Mahmoud H (Haj Yousef) Ayesh, Ahnaf M Bataineh, Mohamed Rababeih, Sulieman M Momani and Khaldoon Alawneh
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Ivan Barbov, Jasmina Korunoska, Valentina Bonevska and Aleksandar Smokovski
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Adina Hadade, Daniela Ionescu, Teodora Mocan, Alexandru Necula and Victor Cristea
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Somchai Amornyotin, Wichit Srikureja, Nonthalee Pausawasdi and Udom Kachintorn
Background: The use of sedation for gastrointestinal endoscopy (GIE) procedures in elderly patients has been established as a safe and effective technique. However, it is still uncertain whether the situation is valid for Asians.
Objective: Evaluate the outcome of intravenous sedation (IVS) for GIE procedures in very elderly patients (>86 years old) in Thailand and compare the clinical efficacy of IVS between very elderly and those younger (<86 years old)
Methods: We undertook a retrospective review of the sedation service records of patients who underwent GIE procedures between 2007 and 2008 at Siriraj Hospital, Thailand. All sedations were administered by anesthetic personnel in the endoscopy room. The cohort was divided into three groups, <65 years old (group 1), 65-85 years old (group 2), and >86 years old (group 3).
Results: Sedation was provided for 1,779 patients (965, 687, and 127 patients in group 1, 2, and 3, respectively) in 2,061 GIE procedures. Fentanyl, midazolam and propofol were the most common IVS drugs used in all three groups. Patients in group 3 required lower mean doses of these intravenous sedatives than those in group 1 or 2 (p <0.001). Mean procedure time in group 3 was longer than in group 1 or 2 (p=0.010). Adverse events in group 3 occurred more frequently when compared to group 1 or 2 (p <0.001). Transient hypotension was the main complication across all aged groups.
Conclusion: IVS for GIE procedure in very elderly patients was associated with higher minor advance events but relatively safe and effective when carried out by trained anesthetic personnel with appropriate monitoring and dose adjustment.
Background: Increasing numbers of acute adverse reactions to contrast media are being seen. Institutional information about incidence and severity of acute adverse reactions to contrast media is essential to inform radiologists of the both common and life-threatening acute adverse reactions encountered.
Objectives: We determined the overall, type-specific and severity of acute adverse reactions to intravenous iodinated contrast media at King Chulalongkorn Memorial hospital between January 2002 and December 2009.
Methods: This retrospective study reviewed 663 report forms for acute adverse reactions to contrast media among 74,010 intravenous iodinated contrast injections using five types of contrast media including meglumine/sodium ioxitalamate, iohexol, iopamidol, iopromide, and iobitridol.
Results: The overall incidence of acute adverse reactions to iodinated contrast media was about 0.9%. Of these 0.8% were minor, and 0.1% were major reactions. The majority of minor reactions were urticaria and the majority of major reactions were facial edema. One contrast-related death was reported. Incidence of acute adverse reactions to nonionic contrast media was 0.58%, and was 4.29 % in the ionic group. The type-specific incidence of acute adverse reactions was 4.29% for meglumine/sodium ioxitalamate, 0.82% for iohexol, 0.29% for iopamidol, 0.65% for iopromide, and 0.25% for iobitridol.
Conclusion: Acute adverse reactions to intravenous iodinated contrast media account for less than one percent of injections. The incidence is higher in the ionic contrast media group. The majority of reactions are mild. However, severe reactions can still be encountered and death related to contrast media exist.
Lipták Tomáš, Capík Igor, Ledecký Valent, Nagy Oskar, Kuricová Mária, Tóthová Csilla, Maďari Aladár, Farbáková Jana, Petrovič Vladimír and Horňák Slavomír
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