Reviewer's report
Title:Comparison between the recovery time of alfentanil and fentanyl in
balanced propofol sedation for gastrointestinal and colonoscopy: a prospective,
randomized study
Version: 1Date:19 August 2012
Reviewer: Barbara Braden
Reviewer's report:
General comments
This randomized, double-blind study by Ho et coworkers is clearly designed and
well presented. It compares alfentanil and fentanyl for additional sedo-analgesia
in patients undergoing combined gastroscopy and colonoscopy under deep
sedation with midazolam and propofol.
The total doses of 0.05 mg of fentanyl and 0.5 mg of alfentanil are relatively small
in a young patient cohort (more than 90% <75 years of age) and probably
contributed only marginally to the deep sedation which was mainly achieved by
intravenous propofol. This might explain why no differences between both groups
apart from the costs have been detected. Previous studies showing differences
between alfentanyl and fentanyl used higher doses and no propofol.
Minor essential revisions:
Abstract:
(1) Not all readers will be familiar with New Taiwan Dollars. The percentage of
excess costs between fentanyl and alfentanil or the cost difference in US Dollars
would be more informative for most readers.
Introduction:
(2) What does “minimal residual effect for endoscopy” mean in terms of
midazolam, fentanyl and alfentanil?
Discussion
(3) It should be discussed whether deep sedation is really desirable or should
better be avoided for standard colonoscopies (10% minor cardiopulmonary
complications in mainly healthy subjects in this study). Pain sensation is a valued
alarm signal for the endoscopist who might risk perforation if he ignores it and
pain during colonoscopy often indicates suboptimal endoscopic techniques.
(4) Mean total procedure times of 15 minutes for gastroscopy, changing scopes
and colonoscopy appear rather short in the light of the recommended 6 min
withdrawl time. Please comment.
(5) What are the regulations for propofol sedation (deep sedation) in Taiwan?
Is the administration of propofol restricted to anasthetists? Is ECG monitoring or
capnography mandatory for endoscopic procedures under deep sedation?
The paper will need careful revision of spelling/grammar.
Discretionary Revisions:
Anaesthetic costs:
(7) In many countries, propofol is administered safely by non-anaesthetists (Rex
et al., Gastroenterology 2009, 137:1229), even in general practices. In other
countries such as the UK, propofol sedation requires administration by an
anaesthetist. Is there any evidence that the very costly presence of an
anaesthetist improves the safety outcome?
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Comparison between the recovery time of alfentanil and fentanyl in
balanced propofol sedation for gastrointestinal and colonoscopy: a prospective,
randomized study
Version: 1Date:19 August 2012
Reviewer: Barbara Braden
Reviewer's report:
General comments
This randomized, double-blind study by Ho et coworkers is clearly designed and
well presented. It compares alfentanil and fentanyl for additional sedo-analgesia
in patients undergoing combined gastroscopy and colonoscopy under deep
sedation with midazolam and propofol.
The total doses of 0.05 mg of fentanyl and 0.5 mg of alfentanil are relatively small
in a young patient cohort (more than 90% <75 years of age) and probably
contributed only marginally to the deep sedation which was mainly achieved by
intravenous propofol. This might explain why no differences between both groups
apart from the costs have been detected. Previous studies showing differences
between alfentanyl and fentanyl used higher doses and no propofol.
Minor essential revisions:
Abstract:
(1) Not all readers will be familiar with New Taiwan Dollars. The percentage of
excess costs between fentanyl and alfentanil or the cost difference in US Dollars
would be more informative for most readers.
Introduction:
(2) What does “minimal residual effect for endoscopy” mean in terms of
midazolam, fentanyl and alfentanil?
Discussion
(3) It should be discussed whether deep sedation is really desirable or should
better be avoided for standard colonoscopies (10% minor cardiopulmonary
complications in mainly healthy subjects in this study). Pain sensation is a valued
alarm signal for the endoscopist who might risk perforation if he ignores it and
pain during colonoscopy often indicates suboptimal endoscopic techniques.
(4) Mean total procedure times of 15 minutes for gastroscopy, changing scopes
and colonoscopy appear rather short in the light of the recommended 6 min
withdrawl time. Please comment.
(5) What are the regulations for propofol sedation (deep sedation) in Taiwan?
Is the administration of propofol restricted to anasthetists? Is ECG monitoring or
capnography mandatory for endoscopic procedures under deep sedation?
The paper will need careful revision of spelling/grammar.
Discretionary Revisions:
Anaesthetic costs:
(7) In many countries, propofol is administered safely by non-anaesthetists (Rex
et al., Gastroenterology 2009, 137:1229), even in general practices. In other
countries such as the UK, propofol sedation requires administration by an
anaesthetist. Is there any evidence that the very costly presence of an
anaesthetist improves the safety outcome?
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Comparison between the recovery time of alfentanil and fentanyl in
balanced propofol sedation for gastrointestinal and colonoscopy: a prospective,
randomized study
Version: 1Date:19 August 2012
Reviewer: Barbara Braden
Reviewer's report:
General comments
This randomized, double-blind study by Ho et coworkers is clearly designed and
well presented. It compares alfentanil and fentanyl for additional sedo-analgesia
in patients undergoing combined gastroscopy and colonoscopy under deep
sedation with midazolam and propofol.
The total doses of 0.05 mg of fentanyl and 0.5 mg of alfentanil are relatively small
in a young patient cohort (more than 90% <75 years of age) and probably
contributed only marginally to the deep sedation which was mainly achieved by
intravenous propofol. This might explain why no differences between both groups
apart from the costs have been detected. Previous studies showing differences
between alfentanyl and fentanyl used higher doses and no propofol.
Minor essential revisions:
Abstract:
(1) Not all readers will be familiar with New Taiwan Dollars. The percentage of
excess costs between fentanyl and alfentanil or the cost difference in US Dollars
would be more informative for most readers.
Introduction:
(2) What does “minimal residual effect for endoscopy” mean in terms of
midazolam, fentanyl and alfentanil?
Discussion
(3) It should be discussed whether deep sedation is really desirable or should
better be avoided for standard colonoscopies (10% minor cardiopulmonary
complications in mainly healthy subjects in this study). Pain sensation is a valued
alarm signal for the endoscopist who might risk perforation if he ignores it and
pain during colonoscopy often indicates suboptimal endoscopic techniques.
(4) Mean total procedure times of 15 minutes for gastroscopy, changing scopes
and colonoscopy appear rather short in the light of the recommended 6 min
withdrawl time. Please comment.
(5) What are the regulations for propofol sedation (deep sedation) in Taiwan?
Is the administration of propofol restricted to anasthetists? Is ECG monitoring or
capnography mandatory for endoscopic procedures under deep sedation?
The paper will need careful revision of spelling/grammar.
Discretionary Revisions:
Anaesthetic costs:
(7) In many countries, propofol is administered safely by non-anaesthetists (Rex
et al., Gastroenterology 2009, 137:1229), even in general practices. In other
countries such as the UK, propofol sedation requires administration by an
anaesthetist. Is there any evidence that the very costly presence of an
anaesthetist improves the safety outcome?
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant