Content of review 1, reviewed on October 16, 2020

Brief overview of the paper and its main findings

This article is written for post-hyperventilation apnea episode after monitored anesthesia care. There are some interesting episode and value to be posted.
If authors can resolve my comments, this article can accept in the BioPsychoSocial Medicine. My findings and recommendations are follows.

Title At third episode, there were not administered midazolam, therefore title does not represent correctly the contents.

At first episode Authors used bag-valve-mask for respiration control after hyperventilation with desaturation. My first question is The patient PaCO2 level is low or high during artificial respiration? When PaCO2 level low, I agree that midazolam inhibited arousal reaction because PaCO2 and PaO2 imbalance. If PaCO2 level high, there is difficult for thinking that small dose midazolam cause apnea reaction, because central nervous system occur strong drive for ventilation. Therefore authors should describe detail of ventilation status during bag-valve-mask using.

At second episode Because there was same description in first episode, I recommend erasing that detail of dental treatment in second paragraph (at third episode there are also same sentence in second paragraph).

Authors administered midazolam for premedication. Which injection did authors choose IM or IV? Effective time is different between IM and IV. In my opinion, duration of midazolam is important for this report.

Authors describe that small dose midazolam may caused post-hyperventilation apnea. At first episode authors administer 0.5mg midazolam and at second episode administered 1mg of it 1 hour 20 minutes before post-hyperventilation apnea. I can't believe that these apnea episodes due to only midazolam administration. Authors explained that hyperventilation syndrome patients should be carefully chosen of drugs for treatment of seizure. I want to hear more specific description of this topic. These paragraph is insufficient explanation.

In conclusion, Authors write "Our experience suggests that monitored anesthesia care with combination of midazolam and propofol may be effective general management for patients with severe hyperventilation syndrome and post-hyperventilation apnea.” This is not concluding this article correctly. Authors must rewrite this sentence.

This article attached three figures but there are no indications for insert location.

Please provide a brief overview of the paper and its main findings.

Major and minor points

This should be the main substance of your review and should bring up any weaknesses, inconsistencies, things that need to be clarified or questions you have for the authors.

Conflicts of interest

Do you have any conflicts of interest here?

I don't have any COI this manuscript.


    © 2020 the Reviewer (CC BY 4.0).


    Masato, K., Shinji, K., Takuro, S., Ichiro, O., Takao, A. 2014. Management of post-hyperventilation apnea during dental treatment under monitored anesthesia care with propofol. BioPsychoSocial Medicine.