Evaluation Of Adverse Events During Painless Gastroscopy In Smokers And Optimizing Anesthesia Protocols Of The Gastroscopy

Part I Evaluation of Adverse Events During Painless Gastroscopy in SmokersObjective: This study was designed to observe and compare the differences in adverse events between smokers and non-smokers in outpatients undergoing painless gastroscopy.Methods: 1.This study was approved by ethics committee of affiliated hospital of Zun Yi medicine university.The patients and their family members are aware of the research content and voluntarily signed the informed consent form.120 patients were divided into smoking group and non-smoking group(n=60)according to whether they smoked or not.Record the patient’s age,height,weight,body mass index and other demographic characteristics,as well as the MOAA/S,ASA grade,smoking history,past medical history,and baseline of vital signs.2.The patient was admitted to the gastroscopy room and received ECG monitoring.inhale oxygen through the mask(4 L/min),inject 50μg of fentanyl intravenously and then intravenously inject propofol 2.0mg/kg,after the patient’s MOAA/S≤2 points,the examination can be started.During the examination,propofol injection 0.5mg/kg/time can be added according to the patient’s condition.Data to be recorded during the inspection:(1)SBP,MAP,DBP,HR once per 3 min;(2)Sp O2,RR,MOAA/S per 1 min;(3)Time variable indicators: anesthesia time,endoscopic operation time,wakeup time,discharge time;(4)drug use details;(5)adverse reactions of the respiratory and circulatory systems,and hiccups,nausea,vomiting,etc.3.After the examination,the patient was sent to the PACU,and continued monitoring until the patient fully recovered.Data recorded during the observation period:(1)SBP,MAP,DBP,HR once per 5 min;(2)Sp O2,RR,MOAA/S per 1 min;(3)Satisfaction score of anesthesiologists and endoscopists.When the patient’s Aldrete ≥9 points,the patient can leave the hospital accompanied by family members.The patients were followed up by telephone and filled out the satisfaction questionnaire in the next day.4.Observation indicators:(1)Main indicators:(1)adverse events of the respiratory system;(2)circulatory system fluctuations and adverse events;(2)secondary indicators:(1)drug use details;(2)time variable indicators;(3)other adverse events;(4)endoscopists,Anesthesiologist and patient satisfaction survey questionnaire score.Results: 1.A total of 120 patients met the criteria and entered the study.8 patients were excluded and dropped out,and 112 patients were finally included.There were 55 cases in the smoking group and 57 cases in the non-smoking group.There was no significant difference in baseline data of age,height,weight,BMI,and modified mallampati score and ASA grade,past medical history,baseline vital signs,and endoscopic operation time,in the two groups(P>0.05).2.Smoking history: There were 55 cases in the smoking group.Distribution of smoking years:(1)0-10 years group: 3 cases;(2)10-20 years group: 26 cases;(3)20-30 years: 0 cases;(4)30-40 years group: 22 cases;(5)>40 years group: 4 cases.3.Adverse events: No patients had serious adverse reactions.The total number of patients with adverse reactions was 34(61.8%)in the smoking group and 32(56.1%)in the non-smoking group.There was no significant difference between the groups(P>0.05).(1)Respiratory adverse events: The total number of adverse events of the respiratory system in the smoking group was 23(41.8%)and 24(42.1%)in the non-smoking group.There was no significant difference between the groups(P>0.05);The incidence of RR<10 beats/min(respiratory depression)in the smoking group(10.91%)was significantly lower than that in the non-smoking group(29.82%)(P<0.05).There was no significant difference in the incidence of postoperative cough and sputum,choking,Sp O2<90%,mandibular support,apnea and assisted ventilation between the two groups(P>0.05). (2)Adverse events in the circulatory system: The adverse events observed in the smoking group and non-smoking group were blood pressure drop and heart rate slowing.There was no significant difference in the incidence of blood pressure drop and heart rate slowing between the two groups(P>0.05).(3)Other adverse events: Other adverse events with a higher incidence were observed during the study:(1)Hiccups: The incidence of 17 cases(30.91%)in the smoking group was significantly higher than that of 8 cases(14.55%)in the non-smoking group(P< 0.05);(2)Dizziness: 1 patient in the non-smoking group had mild dizziness.4.Changes in vital signs: There was no significant difference in vital signs between the two groups of patients before induction of anesthesia,during endoscopy and when entering PACU(P>0.05).(1)Blood pressure: SBP,DBP and MAP of smoking group and non-smoker group were lower than the baseline value before induction of anesthesia.At 6min and 12 min after anesthesia,SBP of smoking group was lower than non-smoking group.At 15 min after anesthesia,smoking The DBP of the group was lower than that of the non-smoking group(P<0.05).But the blood pressure drop in both groups was within a safe range.Those who needed drug intervention were 4 cases(7.27%)in the smoking group and 2 cases(3.51%)in the non-smoking group.The blood pressure drop of the patients improved after treatment with 6 mg of ephedrine.The SBP,DBP,and MAP in the PACU observation period of the smoking group and the non-smoker group gradually increased to the baseline level,and there was no significant difference in blood pressure changes between the two groups of patients during the observation period(P>0.05).(2)HR: The HR of patients in the smoking group showed an upward trend after anesthesia,and there was no significant difference at each time(P>0.05).(3)Sp O2 and RR:The Sp O2 of the two groups of patients after anesthesia was lower than the value under the state of oxygen inhalation before anesthesia,and there was no significant difference in the changes of Sp O2 and RR at each time between the two groups of patients(P>0.05).The Sp O2 of the non-smoking group was slightly higher than that of the smoking group from the 6th to 13 th minutes of entering PACU(P<0.05),but there was no Sp O2<90% in the PACU observation period;there was no RR<10 bpm in the PACU observation period of the two groups There was no significant difference in RR changes at each observation time point(P>0.05).5.MOAA/S: The MOAA/S of the two groups of patients decreased after anesthesia with the same rate of decrease,and both reached the lowest value of MOAA/S within 2 minutes after administration.There was no significant difference in MOAA/S at each time(P>0.05).During the PACU observation period,the MOAA/S of the two groups gradually increased to the baseline level.The MOAA/S score of the smoking group increased more than that of the smoking group,at 3min,4min,6min,7min and 11 min after entering the PACU,the non-smoking group had MOAA /S was higher than the smoking group(P<0.05);6.Details of drug use:(1)Propofol: The total dose of propofol used in the smoking group was greater than that in the non-smoking group(P<0.05);the number of additional patients in the two groups was 31(56.4%)and 30(52.6%),the average number of additional times was 1.39 and 1.20 respectively(P>0.05).(2)Fentanyl: the same dose of fentanyl was used in the two groups(P>0.05).(3)Ephedrine and atropine: There were no significant difference between the two groups(P>0.05).7.Time variable indicators:(1)Time to recovery from anesthesia: The time to wake up for patients in the smoking group and non-smoking group were 18.3 minutes and 17.3 minutes(P>0.05);(2)Time to discharge: the smoking group and the non-smoking group were satisfied to leave the hospital the standard time was 12.87 min and 12.67 min respectively(P>0.05).8.Satisfaction questionnaire scores: There was no significant difference in the scores of the anesthesiologists,endoscopists,and patient satisfaction surveys between the smoking group and the non-smoking group(P>0.05).9.Follow-up after discharge: There was no discomfort or adverse events in the followup after discharge of the two groups of patients.There was no significant difference in the satisfaction survey questionnaire scores between the two groups on the next day(P>0.05).Conclusion: Painless gastroscopy is safe for both smoking and non-smokers,and there is no significant difference in the incidence of adverse events.The recovery time and discharge time of the two groups of patients are similar,but the propofol dosage and hemodynamic fluctuations of the smoking group are both Greater than non-smokers.Part Ⅱ Optimizing Anesthesia Protocols of the GastroscopyObjective: This study was designed to observe and compare the incidence of adverse events and anesthesia effects of alfentanyl and fentanyl combined with propofol for painless gastroscopy.Methods: 1.This study was approved by ethics committee of affiliated hospital of Zun Yi medicine university.The patients and their family members are aware of the research content and voluntarily signed the informed consent form.120 patients were randomly divided into alfentanyl group and fentanyl group(n=60).Record the NRS score,and the rest is the same as the first part of the experiment.2.The patient was admitted to the gastroscopy room and received ECG monitoring.inhale oxygen through the mask(4 L/min),The alfentanyl group received intravenous injection of Alfentanil 5μg/kg,and the fentanyl group received intravenous injection of fentanyl 50μg for pre-analgesia according to our hospital’s routine procedures.Then intravenously inject propofol 2.0mg/kg,after the patient’s MOAA/S≤2 points,the examination can be started.During the examination,propofol injection 0.5mg/kg/time can be added according to the patient’s condition.And observation indexes were basically the same as the first part of the study.3.After the examination,the patient was sent to the PACU,and continued monitoring until the patient fully recovered.Record the patient’s NRS pain score,and the rest of part were basically the same as the first part of the study.When the patient’s Aldrete ≥9 points,the patient can leave the hospital accompanied by family members.The patients were followed up by telephone and filled out the satisfaction questionnaire in the next day.4.Observation indicators:(1)Main indicators: Same as part I.(2)secondary indicators:(1)Record the patient’s NRS pain score,and the rest of part were basically the same as the first part of the study.Results: 1.A total of 120 patients met the criteria and entered the study.1 patient were excluded,and 119 patients were finally included.There were 60 cases in the alfentanyl group and 59 cases in the fentanyl group.There was no significant difference in baseline data of age,height,weight,BMI,and modified mallampati score and ASA grade,NRS pain score,past medical history,baseline vital signs,and endoscopic operation time,in the two groups(P>0.05).2.Adverse events: No patients had serious adverse reactions.The total number of patients with adverse reactions was 27(45.0%)in the alfentanyl group and 34(57.6%)in the fentanyl group.There was no significant difference between the groups(P>0.05).(1)Adverse events of respiratory system: The total number of adverse respiratory reactions in the alfentanyl group was 23(38.3%),and 28(47.5%)in the fentanyl group.There was no significant difference between the groups(P>0.05);3 cases of coughing after anesthesia(5.00%)in the alfentanyl group were significantly lower than 13 cases(22.03%)in the fentanyl group(P<0.05).There was no significant difference in the incidence of postoperative cough and sputum,RR<10 bpm,Sp O2<90%,mandibular support,apnea,and assisted ventilation(P>0.05).(2)Circulatory system adverse events: The only circulatory system adverse reaction observed in the two groups of patients was a drop in blood pressure.The incidence of blood pressure drop in the alfentanyl group was 3 cases(5.00%),and the fentanyl group was 3 cases(5.08%).Among them,3 cases(5.00%)and 2 cases(3.39%)needed drug intervention.The blood pressure drop of the patients improved after treatment with 6 mg of ephedrine.There was no significant difference in the incidence of blood pressure drop between the two groups(P>0.05).(3)Hiccups: During the study,only hiccups were observed in other adverse events.4 cases(6.67%)in the alfentanyl group were significantly lower than 11 cases(18.64%)in the fentanyl group(P<0.05).3.NRS: The two groups of patients did not complain of pain before and after the examination,and the NRS was 0 points.There was no significant difference in the NRS pain score between the two groups(P>0.05).4.Changes in vital signs: There was no significant difference in vital signs between the two groups of patients before induction of anesthesia,and when entering PACU(P>0.05).(1)Blood pressure: The blood pressure of the two groups of patients after anesthesia was lower than the baseline value,and the blood pressure drop of the two groups was within a safe range,and there was no significant difference in SBP,DBP and MAP changes at each time(P>0.05).The blood pressure during the PACU observation period of the alfentanyl group and the fentanyl group gradually rose to the baseline level,and there was no significant difference in blood pressure changes during the PACU observation period between the two groups(P>0.05).(2)HR: There was no significant difference in HR changes between the two groups of patients at each time after anesthesia to the patient’s recovery(P>0.05).(3)Sp O2 and RR: No severe hypoxemia or respiratory depression occurred in the two groups.The Sp O2 of the alfentanyl group decreased more than that of the fentanyl group within 3 minutes after anesthesia,the Sp O2 of the alfentanyl group was lower than that of the fentanyl group from 1 to 3 minutes after anesthesia,and the Sp O2 of the alfentanyl group was higher than the fentanyl group at 11 minutes after anesthesia(P<0.05),PACU observation period There was no significant difference in Sp O2 changes at each observation time point(P>0.05);there was no significant difference in RR changes at each time in the inspection period and PACU observation period between the two groups(P>0.05).5.MOAA/S: Both groups of patients reached the lowest value of MOAA/S score within 2 minutes after anesthesia.The MOAA/S of the alfentanyl group was lower than the fentanyl group during the inspection period.Within 2-6 minutes and 12-14 minutes after anesthesia,the MOAA/S of the alfentanyl group was significantly lower than that of the fentanyl group(P<0.05).During the PACU observation period,the MOAA/S of the two groups gradually rose to the baseline level steadily,and there was no significant difference in MOAA/S changes at each time(P>0.05).6.Details of drug use:(1)Alfentanyl drugs: The alfentanyl group was intravenously injected with Alfentanyl 5μg/kg,the minimum dose was 220μg,the maximum dose was 420μg,and the average dose was 309.00±45.09μg;the fentanyl group was intravenously injected fentanyl 50μg according to our hospital’s routine operation.(2)Propofol: There was no significant difference in the total dose of propofol between the two groups(P>0.05);the number of additional cases in the alfentanyl group was 15 cases(25.00%)lower than 36 cases in the fentanyl group(61.01%)(P<0.05).(3)Ephedrine and atropine: There were no significant difference in the use of ephedrine and atropine between the two groups(P>0.05).7.Time variable indicators:(1)Time to recovery from anesthesia: The time to wake up for patients in the alfentanyl group and the fentanyl group were 16.93 min and 16.64min(P>0.05).(2)Time to discharge: the discharge time of patients in the alfentanyl group was 9.88 min significantly lower than that in the fentanyl group 12.34 min(P<0.05).8.Satisfaction questionnaire score: the satisfaction survey scores of the anesthesiologists and endoscopists in the alfentanyl group were better than those of the fentanyl group(P<0.05);there was no significant difference in the two groups of patient satisfaction questionnaire scores(P>0.05).9.Follow-up after discharge: There was no discomfort or adverse events in the followup after discharge of the two groups of patients.There was no significant difference in the satisfaction survey questionnaire scores between the two groups on the next day(P>0.05).Conclusion: Optimize the analgesic strategy and use alfentanil for painless gastroscopy,which can significantly reduce the incidence of coughing and hiccups after anesthesia,reduce the dosage of propofol,shorten the patient’s discharge time,and do not increase the adverse events of the patient’s respiratory and circulatory systems.