for faster sedation induction and recovery, more rapid discharge, and higher patient satisfaction compared with previous sedation experiences, while maintaining a safety profile similar to that of midazolam. Trial registration ClinicalTrials.gov (NCT05836545) Key Summary Summarise the established knowledge on this subject ◦ Remimazolam, a new ultra‐short‐acting benzodiazepine, is a safe and effective option for procedural sedation. ◦ No study has yet directly compared remimazolam and midazolam in diagnostic upper gastrointestinal endoscopy. What are the significant and/or new findings of this study? ◦ Remimazolam significantly reduced total procedure time compared with midazolam in diagnostic upper gastrointestinal endoscopy. ◦ Remimazolam enabled faster sedation induction and quicker recovery while maintaining a safety profile comparable to midazolam. ◦ Compared to previous sedation experiences, a significantly higher proportion of patients in the remimazolam group reported greater satisfaction.

Background: This systematic review was undertaken to compare the benefits of intranasal dexmedetomidine (IND) versus oral chloral hydrate (OCH) in the pediatric age group undergoing procedural sedation analgesia (PSA). Randomized clinical trials (RCT) of the various studies done over the years were taken up and analyzed. Since IND has the additional advantages of a faster onset of action, greater success with a single bolus dose, and enhanced recovery, this systematic review was conducted to prove the superiority of IND over OCH in pediatric PSA. Objective: To compare the efficacy of IND versus OCH for PSA in pediatric patients. Search Strategy: We searched the electronic databases from August 2012 to September 2019 without language restrictions. Design and Selection Criteria: A review of 10 RCTs on the use of IND and OCH for PSA in the pediatric age group for a variety of diagnostic procedures was done and the superiority of IND as per the sedation time and adverse effects were analyzed. Results: Out of the RCTs considered, six trials were a direct comparison between OCH and IND which showed that IND had a faster onset of action, improved recovery characteristics with better return to baseline physical activity on the same day of the procedure. When compared to OCH, IND showed no evidence of second-dose requirement and no record of postoperative nausea and vomiting (PONV). Conclusion: This systematic review revealed that IND is superior to OCH for PSA in the pediatric age group and proved to be safe and effective with better recovery characteristics.

To compare the frequency of airway and respiratory adverse events leading to an intervention between moderate sedation using alfentanil or propofol. We performed a randomized clinical trial in which adults undergoing moderate sedation in the ED received either alfentanil or propofol. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, sedation time, patient satisfaction, pain, and satisfaction. 108 subjects completed the trial: 52 receiving alfentanil and 56 receiving propofol. Airway or respiratory adverse events leading to an intervention were similar between the two groups: 23% for alfentanil and 20% for propofol (p=0.657). There were no serious adverse events in any group. Secondary outcomes were notably different in the rate of reported pain (48% for alfentanil, 13% for propofol) and recall (75% for alfentanil, 23% for propofol) and similar in the rate of satisfaction with the procedure (87% for alfentanil, 84% for propofol). We found a similar frequency of airway and respiratory adverse events leading to intervention between alfentanil and propofol used for moderate procedural sedation. Both agents appear safe for moderate procedural sedation.

Ciprofol, a novel intravenous anesthetic, provides rapid recovery in patients undergoing colonoscopy. We aimed to examine the efficacy and safety of ciprofol in comparison with propofol for sedation or anesthesia in non-operating room settings including endoscopic submucosal dissection, endoscopic retrograde cholangiopancreatography, and flexible bronchoscopy (FB). Prospective, randomized, double-blind, parallel-group clinical trial. University-affiliated teaching hospital. We recruited 207 patients scheduled for an endoscopic procedure from October 2021 to December 2021. Patients were randomized into three groups according to the dose during induction (n = 69 each): 1) ciprofol 6 mg/kg/h, 2) ciprofol 8 mg/kg/h, or 3) propofol 40 mg/kg/h. Ciprofol or propofol was administered throughout the procedure. The primary outcome was the success rate of sedation or anesthesia for the procedures. Secondary outcomes included induction time, endoscope insertion time, recovery time, discharge time, incidence of drug-related adverse events (AEs), neurological and inflammatory outcomes. The procedure success rates in the three groups were 100%. The induction time in the 6 (3.3 ± 1.0 min) and 8 mg/kg/h (2.9 ± 0.6 min) ciprofol groups was longer than that in the propofol group (2.5 ± 0.6 min) only in patients undergoing FB (p = 0.004). The time for patients to be fully alert and discharged from the post-anesthesia care unit was comparable across the three groups (p > 0.05). The incidence of drug-related AEs in the propofol and 6 and 8 mg/kg/h ciprofol groups was 84.1%, 76.8%, and 79.7%. No pain on injection was reported by ciprofol groups. Neurological outcomes and inflammatory responses were comparable among the three groups. Ciprofol induced a level of sedation or anesthesia equivalent to that induced by propofol in non-operating room settings except for a prolonged induction time in patients undergoing FB. Ciprofol had a safety profile similar to that of propofol. No pain on injection was reported by ciprofol. •Ciprofol, a novel intravenous anesthetic, and propofol induced equivalent sedation or anesthesia in non-operating room settings.•Ciprofol had a similar safety profile to that of propofol.•No pain on injection was reported by the ciprofol groups.•Ciprofol and propofol anesthesia had similar neurological outcomes and inflammatory parameters.

Procedural sedation and analgesia (PSA) are a common practice in emergency departments (EDs), aiming to alleviate pain, anxiety, and discomfort during various medical procedures. We have undertaken a systematic review and meta-analysis with the aim of assessing the incidence of adverse events associated with PSA, including those related to individual drugs and various drug combinations. The study adhered to PRISMA guidelines for a systematic review and meta-analysis of adverse events in ED sedation. A comprehensive search strategy was employed across ten databases, supplemented by searches on clinicaltrials.gov and manual reviews of reference lists. Data extraction focused on medication administration and adverse events. The study considered four types of adverse events: cardiac, respiratory, gastrointestinal, and neurological. Only randomized controlled trials (RCTs) focusing on PSA administered to adult patients within the ED setting were included. The statistical analysis employed OpenMeta Analyst to conduct a one-arm meta-analysis, with findings presented alongside their corresponding 95% Confidence Intervals. Forest plots were constructed to combine and evaluate results, and sensitivity analyses were performed to identify sources of heterogeneity. From a literature search of 4246 records, 32 RCTs were deemed suitable for this meta-analysis. The analysis included 6377 procedural sedations. The most common adverse event was hypoxia, with an incidence rate of 78.5 per 1000 sedations (95% CI = 77.5–133.5). This was followed by apnea and hypotension, with incidence rates of 31 (95% CI = 19.5–41.8) and 28.1 (95% CI = 17.4–38.9) per 1,000 sedations, respectively. Agitation and vomiting each occurred in 15.6 per 1,000 sedations (95% CI = 8.7–22.6). Severe adverse events were rare, with bradycardia observed in 16.7 per 1,000 sedations, laryngospasm in 2.9 per 1,000 sedations (95% CI =  – 0.1 to 6), intubation in 10.8 per 1,000 sedations (95% CI = 4–17), and aspiration in 2.7 per 1,000 sedations (95% CI =  – 0.3 to 5.7). Ketamine is found to be the safest option in terms of respiratory adverse events, with the lowest rates of apnea and hypoxia, making it the least respiratory depressant among the evaluated drugs. Etomidate has the least occurrence of hypotension when used alone. Propofol has the highest incidence of hypotension when used alone and ranks second in hypoxia-related adverse events after midazolam. Using combinations of sedating agents, such as propofol and ketamine, has been found to offer several advantages over single drugs, especially in reducing adverse events like vomiting, intubation difficulty, hypotension, bradycardia, and laryngospasm. The combination significantly reduces the incidence of hypotension compared to using propofol or ketamine individually. Despite the regular use of procedural sedation, it can sometimes lead to serious adverse events. Respiratory issues like apnea and hypoxia, while not common, do occur more often than cardiovascular problems such as hypotension. However, the least frequent respiratory complications, which can also pose a threat to life, include laryngospasm, aspiration, and intubation. These incidents are extremely rare.

INTRODUCTION:Divergent recommendations for periprocedural management of glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1 RA) medications rely on limited evidence. We performed a systematic review and meta-analysis to provide quantitative measures of gastric emptying relevant to mechanisms of weight loss and to periprocedural management of GLP-1 RA. We hypothesized that the magnitude of gastric emptying delay would be low and of limited clinical significance to procedural sedation risks.METHODS:A protocolized search identified studies on GLP-1 RA that quantified gastric emptying measures. Pooled estimates using random effects were presented as a weighted mean difference with 95% confidence intervals (CIs). Univariate meta-regression was performed to assess the influence of GLP-1 RA type, short-acting vs long-acting mechanism of action, and duration of treatment on gastric emptying.RESULTS:Fifteen studies met the inclusion criteria. Five studies (n = 247) utilized gastric emptying scintigraphy. Mean T1/2 was 138.4 minutes (95% CI 74.5-202.3) for GLP-1 RA vs 95.0 minutes (95% CI 54.9-135.0) for placebo, with a pooled mean difference of 36.0 minutes (95% CI 17.0-55.0, P < 0.01, I2 = 79.4%). Ten studies (n = 411) utilized the acetaminophen absorption test, with no significant delay in gastric emptying measured by Tmax, area under the curve (AUC)4hr, and AUC5hr with GLP-1 RA (P > 0.05). On meta-regression, the type of GLP-1 RA, mechanism of action, and treatment duration did not impact gastric emptying (P > 0.05).DISCUSSION:While a gastric emptying delay of ∼36 minutes is quantifiable on GLP-1 RA medications, it is of limited magnitude relative to standard periprocedural fasting periods. There were no substantial differences in gastric emptying on modalities reflective of liquid emptying (acetaminophen absorption test), particularly at time points relevant to periprocedural care.

Procedural sedation and analgesia (PSA) is a technique involving sedative and analgesic agents to suppress consciousness to varying degrees, providing pain relief simultaneously. The demand for PSA in pediatric populations has increased exponentially as many unpleasant procedures warrant optimum sedation and analgesia. The aim of current study is to evaluate the safety and efficacy of low-dose ketamine and propofol combination in pediatric patients undergoing diagnostic magnetic resonance imaging (MRI). A prospective observational study was performed from July 2020 to January 2022. Patients aged six months to 18 years, weighing more than 5 kg, and undergoing an MRI with an American Society of Anesthesiology (ASA) classification of two or less than two and a Mallampati score of two or less than two were enrolled through a convenience sampling technique. Continuous monitoring of vitals signs was done, and data was collected for drugs doses, duration of sedation, recovery time, adverse events (apnea, hypoxia, failure to sedate). A total of 218 patients were included in the final analysis. The mean age of study population was 4.0 ± 3.2 years, with 60.4% (n = 131) males. MRI was successfully completed under sedation in 213 (97.7%) patients. Indications for MRI were seizure disorders (n = 99, 45.4%) and global developmental delay (GDD) (n = 89, 40.8%). The mean initial dose of ketamine administered was 0.9 ± 0.2 mg/kg, titrated up to a mean total dose of 1.2 ± 0.5 mg/kg. mean initial dose of propofol was 1.1 ± 0.4 mg/kg and titrated to a mean total dose of 2.7 ± 1.4 mg/kg. The mean duration of MRI was 43.8 min, and 81.7% of the patients recovered in less than 5 min. Most patients had respiratory and hemodynamic stability, and only four required suction. This study showed that a combination of low-dose ketamine followed by propofol titration drug is a feasible technique for PSA in pediatric patients undergoing MRI.