Title: Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for
deep sedation of elderly patients undergoing ERCP
Version: 2 Date: 21 Jan 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Not sure - I am not able to assess the statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Thank you for the thoughtful responses to the original critique of
this manuscript.  The inclusion of a middle-aged comparator group strengthens the authors'
conclusions, although I would ensure to draw attention to the need for lower doses of medications
utilized in the elderly and very elderly group.  This is consistent with known needs for lower
doses in older patients to achieve similar therapeutic effects and minimize adverse reactions.
This should be reflected somewhere in the conclusion and abstract.
My only remaining suggestion is that the discussion is fairly lengthy and meandering, which
loses the main ideas in the amount of data from other studies presented in the text.  I would work
to summarize these studies and background data to make a more cohesive discussion.
REQUESTED REVISIONS:
See prior comments.  I am unable to appropriately evaluate the statistics - the inclusion of
three groups makes the statistical analysis a little more complicated.  An ANOVA test is likely
appropriate, but there may need to be a three way test for categorical data.
ADDITIONAL REQUESTS/SUGGESTIONS:
None as from what have previously been described
Title: Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for
deep sedation of elderly patients undergoing ERCP
Version: 2 Date: 21 Jan 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Not sure - I am not able to assess the statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Thank you for the thoughtful responses to the original critique of
this manuscript.  The inclusion of a middle-aged comparator group strengthens the authors'
conclusions, although I would ensure to draw attention to the need for lower doses of medications
utilized in the elderly and very elderly group.  This is consistent with known needs for lower
doses in older patients to achieve similar therapeutic effects and minimize adverse reactions.
This should be reflected somewhere in the conclusion and abstract.
My only remaining suggestion is that the discussion is fairly lengthy and meandering, which
loses the main ideas in the amount of data from other studies presented in the text.  I would work
to summarize these studies and background data to make a more cohesive discussion.
REQUESTED REVISIONS:
See prior comments.  I am unable to appropriately evaluate the statistics - the inclusion of
three groups makes the statistical analysis a little more complicated.  An ANOVA test is likely
appropriate, but there may need to be a three way test for categorical data.
ADDITIONAL REQUESTS/SUGGESTIONS:
None as from what have previously been described
Please review this paper.
user
Title: Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for
deep sedation of elderly patients undergoing ERCP
Version: 2 Date: 21 Jan 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Not sure - I am not able to assess the statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Thank you for the thoughtful responses to the original critique of
this manuscript.  The inclusion of a middle-aged comparator group strengthens the authors'
conclusions, although I would ensure to draw attention to the need for lower doses of medications
utilized in the elderly and very elderly group.  This is consistent with known needs for lower
doses in older patients to achieve similar therapeutic effects and minimize adverse reactions.
This should be reflected somewhere in the conclusion and abstract.
My only remaining suggestion is that the discussion is fairly lengthy and meandering, which
loses the main ideas in the amount of data from other studies presented in the text.  I would work
to summarize these studies and background data to make a more cohesive discussion.
REQUESTED REVISIONS:
See prior comments.  I am unable to appropriately evaluate the statistics - the inclusion of
three groups makes the statistical analysis a little more complicated.  An ANOVA test is likely
appropriate, but there may need to be a three way test for categorical data.
ADDITIONAL REQUESTS/SUGGESTIONS:
None as from what have previously been described
assistant