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Although two previous reviewers recommended rejection, the other two reviewers recommended acceptance. I also reviewed the manuscript and found no obvious risks to publication. Therefore, I also approved the publication of this manuscript.
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Based on clinical anesthesia records database, the authors assessed the benefits of combined use of Sufentanil, Alfentanil, or Ketamine to propofol-based deep sedation for colonoscopy procedure. This research holds significant value.
In the revised manuscript, the discussion and data presentation has been significantly improved. I don’t have any further revision suggestions.
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The authors are requested to carefully revise the manuscript and answer the questions raised by the reviewers.
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Limitations of this study include the following Because the results of this study may have been due to the time taken for the procedure and pharmacokinetics, it is not known if these results can be replicated in all clinicians/hospitals.
If we assume that differences in the pharmacokinetics of sufentanil and alfentanil are responsible for the differences in this study, an explanation could be added regarding pharmacokinetics.
In particular, if we assume that the rapid increase in opioid effect site concentrations is inducing hypoxia, it might be worth mentioning.
If this is the case, then it is conceivable that small doses of i.v. morphine can be the safer to use.
Thank you for reviewing the manuscript"Propofol-based deep sedation for colonoscopy and
gastroscopy: Does sufentanil, alfentanil or ketamine help? A
propensity score weighted retrospective study"
The author described about the whether the addition of sufentanil, alfentanil, or ketamine to
propofol has a propofol-sparing eûect and, secondarily, how these drugs aûect the
patient's hemodynamic and respiratory parameters as well as the duration of the
procedure.
While the results of the authors' study seem interesting, I think there are some serious problems.
Major Concern
#Statical problem
This paper appears to compare four groups (Groups P, S, K, A) using an inverse propensity weighting (IPTW).
A p value of 0.05 or less is considered to indicate a significant difference, but did they compare the P group with each other using a t-test or something similar? If so, it seems that the problem of multiple testing has been ignored.
In other words, the statistical method used to compare the four groups is unclear, which calls into question the reliability of this study.
If a significant difference was to be shown, p value would have to be a much smaller value (probably a fairly small value, such as 0.001 or less).
The authors should provide a more detailed and rational explanation of their statistical methods.
See the "Basic reports".
There is serious problem about statics methods.
See the "Basic reports".
There is serious problem about statics methods.
See the "Basic reports".
There is serious problem about statics methods.
Peer J: 103673 V2
Propofol-based deep sedation for colonoscopy and gastroscopy: Does sufentanil, alfentanil or ketamine help? A propensity score weighted retrospective study
Based on clinical anesthesia records database, the authors assessed the benefits of combined use of Sufentanil, Alfentanil, or Ketamine to propofol-based deep sedation for colonoscopy procedure. This research holds significant value. Although the manuscript has been substantially improved following the reviewers’ comments, the revised version still presents several issues, with the study results lacking clarity and quality. Additional revisions and improvements are necessary.
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1. Confusing dosing regimen description: In Method, S group was given with “an additional 5 mcg…. Sufentanil”. Dis this indicate a dual combined sedation of propofol & lidocaine & sufentanil or dual combination of propofol & sufentanil? So did A Group.
2. Optimized dosage discussion: Since the dosage of sufentanil, alfentanil and ketamine used in this case are very different, is there any potential benefit of alfentanil and ketamine at optimized dosages? Please expand on this point in Discussion.
3. More objective conclusion: Please revise the conclusion (Line 41) “Sufentanil is the most appropriate and safest drug when used as an adjuvant in sedation for colonoscopy” to make it more definitive and conservative.
4. Format and Typo issues:
(1) There should be a space between numbers and units. Such as -33 mg in Line 128.
(2) In Table 1, clearly indicate which data correspond to characteristics before weighting and which correspond to those after weighting. Add table notes to explain abbreviations such as OSAS, ICM, and COPD.
(3) It is better to merge Table 2 and 3.
(4) Table 2 and 3 are too busy. Please redesign them. Merge some related rows.
(5) In table 2, it appears that the “ propofol(mg) ” for S, A, and K groups are the delta propofol instead of absolute dose.
(6) In Line 128, clarify which group is “PRO group”?
(7) in Line 150 and 172, Zhou & al. ? (Zhou et al.)
The authors are requested to carefully revise the manuscript and answer the questions raised by the reviewers. Although their reports are brief, both reviewers had serious concerns to address.
English is clear, literature references are not comprehensive. Tables are not prepared well.
The use of propensity score is commendable. Methods described sufficiently.
This study examined the effect of propofol sedation for colonoscopy and gastroscopy when combined with other sedative drugs. Groups were compared using propensity score weighting, and the study is retrospective.
The title suggests propofol-based sedation for both colonoscopies and gastroscopies. However, the Introduction, as well as the Materials and Methods section, primarily refer to colonoscopies. It is essential to clarify which area is being focused on. The Introduction does include a discussion about gastroscopy.
The Introduction is not well-written. There needs to be more emphasis on the anesthesiology aspect, the available literature, and general practice. Additionally, the Introduction includes an institutional protocol, which may not be relevant. Such discussions should be framed within the broader spectrum of existing research studies.
One issue with studies on sedation is that protocols differ between countries and regions. Typically, midazolam is used for sedation, while propofol is considered deep sedation. This has not been fully discussed in the article.
The article is challenging to follow, and the tables, especially Table 2, are not presented well.
SpO2 is compared between groups, yet it should be categorized as the occurrence of hypoxemia (SpO2 < 88).
Basic characteristics, including Mallampati score, are missing, and there is no information about the proportion of patients who had biopsies taken or failed colonoscopies
The article aims to determine whether adding sufentanil, alfentanil, or ketamine to propofol has a propofol-sparing effect and, secondarily, how these drugs affect hemodynamic and respiratory parameters and the duration of the procedure. The title is “Propofol-based deep sedation for colonoscopy and gastroscopy: Does sufentanil, alfentanil or ketamine help? A propensity score weighted retrospective study”.
1. This is a retrospective study.
2. The sample size of the ketamine group is relatively small.
3. Several factors influence the outcome of the study. Please discuss these.
4. Please review the literature and add more details in the discussion section.
5. What is the new knowledge of the study?
6. Please recommend “How to apply this knowledge?” to the readers.
This is a retrospective study. Some limitations might have occurred.
The sample size of the ketamine group is relatively small.
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