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

Division of Gastroenterology & Hepatology, Washington University, St. Louis, Missouri 63110, USA.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association (Impact Factor: 6.53). 07/2009; 8(2):137-42. DOI: 10.1016/j.cgh.2009.07.008
Source: PubMed

ABSTRACT 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.
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 [SpO(2)] < 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-).
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.
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.

1 Follower
  • Source
    • "There was one death, less than 1% of cases had to be converted to general anaesthesia , and approximately 6% of cases were deemed to require general anaesthesia electively for the procedures. Coté et al. [15] prospectively studied 799 cases of patients undergoing endoscopy (ERCP, EUS, and small bowel enteroscopy) procedures under propofol sedation and found a hypoxemia rate of 12.8% and a hypotension rate of 0.8% during the procedure. There was a premature termination rate of 0.6%. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Propofol sedation for endoscopic retrograde cholangiopancreatography (ERCP) procedures is a popular current technique that has generated controversy in the medical field. Worldwide, both anesthetic and nonanesthetic personnel administer this form of sedation. Although the American and Canadian societies of gastroenterologists have endorsed the administration of propofol by nonanesthesia personnel, the US Food and Drug Administration (FDA) has not licensed its use in this manner. There is some evidence for the safe use of propofol by nonanesthetic personnel in patients undergoing endoscopy procedures, but there are few randomized trials addressing the safety and efficacy of propofol in patients undergoing ERCP procedures. A serious possible consequence of propofol sedation in patients is that it may result in rapid and unpredictable progression from deep sedation to general anesthesia, and skilled airway support may be required as a rescue measure. Potential complications following deep propofol sedation include hypoxemia and hypotension. Propofol sedation for ERCP procedures is an area of clinical practice where discussion and mutual cooperation between anesthesia and nonanesthesia personnel may enhance patient safety.
    Diagnostic and Therapeutic Endoscopy 01/2012; 2012:639190. DOI:10.1155/2012/639190
  • The Nurse Practitioner 02/1998; 23(2):119.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A novel reconfigurable digital filter has been proposed for a mobile terminal receiver that can drastically reduce power dissipation dependant on adjacent channel interference. It automatically scales the number of filter coefficients by monitoring the in-band and out-of-band powers. This new filter performance was evaluated in a simulation UTRA-TDD environment because of the large near far problem caused by adjacent channel interference from adjacent mobiles and base stations. The UTRA-TDD downlink mode was examined statistically and results show that this reconfigurable filter can save an average of 75% power dissipation when compared to a fixed filter length of 41. This will prolong talk and standby time in a mobile terminal. The average number of taps was calculated to be 10.1 for an outage of 97%.
    Global Telecommunications Conference, 2002. GLOBECOM '02. IEEE; 12/2002
Show more