Reviewer's report
Title:Combined sedation with midazolam / propofol for gastrointestinal
endoscopy in elderly patients
Version: 1Date:19 November 2009
Reviewer: Shajan Peter
Reviewer's report:
Reviewer Comments:
The authors present a retrospective study to assess the role of combined
sedation with midazolam/propofol in elderly patients and concluded that
compared to the younger age group, elderly patients required a lower dose of
combination sedation for gastrointestinal endoscopic procedures
Comments:
Major Compulsory Revisions
• Single center retrospective data : selection bias can’t be avoided, need to be
mentioned in limitations
• Please mention the desired level of sedation? mild, moderate
• Who administered the sedation is not clear from the methodology?
• Recovery times, quality of recovery, and satisfaction with care are not recorded
as this may be important when administering a benzodiazepine, even though a
fixed dose was administered in this study and this should be mentioned in the
limitations.
• The mean dose of combination will vary with each procedure, the authors have
provided and overall total dose required. It would be nice to provide these details
too in the table.
• Clearly, there are more patients with higher ASA scores in the >70 group, which
therefore would result in lower titrated doses of sedation and explain increased
sensitivity in this group.
• Though the mean doses are significantly lower in the elderly group, the range
(SD) is large in both the groups
• To prove, that combination helps in decreasing propofol levels in the elderly,
this has to be ideally compared with single sedation propofol vs. combo in the
same age group population.
• In discussion, please remove the sentence mentioning randomized studies on
sedation for cardioversion in patients with atrial fibrillation as its less relevance to
this study.
Minor Essential Revisions
• Discussion: last sentence, after thus please add coma
• Conlusion last sentence: These findings………………..
Overall Comments:
This study has been overall well done though it has its limitations as it being
retrospective in nature; it adds to the growing data to the safety profile of propofol
sedation in elderly though the dosing will be less as compared to the younger
population. Adequate training for administration will be required to handle any
events during sedation in this age group.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Combined sedation with midazolam / propofol for gastrointestinal
endoscopy in elderly patients
Version: 1Date:19 November 2009
Reviewer: Shajan Peter
Reviewer's report:
Reviewer Comments:
The authors present a retrospective study to assess the role of combined
sedation with midazolam/propofol in elderly patients and concluded that
compared to the younger age group, elderly patients required a lower dose of
combination sedation for gastrointestinal endoscopic procedures
Comments:
Major Compulsory Revisions
• Single center retrospective data : selection bias can’t be avoided, need to be
mentioned in limitations
• Please mention the desired level of sedation? mild, moderate
• Who administered the sedation is not clear from the methodology?
• Recovery times, quality of recovery, and satisfaction with care are not recorded
as this may be important when administering a benzodiazepine, even though a
fixed dose was administered in this study and this should be mentioned in the
limitations.
• The mean dose of combination will vary with each procedure, the authors have
provided and overall total dose required. It would be nice to provide these details
too in the table.
• Clearly, there are more patients with higher ASA scores in the >70 group, which
therefore would result in lower titrated doses of sedation and explain increased
sensitivity in this group.
• Though the mean doses are significantly lower in the elderly group, the range
(SD) is large in both the groups
• To prove, that combination helps in decreasing propofol levels in the elderly,
this has to be ideally compared with single sedation propofol vs. combo in the
same age group population.
• In discussion, please remove the sentence mentioning randomized studies on
sedation for cardioversion in patients with atrial fibrillation as its less relevance to
this study.
Minor Essential Revisions
• Discussion: last sentence, after thus please add coma
• Conlusion last sentence: These findings………………..
Overall Comments:
This study has been overall well done though it has its limitations as it being
retrospective in nature; it adds to the growing data to the safety profile of propofol
sedation in elderly though the dosing will be less as compared to the younger
population. Adequate training for administration will be required to handle any
events during sedation in this age group.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Combined sedation with midazolam / propofol for gastrointestinal
endoscopy in elderly patients
Version: 1Date:19 November 2009
Reviewer: Shajan Peter
Reviewer's report:
Reviewer Comments:
The authors present a retrospective study to assess the role of combined
sedation with midazolam/propofol in elderly patients and concluded that
compared to the younger age group, elderly patients required a lower dose of
combination sedation for gastrointestinal endoscopic procedures
Comments:
Major Compulsory Revisions
• Single center retrospective data : selection bias can’t be avoided, need to be
mentioned in limitations
• Please mention the desired level of sedation? mild, moderate
• Who administered the sedation is not clear from the methodology?
• Recovery times, quality of recovery, and satisfaction with care are not recorded
as this may be important when administering a benzodiazepine, even though a
fixed dose was administered in this study and this should be mentioned in the
limitations.
• The mean dose of combination will vary with each procedure, the authors have
provided and overall total dose required. It would be nice to provide these details
too in the table.
• Clearly, there are more patients with higher ASA scores in the >70 group, which
therefore would result in lower titrated doses of sedation and explain increased
sensitivity in this group.
• Though the mean doses are significantly lower in the elderly group, the range
(SD) is large in both the groups
• To prove, that combination helps in decreasing propofol levels in the elderly,
this has to be ideally compared with single sedation propofol vs. combo in the
same age group population.
• In discussion, please remove the sentence mentioning randomized studies on
sedation for cardioversion in patients with atrial fibrillation as its less relevance to
this study.
Minor Essential Revisions
• Discussion: last sentence, after thus please add coma
• Conlusion last sentence: These findings………………..
Overall Comments:
This study has been overall well done though it has its limitations as it being
retrospective in nature; it adds to the growing data to the safety profile of propofol
sedation in elderly though the dosing will be less as compared to the younger
population. Adequate training for administration will be required to handle any
events during sedation in this age group.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
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