Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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New sedatives and analgesic drugs for gastrointestinal endoscopic procedures

  • Jae Min Lee (Department of Internal Medicine, Korea University Anam Hospital) ;
  • Yehyun Park (Department of Internal Medicine, Ewha Womans University Seoul Hospital) ;
  • Jin Myung Park (Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine) ;
  • Hong Jun Park (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Jun Yong Bae (Department of Internal Medicine and Digestive Disease Center, Seoul Medical Center) ;
  • Seung Young Seo (Department of Internal Medicine and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital) ;
  • Jee Hyun Lee (Department of Pediatrics, Seoul Metropolitan Children's Hospital) ;
  • Hyung Ku Chon (Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine) ;
  • Jun-Won Chung (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Hyun Ho Choi (Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jun Kyu Lee (Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Byung-Wook Kim (Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Endoscopic Sedation Committee of the Korean Society of Gastrointestinal Endoscopy (Korean Society of Gastrointestinal Endoscopy)
  • Received : 2021.11.15
  • Accepted : 2022.03.02
  • Published : 2022.09.30
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Abstract

Procedural sedation has become increasingly common in endoscopy. Sedatives and analgesics induce anxiolysis and amnesia. In addition, an appropriate level of sedation is necessary for safe procedures including therapeutic endoscopy. Midazolam and propofol are the most commonly used drugs in sedative endoscopy. In recent years, the need to ascertain the safety and effectiveness of sedation has increased in practice. Therefore, new sedatives and analgesic drugs for optimal sedative endoscopy, have recently emerged. This article reviews the characteristics of sedatives and analgesics, and describes their clinical use in gastrointestinal endoscopy.

Keywords

References

  1. Conscious Sedation TFT Committee of KSGE. A guidebook on sedation for gastrointestinal endoscopy. Seoul: Medbook; 2015. 
  2. Training Committee. American Society for Gastrointestinal Endoscopy. Training guideline for use of propofol in gastrointestinal endoscopy. Gastrointest Endosc 2004;60:167-172. 
  3. Waring JP, Baron TH, Hirota WK, et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 2003;58:317-322. 
  4. Goudra BG, Singh PM. Propofol alternatives in gastrointestinal endoscopy anesthesia. Saudi J Anaesth 2014;8:540-545. 
  5. Goudra B, Gouda G, Mohinder P. Recent developments in drugs for GI endoscopy sedation. Dig Dis Sci 2020;65:2781-2788. 
  6. Forman SA. Clinical and molecular pharmacology of etomidate. Anesthesiology 2011;114:695-707. 
  7. Han SJ, Lee TH, Yang JK, et al. Etomidate sedation for advanced endoscopic procedures. Dig Dis Sci 2019;64:144-151. 
  8. Lee JM, Min G, Lee JM, et al. Efficacy and safety of etomidate-midazolam for screening colonoscopy in the elderly: a prospective double-blinded randomized controlled study. Medicine (Baltimore) 2018;97:e10635. 
  9. Zhou X, Li BX, Chen LM, et al. Etomidate plus propofol versus propofol alone for sedation during gastroscopy: a randomized prospective clinical trial. Surg Endosc 2016;30:5108-5116. 
  10. Chen L, Liang X, Tan X, et al. Safety and efficacy of combined use of propofol and etomidate for sedation during gastroscopy: systematic review and meta-analysis. Medicine (Baltimore) 2019;98:e15712. 
  11. Kim JH, Byun S, Choi YJ, et al. Efficacy and safety of etomidate in comparison with propofol or midazolam as sedative for upper gastrointestinal endoscopy. Clin Endosc 2020;53:555-561. 
  12. Scheinin H, Aantaa R, Anttila M, et al. Reversal of the sedative and sympatholytic effects of dexmedetomidine with a specific alpha2-adrenoceptor antagonist atipamezole: a pharmacodynamic and kinetic study in healthy volunteers. Anesthesiology 1998;89:574-584. 
  13. Liu W, Yu W, Yu H, et al. Comparison of clinical efficacy and safety between dexmedetomidine and propofol among patients undergoing gastrointestinal endoscopy: a meta-analysis. J Int Med Res 2021;49:3000605211032786. 
  14. Chen YT, Sun CK, Wu KY, et al. The use of propofol versus dexmedetomidine for patients receiving drug-induced sleep endoscopy: a meta-analysis of randomized controlled trials. J Clin Med 2021;10:1585. 
  15. Nishizawa T, Suzuki H, Hosoe N, et al. Dexmedetomidine vs propofol for gastrointestinal endoscopy: a meta-analysis. United European Gastroenterol J 2017;5:1037-1045. 
  16. Nishizawa T, Suzuki H, Sagara S, et al. Dexmedetomidine versus midazolam for gastrointestinal endoscopy: a meta-analysis. Dig Endosc 2015;27:8-15. 
  17. Belleville JP, Ward DS, Bloor BC, et al. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology 1992;77:1125-1133. 
  18. Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000;90:699-705. 
  19. Jalowiecki P, Rudner R, Gonciarz M, et al. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology 2005;103:269-273. 
  20. Zhang F, Sun HR, Zheng ZB, et al. Dexmedetomidine versus midazolam for sedation during endoscopy: a meta-analysis. Exp Ther Med 2016;11:2519-2524. 
  21. Kilpatrick GJ, McIntyre MS, Cox RF, et al. CNS 7056: a novel ultra-short-acting benzodiazepine. Anesthesiology 2007;107:60-66. 
  22. Goudra BG, Singh PM. Remimazolam: the future of its sedative potential. Saudi J Anaesth 2014;8:388-991. 
  23. Borkett KM, Riff DS, Schwartz HI, et al. A phase IIa, randomized, double-blind study of remimazolam (CNS 7056) versus midazolam for sedation in upper gastrointestinal endoscopy. Anesth Analg 2015;120:771-780. 
  24. Chen SH, Yuan TM, Zhang J, et al. Remimazolam tosilate in upper gastrointestinal endoscopy: a multicenter, randomized, non-inferiority, phase III trial. J Gastroenterol Hepatol 2021;36:474-481. 
  25. Zhu X, Wang H, Yuan S, et al. Efficacy and safety of remimazolam in endoscopic sedation-a systematic review and meta-analysis. Front Med (Lausanne) 2021;8:655042. 
  26. Jhuang BJ, Yeh BH, Huang YT, et al. Efficacy and safety of remimazolam for procedural sedation: a meta-analysis of randomized controlled trials with trial sequential analysis. Front Med (Lausanne) 2021;8:641866. 
  27. Domino EF, Chodoff P, Corssen G. Pharmacologic effects of CI581, a new dissociative anesthetic, in man. Clin Pharmacol Ther 1965;6:279-291. 
  28. Cohen LB, Delegge MH, Aisenberg J, et al. AGA institute review of endoscopic sedation. Gastroenterology 2007;133:675-701. 
  29. Akbulut UE, Saylan S, Sengu B, et al. A comparison of sedation with midazolam-ketamine versus propofol-fentanyl during endoscopy in children: a randomized trial. Eur J Gastroenterol Hepatol 2017;29:112-118. 
  30. Eskander AE, Baroudy NR, Refay AS. Ketamine sedation in gastrointestinal endoscopy in children. Open Access Maced J Med Sci 2016;4:392-396. 
  31. Lee YM, Kang B, Kim YB, et al. Procedural sedation for pediatric upper gastrointestinal endoscopy in Korea. J Korean Med Sci 2021;36:e136. 
  32. Fechner J, Ihmsen H, Jeleazcov C, et al. Fospropofol disodium, a water-soluble prodrug of the intravenous anesthetic propofol (2,6-diisopropylphenol). Expert Opin Investig Drugs 2009;18:1565-1571. 
  33. Cohen LB. Clinical trial: a dose-response study of fospropofol disodium for moderate sedation during colonoscopy. Aliment Pharmacol Ther 2008;27:597-608. 
  34. Toklu S, Iyilikci L, Gonen C, et al. Comparison of etomidate-remifentanil and propofol-remifentanil sedation in patients scheduled for colonoscopy. Eur J Anaesthesiol 2009;26:370-376. 
  35. Mandel JE, Tanner JW, Lichtenstein GR, et al. A randomized, controlled, double-blind trial of patient-controlled sedation with propofol/remifentanil versus midazolam/fentanyl for colonoscopy. Anesth Analg 2008;106:434-439. 
  36. Fossler MJ, Sadler BM, Farrell C, et al. Oliceridine (TRV130), a novel G protein-biased ligand at the μ-opioid receptor, demonstrates a predictable relationship between plasma concentrations and pain relief. I: development of a pharmacokinetic/pharmacodynamic model. J Clin Pharmacol 2018;58:750-761. 
  37. Food and Drug Administration (FDA). FDA approved drug products: Olinvyk (Oliceridine) injection [Internet]. Silver Spring (MD): FDA; 2020 [cited 2022 Jan 17]. Available from: https://www.access-data.fda.gov/drugsatfda_docs/label/2020/210730s000lbl.pdf. 
  38. Singla N, Minkowitz HS, Soergel DG, et al. A randomized, phase IIb study investigating oliceridine (TRV130), a novel μ-receptor G-protein pathway selective (μ-GPS) modulator, for the management of moderate to severe acute pain following abdominoplasty. J Pain Res 2017;10:2413-2424. 
  39. Liang DY, Li WW, Nwaneshiudu C, et al. Pharmacological characters of oliceridine, a μ-opioid receptor G-protein-biased ligand in mice. Anesth Analg 2019;129:1414-1421.