Review for 10.1186/1471-230X-12-164 (2012)

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:18 August 2012
Reviewer: Massimo Agostoni
Reviewer's report:
Dear Editor
Thank you for the opportunity to review this interesting work.
In “Comparison between the recovery time of alfentanil and fentanyl in balanced
propofol sedation for gastrointestinal and colonoscopy: a prospective,
randomized study” the authors investigate the differences between two opioids
used to deep-sedate patients undergone to a combined endoscopic procedure
wide used : egd+colonoscopy.
The question is clearly posed and the work is well conducted.
The work does not pose ethical issues.
I think you can accept the work even if somewhere the English could be
improved, I suggest minor/discretionary revisions about the following points.
Minor revision
Pag 1 in abstract
“safety and the efficacy of aflentanil”
alfentanil
Page 3
“Upper gastrointestinal endoscopy and colonoscopy (UGIEC) are..”
In my opinion the blossoming of new acronyms should be limited because create
confusion among the readers: UGIEC could be better referred as “EGD and
colonoscopy”; if other upper gastrointestinal procedures are performed (i.e.
ultrasound endoscopy) “EGD/EUS and colonoscopy” could better characterize
the procedures performed.
Check also the abstract.
Pag 5
“health examination”
I think that the endoscopic procedures were done, as screening exams, to
prevent a pathologic GI lesion, so they are “diagnostic procedures”, as correctly
stated in the abstract. Otherwise, if the exams were done to cure a GI lesion,
refer to them as “operative procedures” and better explain their nature (i.e.
endoscopic hemostasis; polipectomy).
Check also the abstract.
Page 6
“The opioid and midazolam are given by intravenous bolus injection at the
initiation of sedation. All the patients receive midazolam 2.5mg, and in combined
with alfentanil 0.25mg…”
Please check the correctness of this sentence and use the same tense of the
whole work.
“The gastroscopy was performed first and followed with colonoscopy”
According to the previous suggestion: in this page finally the author reveal the
real nature of “UGIE”: it is a gastroscopy!! So, if you want to use the acronym,
EGD is better known.
“Blinding was achieved by having an independent research nurse provide,
according to a grid known only to her, a 1 ml tuberculin syringe containing either
alfentanil 0.5mg/ml or fentanyl 0.05mg/ml for each patient.”
Please check the correctness of this sentence
Page 8
“Individual total anesthetic cost, including all sedative and analgesic consumed
only, will be calculated and analysis between the groups.”
Rewrite the sentence using the same tense used so far. Check the correctness
of the subjects.
Pag 10
“The overall rate of cardiopulmonary adverse events was 10.6% (14/129)”
Check the different figure in tab 3: 10.9% is the correct percentage
Page 13
“Small dose of midazolam 2.5mg was chosen in the present randomized study.”
Please refer to midazolam dose as mg/kg (according to the exposed data I
suppose 0.04 mg/kg).
Tab 1
Baseline data can be described only in the results section
Tab 3
The author could describe the adverse events which were not recorded in both
groups, only in the results section.
Discretional revision
Pag 14
“…the incidence of cardiopulmonary complications was 7.2% (15/206) which was
lower than in the present study (10.8%, 28/260).”
Deep sedation can cause a bigger incidence of cardiopulmonary adverse events.
Confront with a recent published work (Gastrointest Endosc 2011;74:266-75.)
could be interesting (considering only combined exams). Deep sedation was
achieved with propofol monotherapy and the incidence of adverse events was
very low. Comment the difference regard to the drugs and the method of
administration used.
Pag 15
“The other important finding in this study was the high patient overall satisfaction
with the procedure.”
Comment your results versus a different technique of moderate sedation equally
useful to achieve a patients' high satisfaction (Am J Gastroenterol 2009;
104:1119 – 1124; doi: 10.1038/ajg.2009.53)
Level of interest: An article of importance in its field
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