Biomedical subjects

A C N Li

Publications and source records attributed to A C N Li.

3 recordsLinked to original sources

PubMed2004

Can visual distraction decrease the dose of patient-controlled sedation required during colonoscopy? A prospective randomized controlled trial.

BACKGROUND AND STUDY AIMS: We previously demonstrated that audio distraction using relaxation music could lead to a decrease in the dose of sedative medication required and improve patient satisfaction during colonoscopy. This prospective randomized controlled trial was designed to test the hypotheses that visual distraction may also decrease the requirement for sedatives and that audio and visual distraction may have additive beneficial effects when used in combination. PATIENTS AND METHODS: 165 consecutive patients who underwent elective colonoscopy were randomly allocated into three groups to receive different modes of sedation: group 1 received visual distraction and patient-controlled sedation (PCS); group 2 received audiovisual distraction and PCS; group 3 received PCS alone. A mixture of propofol and alfentanil, delivered by a Graseby 3300 PCA pump, was used for PCS in these groups. Each bolus of PCS delivered 4.8 mg propofol and 12 micro g alfentanil. Measured outcomes included the dose of PCS used, complications, recovery time, pain score, satisfaction score, and willingness to use the same mode of sedation if the procedure were to be repeated. RESULTS: Eight patients were excluded after randomization. The mean+/-SD dose of propofol used in group 2 (0.81 mg/kg +/- 0.49) was significantly less than the dose used in group 1 (1.17 mg/kg +/- 0.81) and that used in group 3 (1.18 mg/kg +/- 0.60) ( P < 0.01, one-way analysis of variance). The mean +/- SD pain score was also lower in group 2 (5.1 +/- 2.5), compared with the pain scores in group 1 (6.2 +/- 2.2) and group 3 (7.0 +/- 2.4) ( P < 0.01, one-way analysis of variance). The mean +/- SD satisfaction score was higher in groups 1 (8.2 +/- 2.4)) and 2 (8.4 +/- 2.4), compared with the score in group 3 (6.1 +/- 2.9) ( P < 0.01, one-way analysis of variance). A majority of patients in groups 1 (73 %) and 2 (85 %) said that they would be willing to use the same mode of sedation again, compared with only 53 % in group 3 ( P < 0.01, chi-squared test). CONCLUSIONS: Visual distraction alone did not decrease the dose of sedative medication required for colonoscopy. When audio distraction was added, both the dose of sedative medication required and the pain score decreased significantly. Both visual and audiovisual distraction might improve patients' acceptance of colonoscopy.

Acoustic Stimulation↗

PubMed2004

The safety, feasibility, and acceptability of patient-controlled sedation for colonoscopy: prospective study.

OBJECTIVE: To assess the safety, feasibility, and acceptability of patient-controlled sedation for elective day-case colonoscopy, and the factors predicting patients' unwillingness to use patient-controlled sedation for colonoscopy. DESIGN: Prospective, non-randomised study. SETTING: University-affiliated endoscopy centre, Hong Kong. PARTICIPANTS: Five hundred patients who underwent elective day-case colonoscopy were prospectively recruited from January 2001 to June 2002. INTERVENTION: Sedation for colonoscopy was a mixture of propofol and alfentanil, which was delivered by means of a patient-controlled syringe pump. Each bolus delivered 4.8 mg propofol and 12 microg alfentanil. No loading dose was used and the lockout time was set at zero. MAIN OUTCOME MEASURES: Cardiopulmonary complications, dose of patient-controlled sedation used, recovery time, satisfaction score, delayed side-effects, and the willingness to use the same sedation protocol for future colonoscopy. A multiple stepwise logistic regression model was used to assess which factors might predict unwillingness to use patient-controlled sedation for colonoscopy. RESULTS: The mean (standard deviation) age of patients was 53.0 (13.9) years. The mean dose of propofol consumed was 0.93 (0.69) mg/kg. Forty-three (8.6%) patients developed hypotension during the procedure. The mean satisfaction score was 7.2 (2.6). Sixteen (3.2%) patients developed delayed side-effects. The median (interquartile range) recovery time was 0 (0-5) minutes. Approximately 78% of patients were willing to use patient-controlled sedation for future colonoscopy if needed. Younger age (<50 years), female sex, a higher mean dose of sedatives used, a lower satisfaction score, and the presence of delayed side-effects were independent factors that were associated with patients' unwillingness to use patient-controlled sedation for colonoscopy. CONCLUSION: . The use of patient-controlled sedation for elective colonoscopy is safe, feasible, and acceptable to most patients.

Adolescent↗

PubMed2004

Percutaneous cholecystostomy for the treatment of acute cholecystitis in the critically ill and elderly.

OBJECTIVE: To evaluate the clinical efficacy and outcomes of percutaneous cholecystostomy as an alternative treatment option for elderly and critically ill patients who have acute cholecystitis. PATIENTS AND METHODS: The medical records of patients who underwent emergency percutaneous cholecystostomy at the North District Hospital, Hong Kong from September 1999 to July 2002 were reviewed. Indications for the procedure, patient demographics, and other clinical details were recorded. RESULTS: A total of 25 patients (10 male, 15 female) with a median age of 81 years (range, 39-97 years) presented with acute cholecystitis and underwent percutaneous cholecystostomy with ultrasound guidance. Two patients required emergency cholecystectomy on day 1 after the procedures because of deteriorating conditions. The rest of the patients clinically improved after drainage. There was no major periprocedural complication, and four patients had their catheter accidentally dislodged but did not require re-insertion. There were five in-patient mortalities, although the majority of these deaths were from unrelated illness. Subsequently, only six patients underwent elective cholecystectomy, one open and five laparoscopic. Two patients were offered percutaneous endoscopic cholecystolithotripsy, one defaulted and the other could not tolerate the procedure. Eleven patients declined further intervention due to the high surgical risks, three of these patients developed biliary symptoms, one had acute cholecystitis, and the other two had cholangitis. The rest of patients had no symptoms related to the gallstones. The median follow-up period was 81 weeks (range, 27-162 weeks). CONCLUSION: Percutaneous cholecystostomy is a viable treatment option for elderly and critically ill patients presenting with acute cholecystitis. It has a high success rate with minimal procedure-related complications. Elective cholecystostomy is the treatment of choice for low-risk patients after the initial acute cholecystitis.

Adult↗