Doxapram as an additive to propofol sedation for endoscopic retrograde cholangiopancreatography : a placebo-controlled, randomized, double-blinded study

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Jokelainen , J , Belozerskikh , A , Mustonen , H , Udd , M , Kylänpää , L , Lindström , O , Mazanikov , M & Pöyhiä , R 2020 , ' Doxapram as an additive to propofol sedation for endoscopic retrograde cholangiopancreatography : a placebo-controlled, randomized, double-blinded study ' , Surgical Endoscopy , vol. 34 , no. 12 , pp. 5477-5483 . https://doi.org/10.1007/s00464-019-07344-2

Title: Doxapram as an additive to propofol sedation for endoscopic retrograde cholangiopancreatography : a placebo-controlled, randomized, double-blinded study
Author: Jokelainen, Jarno; Belozerskikh, Anna; Mustonen, Harri; Udd, Marianne; Kylänpää, Leena; Lindström, Outi; Mazanikov, Maxim; Pöyhiä, R.
Contributor: University of Helsinki, South Carelia Social and Health care District Eksote
University of Helsinki, Anestesiologian yksikkö
University of Helsinki, HUS Abdominal Center
University of Helsinki, Clinicum
University of Helsinki, Department of Surgery
University of Helsinki, University of Helsinki
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
Date: 2020-12
Language: eng
Number of pages: 7
Belongs to series: Surgical Endoscopy
ISSN: 0930-2794
URI: http://hdl.handle.net/10138/325637
Abstract: Background Endoscopic retrograde cholangiopancreatography (ERCP) requires moderate to deep sedation, usually with propofol. Adverse effects of propofol sedation are relatively common, such as respiratory and cardiovascular depression. This study was conducted to determine if doxapram, a respiratory stimulant, could be used to reduce the incidence of respiratory depression. Methods This is a single-center, prospective randomized double-blind study performed in the endoscopy unit of Helsinki University Central Hospital. 56 patients were randomized in a 1:1 ratio to either receive doxapram as an initial 1 mg/kg bolus and an infusion of 1 mg/kg/h (group DOX) or placebo (group P) during propofol sedation for ERCP. Main outcome measures were apneic episodes and hypoxemia (SpO(2) <90%). Mann-Whitney test for continuous variables and Fisher's exact test for discrete variables were used and mixed effects modeling to take into account repeated measurements on the same subject and comparing both changes within a group as a function of time and between the groups. Results There were no statistically significant differences in apneic episodes (p = 0.18) or hypoxemia (p = 0.53) between the groups. There was a statistically significant rise in etCO(2) levels in both groups, but the rise was smaller in group P. There was a statistically significant rise in Bispectral Index (p = 0.002) but not modified Observer's Assessment of Agitation/Sedation (p = 0.21) in group P. There were no statistically significant differences in any other measured parameters. Conclusions Doxapram was not effective in reducing respiratory depression caused by deep propofol sedation during ERCP. Further studies are warranted using different sedation protocols and dosing regimens.
Subject: Endoscopy
Sedation
Cholangiopancreatography
Endoscopic
Doxapram
Propofol
VENTILATORY RESPONSES
ANESTHESIA
AMINOPHYLLINE
RECOVERY
PATIENT
AROUSAL
ERCP
3126 Surgery, anesthesiology, intensive care, radiology
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