Digestive diseases and sciences
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Randomized Controlled Trial
Bispectral index monitoring for nurse-administered propofol sedation during upper endoscopic ultrasound: a prospective, randomized controlled trial.
Bispectral index monitoring (BIS) is a quantitative assessment of brain cortical activity. The aim of this study was to determine if BIS-guided nurse-administered propofol sedation would decrease by > or = 20% both recovery time and propofol dose compared to standard propofol sedation for endoscopic ultrasound (EUS). Prospectively, eligible outpatients were randomized to BIS-guided or standard propofol sedation during EUS. ⋯ Of 50 patients enrolled, data for 44 randomized to BIS-guidance (n = 24) and the control group (n = 20) were evaluated. Between the BIS-guided and control group there was no difference between the mean procedure duration, total propofol dose, recovery time, mean intraoperative MOAA/S, and mean BIS score. Compared to standard propofol sedation for EUS, BIS-guided propofol sedation offers no significant decrease in postprocedure recovery times or propofol doses.
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Randomized Controlled Trial
Intramuscular neostigmine and glycopyrrolate safely accelerated bowel evacuation in patients with spinal cord injury and defecatory disorders.
Difficulty with evacuation after spinal cord injury (SCI) may be due to a lack of parasympathetic stimulation of the colon. Prior studies in persons with spinal cord injury have suggested that intravenous administration of neostigmine stimulates colonic motility while glycopyrrolate attenuates some of the cholinergic side effects of neostigmine. We thus performed a double-blind, cross-over study to evaluate the effect of neostigmine/glycopyrrolate injections in patients with SCI and defecatory difficulties. ⋯ Compared with placebo, neostigmine/glycopyrrolate reduced the total bowel evacuation time from 98.1 +/- 7.2 to 74.8 min +/- 5.8 (p < 0.05). The lowest heart rate or blood pressure was not significantly different between the treatment and placebo groups. In conclusion, neostigmine/glycopyrrolate may improve bowel evacuation in patients with SCI-related defecatory disorders.