Title: Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for
deep sedation of elderly patients undergoing ERCP
Version: 1 Date: 24 Nov 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (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?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Thank you for the opportunity to review this manuscript.
Overall, I think the study would benefit from a) renaming the study to include midazolam
in the drug combination name (as the authors themselves due in the conclusion), b) to better
establish safety or better inform any sort of dosing changes, I would recommend a middle
aged (maybe 50-65 yr old) comparator group.  It would seem that the authors' intention is to
establish safety of this regimen during ERCP for elderly patients where there is a scant amount of
literature - therefore, you should include a comparison to younger or better studied age groups.
c)  Throughout the paper, the term "elderly" is use - I would establish what the age group is as
early as possible.  Is it generally accepted that "elderly" is > 65 yrs?  Or is it .70, 75, etc?  d)
I would represent the doses in mg/kg propofol, mcg/kg alfentanil, and then include total dose
of midazolam.
Overall, the paper is easy enough to read, but would benefit from a comparator group and some
clarity on doses in order to best replicate what the authors' practice is.
REQUESTED REVISIONS:
Would include a control group of younger patients to better gauge safety of this combination
of drugs in an older patient population.  If no/limited data exist for older patients, comparing a
group of older (65-79) and even older (> 80) patients isn't the right initial approach
Title: Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for
deep sedation of elderly patients undergoing ERCP
Version: 1 Date: 24 Nov 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (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?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Thank you for the opportunity to review this manuscript.
Overall, I think the study would benefit from a) renaming the study to include midazolam
in the drug combination name (as the authors themselves due in the conclusion), b) to better
establish safety or better inform any sort of dosing changes, I would recommend a middle
aged (maybe 50-65 yr old) comparator group.  It would seem that the authors' intention is to
establish safety of this regimen during ERCP for elderly patients where there is a scant amount of
literature - therefore, you should include a comparison to younger or better studied age groups.
c)  Throughout the paper, the term "elderly" is use - I would establish what the age group is as
early as possible.  Is it generally accepted that "elderly" is > 65 yrs?  Or is it .70, 75, etc?  d)
I would represent the doses in mg/kg propofol, mcg/kg alfentanil, and then include total dose
of midazolam.
Overall, the paper is easy enough to read, but would benefit from a comparator group and some
clarity on doses in order to best replicate what the authors' practice is.
REQUESTED REVISIONS:
Would include a control group of younger patients to better gauge safety of this combination
of drugs in an older patient population.  If no/limited data exist for older patients, comparing a
group of older (65-79) and even older (> 80) patients isn't the right initial approach
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: 1 Date: 24 Nov 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (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?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Thank you for the opportunity to review this manuscript.
Overall, I think the study would benefit from a) renaming the study to include midazolam
in the drug combination name (as the authors themselves due in the conclusion), b) to better
establish safety or better inform any sort of dosing changes, I would recommend a middle
aged (maybe 50-65 yr old) comparator group.  It would seem that the authors' intention is to
establish safety of this regimen during ERCP for elderly patients where there is a scant amount of
literature - therefore, you should include a comparison to younger or better studied age groups.
c)  Throughout the paper, the term "elderly" is use - I would establish what the age group is as
early as possible.  Is it generally accepted that "elderly" is > 65 yrs?  Or is it .70, 75, etc?  d)
I would represent the doses in mg/kg propofol, mcg/kg alfentanil, and then include total dose
of midazolam.
Overall, the paper is easy enough to read, but would benefit from a comparator group and some
clarity on doses in order to best replicate what the authors' practice is.
REQUESTED REVISIONS:
Would include a control group of younger patients to better gauge safety of this combination
of drugs in an older patient population.  If no/limited data exist for older patients, comparing a
group of older (65-79) and even older (> 80) patients isn't the right initial approach
assistant