Prior to the CP, patients were informed about the possibility of IPP, PPP, and PONV. They were trained on the use of the Numeric Pain Rating Scale (NRS) to report pain. On a scale from 0 to 10, 0 indicated no pain, and 10 indicated the worst pain imaginable. Patients were also evaluated for the risk of PONV using the APFEL score before the procedure in order to ensure the homogeneity of the groups. Apfel score is a widely recognized risk score having broad applicability in predicting the incidence of PONV in adults undergoing anesthesia for various types of surgical procedures. Female gender, history of motion sickness or PONV, nonsmoking status, and the use of postoperative opioids were recognized to constitute the independent risk factors of occurrence of PONV. If none, one, two, three, or four of these risk factors were present, the incidences of PONV were estimated as follows: 10%, 21%, 39%, 61%, and 79%, respectively [48 (link),49 (link)].
Prior to the induction of ISA, 10 mL/kg of Optylite Solution (Fresenius Kabi, Kutno, Poland) was administered intravenously. At the induction of ISA, performed according to the current guidelines of the ASA Committee on Quality Management and Departmental Administration regarding the definition of general anesthesia and the levels of sedation/analgesia (43), patients in all groups received a bolus of 1 mcg/kg of FNT (Fentanyl WZF, 50 mcg/mL; 2m, Polfa Warsawa, S.A, Warsaw, Poland) intravenously, and all patients were subsequently induced with 0.5 mg/kg of propofol every 2 min until the depth of sedation reached SE < 70 in the SE and AoA groups and until the eyelash reflex was lost in the control group. During maintenance, additional boluses of 0.5 mg/kg of propofol were administered intravenously in the SE and AoA groups with a target value of 60–70 and using conventional methods in the control group. In the event of inadequate analgesia, confirmed by an increase in SPI >15 from baseline values in the AoA group or an increase in mean blood pressure and heart rate >30% from baseline values in the SE and control groups, additional boluses of 0.5 mcg/kg of FNT were given intravenously at 2-min intervals until a normalization of SPI values in the AoA group or a normalization of hemodynamic parameters in the SE and control group.
Intraprocedural monitoring included pulse oximetry (SpO2), electrocardiography (ECG), non-invasive blood pressure monitoring of systolic arterial pressure (SAP), mean arterial pressure (MAP), diastolic arterial pressure (DAP), RE and SE, and SPI, according to group allocation. A single dose of 10 mg of ephedrine (Ephedrinum hydrochloricum WZF 25 mg/mL; 1 mL Polfa Warsawa, Poland) was administered if MAP decreased <60 mmHg, and a single dose of 0.5 mg of atropine (Atropinum sulfuricum WZF 1 mg/mL; 1 mL Polfa Warsawa, Poland) was administered if HR decreased <45 bpm, at 3 min intervals, until the abovementioned values returned to the normal level.
Postoperatively, patients were evaluated during the first 24 h for incidence of PONV and pain intensity using the NRS scale, and patients’ and endoscopists’ satisfaction was graded using a specially designed satisfaction scale. In the case of PPP, to meet each patient’s specific needs, postoperative analgesia was provided according to the current guidelines of the Polish Society of Anesthesiology and Intensive Therapy [30 (link)].
The statistical analysis perioperative period was divided into three stages: Stage 1: before the induction of ISA; Stage 2: CP; Stage 3: observance after the CP in a postanesthesia care unit (PACU) until full patient recovery from ISA.
Prior to the induction of ISA, 10 mL/kg of Optylite Solution (Fresenius Kabi, Kutno, Poland) was administered intravenously. At the induction of ISA, performed according to the current guidelines of the ASA Committee on Quality Management and Departmental Administration regarding the definition of general anesthesia and the levels of sedation/analgesia (43), patients in all groups received a bolus of 1 mcg/kg of FNT (Fentanyl WZF, 50 mcg/mL; 2m, Polfa Warsawa, S.A, Warsaw, Poland) intravenously, and all patients were subsequently induced with 0.5 mg/kg of propofol every 2 min until the depth of sedation reached SE < 70 in the SE and AoA groups and until the eyelash reflex was lost in the control group. During maintenance, additional boluses of 0.5 mg/kg of propofol were administered intravenously in the SE and AoA groups with a target value of 60–70 and using conventional methods in the control group. In the event of inadequate analgesia, confirmed by an increase in SPI >15 from baseline values in the AoA group or an increase in mean blood pressure and heart rate >30% from baseline values in the SE and control groups, additional boluses of 0.5 mcg/kg of FNT were given intravenously at 2-min intervals until a normalization of SPI values in the AoA group or a normalization of hemodynamic parameters in the SE and control group.
Intraprocedural monitoring included pulse oximetry (SpO2), electrocardiography (ECG), non-invasive blood pressure monitoring of systolic arterial pressure (SAP), mean arterial pressure (MAP), diastolic arterial pressure (DAP), RE and SE, and SPI, according to group allocation. A single dose of 10 mg of ephedrine (Ephedrinum hydrochloricum WZF 25 mg/mL; 1 mL Polfa Warsawa, Poland) was administered if MAP decreased <60 mmHg, and a single dose of 0.5 mg of atropine (Atropinum sulfuricum WZF 1 mg/mL; 1 mL Polfa Warsawa, Poland) was administered if HR decreased <45 bpm, at 3 min intervals, until the abovementioned values returned to the normal level.
Postoperatively, patients were evaluated during the first 24 h for incidence of PONV and pain intensity using the NRS scale, and patients’ and endoscopists’ satisfaction was graded using a specially designed satisfaction scale. In the case of PPP, to meet each patient’s specific needs, postoperative analgesia was provided according to the current guidelines of the Polish Society of Anesthesiology and Intensive Therapy [30 (link)].
The statistical analysis perioperative period was divided into three stages: Stage 1: before the induction of ISA; Stage 2: CP; Stage 3: observance after the CP in a postanesthesia care unit (PACU) until full patient recovery from ISA.
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