Published online Nov 28, 2017. doi: 10.3748/wjg.v23.i44.7875
Peer-review started: August 19, 2017
First decision: August 29, 2017
Revised: September 4, 2017
Accepted: September 13, 2017
Article in press: September 13, 2017
Published online: November 28, 2017
To investigate the efficacy and safety of a combination of sufentanil and propofol injection in patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices (EVs).
Patients with severe EVs who underwent EIS with sufentanil and propofol anesthesia between April 2016 and July 2016 at our hospital were reviewed. Although EIS and sequential therapy were performed under endotracheal intubation, we only evaluated the efficacy and safety of anesthesia for the first EIS procedure. Patients were intravenously treated with 0.5-1 μg/kg sufentanil. Anesthesia was induced with 1-2 mg/kg propofol and maintained using 2-5 mg/kg per hour of propofol. Information, regarding age, sex, weight, American Association of Anesthesiologists (ASA) physical status, Child-Turcotte-Pugh (CTP) classification, indications, preanesthetic problems, endoscopic procedure, successful completion of the procedure, anesthesia time, recovery time, and anesthetic agents, was recorded. Adverse events, including hypotension, hypertension, bradycardia, and hypoxia, were also noted.
Propofol and sufentanil anesthesia was provided in 182 procedures involving 140 men and 42 women aged 56.1 ± 11.7 years (range, 25-83 years). The patients weighed 71.4 ± 10.7 kg (range, 45-95 kg) and had ASA physical status classifications of II (79 patients) or III (103 patients). Ninety-five patients had a CTP classification of A and 87 had a CTP classification of B. Intravenous anesthesia was successful in all cases. The mean anesthesia time was 33.1 ± 5.8 min. The mean recovery time was 12.3 ± 3.7 min. Hypotension occurred in two patients (1.1%, 2/182). No patient showed hypertension during the endoscopic therapy procedure. Bradycardia occurred in one patient (0.5%, 1/182), and hypoxia occurred in one patient (0.5%, 1/182). All complications were easily treated with no adverse sequelae. All endoscopic procedures were completed successfully.
The combined use of propofol and sufentanil injection in endotracheal intubation-assisted EIS for EVs is effective and safe.
Core tip: Propofol is widely used during painless endoscopy because of its rapid onset and rapid recovery properties. Intravenous injection of propofol during endoscopic esophageal varices therapy can reduce the complications associated with poor patient cooperation. Because of complications related to bleeding during endoscopic variceal ligation and endoscopic injection sclerotherapy (EIS), endotracheal intubation is essential for these procedures. However, due to its weak analgesic effect, intraoperative pain stimulation is greater, leading to overt physical movement, thus affecting the operation. Since analgesics are often required to ensure a successful operation, in this study, we used a combination of sufentanil and propofol injection for the endoscopic treatment of esophageal varices. In conclusion, sufentanil and propofol injection, with endotracheal intubation-assisted EIS is effective and safe.