Revie wer’s report  
 
Title: Dexmedetomidine is safe and reduces the additional  dose of midazolam for sedation 
during Endoscopic retrograde cholangiopancreatography in very elderly patients  
 
Version: 1 Date: 08 Sep 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER COMMENTS: To view the full repor t from the academic peer reviewer, 
please see the attached file.  
 
 
REVIEWER COMMENTS FROM REPORT: The authors provide a good introduction with a 
clear objective, and interesting findings within the limitations of a retrospective, non -blinded 
comparative stu dy. A few comments/questions:  
 
I feel the definitive strength with which the authors state their conclusions substantially oversteps 
the ability of this study to provide the answer. While this study provides some useful 
signposting, only an RCT can provide  the certainty that they are already stating.  
 
 
Were the sample sizes appropriate?  
 
 
Why were no patient -reported outcomes obtained, e.g. discomfort, satisfaction, etc? While it is 
useful to understand the safety, if the patients felt more pain and more obtund ed afterwards then 
the addition of Dex is of little benefit to them.  
 
 
What is the cost implication of adding Dex?  
 
In a few places the medical English requires some attention for correct grammar/understanding  
 
 
 
REQUESTED REVISIONS:  
 
See earlier comments above - in particular relating to the strength of the conclusions.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
none  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you re commend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indic ate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary fro m an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of  this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I  declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partn er organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Resear ch Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understan d that my na me will be included 
on my repo rt to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under a n Open Access Creati ve Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to th e open peer review policy of the journal  
 
Revie wer’s report  
 
Title: Dexmedetomidine is safe and reduces the additional  dose of midazolam for sedation 
during Endoscopic retrograde cholangiopancreatography in very elderly patients  
 
Version: 1 Date: 08 Sep 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER COMMENTS: To view the full repor t from the academic peer reviewer, 
please see the attached file.  
 
 
REVIEWER COMMENTS FROM REPORT: The authors provide a good introduction with a 
clear objective, and interesting findings within the limitations of a retrospective, non -blinded 
comparative stu dy. A few comments/questions:  
 
I feel the definitive strength with which the authors state their conclusions substantially oversteps 
the ability of this study to provide the answer. While this study provides some useful 
signposting, only an RCT can provide  the certainty that they are already stating.  
 
 
Were the sample sizes appropriate?  
 
 
Why were no patient -reported outcomes obtained, e.g. discomfort, satisfaction, etc? While it is 
useful to understand the safety, if the patients felt more pain and more obtund ed afterwards then 
the addition of Dex is of little benefit to them.  
 
 
What is the cost implication of adding Dex?  
 
In a few places the medical English requires some attention for correct grammar/understanding  
 
 
 
REQUESTED REVISIONS:  
 
See earlier comments above - in particular relating to the strength of the conclusions.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
none  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you re commend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indic ate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary fro m an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of  this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I  declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partn er organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Resear ch Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understan d that my na me will be included 
on my repo rt to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under a n Open Access Creati ve Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to th e open peer review policy of the journal  
 
Please review this paper.
user
Revie wer’s report  
 
Title: Dexmedetomidine is safe and reduces the additional  dose of midazolam for sedation 
during Endoscopic retrograde cholangiopancreatography in very elderly patients  
 
Version: 1 Date: 08 Sep 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER COMMENTS: To view the full repor t from the academic peer reviewer, 
please see the attached file.  
 
 
REVIEWER COMMENTS FROM REPORT: The authors provide a good introduction with a 
clear objective, and interesting findings within the limitations of a retrospective, non -blinded 
comparative stu dy. A few comments/questions:  
 
I feel the definitive strength with which the authors state their conclusions substantially oversteps 
the ability of this study to provide the answer. While this study provides some useful 
signposting, only an RCT can provide  the certainty that they are already stating.  
 
 
Were the sample sizes appropriate?  
 
 
Why were no patient -reported outcomes obtained, e.g. discomfort, satisfaction, etc? While it is 
useful to understand the safety, if the patients felt more pain and more obtund ed afterwards then 
the addition of Dex is of little benefit to them.  
 
 
What is the cost implication of adding Dex?  
 
In a few places the medical English requires some attention for correct grammar/understanding  
 
 
 
REQUESTED REVISIONS:  
 
See earlier comments above - in particular relating to the strength of the conclusions.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
none  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you re commend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indic ate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary fro m an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of  this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I  declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partn er organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Resear ch Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understan d that my na me will be included 
on my repo rt to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under a n Open Access Creati ve Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to th e open peer review policy of the journal  
 
assistant