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Incidence of Sedation-Related Complications With Propofol Use During Advanced Endoscopic Procedures

https://doi.org/10.1016/j.cgh.2009.07.008Get rights and content

Background & Aims

Propofol is an effective sedative in advanced endoscopy. However, the incidence of sedation-related complications is unclear. We sought to define the frequency of sedation-related adverse events, particularly the rate of airway modifications (AMs), with propofol use during advanced endoscopy. We also evaluated independent predictors of AMs.

Methods

Patients undergoing sedation with propofol for advanced endoscopic procedures, including endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and small-bowel enteroscopy, were studied prospectively. Sedative dosing was determined by a certified registered nurse anesthetist with the goal of achieving deep sedation. Sedation-related complications included AMs, hypoxemia (pulse oximetry [SpO2] < 90%), hypotension requiring vasopressors, and early procedure termination. AMs were defined as chin lift, modified face mask ventilation, and nasal airway. We performed a regression analysis to compare characteristics of patients requiring AMs (AM+) with those who did not (AM−).

Results

A total of 799 patients were enrolled over 7 months. Procedures included endoscopic ultrasound (423), endoscopic retrograde cholangiopancreatography (336), and small-bowel enteroscopy (40). A total of 87.2% of patients showed no response to endoscopic intubation. Hypoxemia occurred in 12.8%, hypotension in 0.5%, and premature termination in 0.6% of the patients. No patients required bag-mask ventilation or endotracheal intubation. There were 154 AMs performed in 115 (14.4%) patients, including chin lift (12.1%), modified face mask ventilation (3.6%), and nasal airway (3.5%). Body mass index, male sex, and American Society of Anesthesiologists class of 3 or higher were independent predictors of AMs.

Conclusions

Propofol can be used safely for advanced endoscopic procedures when administered by a trained professional. Independent predictors of AMs included male sex, American Society of Anesthesiologists class of 3 or higher, and increased body mass index.

Section snippets

Methods

We performed a prospective analysis of patients undergoing advanced endoscopic procedures (ERCP, EUS, single-balloon or spiral overtube-assisted small-bowel enteroscopy and enteral stenting) at Washington University in St. Louis, a tertiary care medical center. In our endoscopy unit, standard practice is to sedate patients undergoing advanced procedures using propofol alone or in combination with low-dose opiate and/or benzodiazepine. Propofol dosing and patient monitoring is directed by a

Results

A total of 799 patients were enrolled over the 7-month study period, including 423 EUS patients (52.9%), 336 ERCP patients (42.1%), and 40 small-bowel enteroscopy or other patients (5.0%). Additional patient characteristics along with procedural and pharmacologic data are summarized in Table 2. Of note, 60.5% of patients met criteria for ASA class 3 or higher and 0.5% had a Mallampati score equal to 4. In addition, no response to endoscopic intubation was observed in 87.2% of cases, which would

Discussion

Propofol can be administered safely to patients undergoing advanced endoscopic procedures. In our series of 799 patients managed by CRNAs, we observed no major sedation-related complications, and our reported rates of hypoxemia (12.8%) and significant hypotension (0.5%) are comparable with published data.9, 10, 11, 12, 13, 14, 19, 20 Our study population is uniquely complex, with 61% of patients having an ASA class of 3 or higher and endoscopy times of 30 ± 19 minutes.

We report the frequency of

References (30)

  • L. Fanti et al.

    Target-controlled propofol infusion during monitored anesthesia in patients undergoing ERCP

    Gastrointest Endosc

    (2004)
  • L.B. Cohen et al.

    Endoscopic sedation in the United States: results from a nationwide survey

    Am J Gastroenterol

    (2006)
  • Practice guidelines for sedation and analgesia by non-anesthesiologists

    Anesthesiology

    (2002)
  • N. Mackenzie et al.

    Propofol for intravenous sedation

    Anaesthesia

    (1987)
  • G. Tohda et al.

    Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists

    Endoscopy

    (2006)
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    Conflicts of interest The authors disclose no conflicts.

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