Adverse events during monitored anesthesia care for GI endoscopy: An 8-year experience

Massimo Agostoni, Lorella Fanti, Marco Gemma, Nicola Pasculli, Luigi Beretta, Pier Alberto Testoni

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Background: The importance of sedation during endoscopy is well established. There is no consensus about the best techniques for sedation, which specialist should perform it, and in which location. Objective: To provide data on the epidemiology of adverse events during sedation for endoscopy. Design: Retrospective analysis of a prospective database. Setting: Endoscopy unit of a university hospital. Procedures: A total of 17,999 procedures performed over 8 years. Interventions: Sedation for GI endoscopy. Main Outcome Measurements: We recorded the following information: sex, age, body mass index, smoking habits, American Society of Anesthesiologists and Mallampati scores, duration of the procedure, type of sedative drug administered, whether the procedure was performed emergently, and endoscopic interventions during the maneuver. Adverse events were defined as occurrences that warranted intervention and were classified as hypotension, desaturation, bradycardia, hypertension, arrhythmia, aspiration, respiratory depression, vomiting, cardiac arrest, respiratory arrest, angina, hypoglycemia, and/or allergic reaction. Results: Deep sedation with intravenous propofol target controlled infusion pump was the most frequently used means of administering sedation. Adverse events were rare in both the adult (4.5%) and pediatric (2.6%) populations. Six complications occurred in more than 0.1% of adult cases: arterial hypotension, desaturation, bradycardia, arterial hypertension, arrhythmia, and aspiration. Only bradycardia (2.1%) and hypotension (0.44%) occurred in children. Three adult patients (0.017%) died, and no pediatric patients died. Some predictive models for the occurrence of complications are proposed. Limitations: Retrospective analysis, single-center data collection. Conclusions: Deep sedation during endoscopic procedures is safe in both adults and children. Our data may be useful for the future planning of new clinical strategies in this setting.

Original languageEnglish
Pages (from-to)266-275
Number of pages10
JournalGastrointestinal Endoscopy
Volume74
Issue number2
DOIs
Publication statusPublished - Aug 2011

Fingerprint

Endoscopy
Anesthesia
Bradycardia
Deep Sedation
Hypotension
Cardiac Arrhythmias
Pediatrics
Hypertension
Infusion Pumps
Propofol
Heart Arrest
Hypnotics and Sedatives
Hypoglycemia
Respiratory Insufficiency
Habits
Vomiting
Consensus
Hypersensitivity
Epidemiology
Body Mass Index

Keywords

  • American Society of Anesthesiologists
  • area under the receiver-operating characteristic curve
  • ASA
  • AUROC
  • BMI
  • body mass index
  • MAC
  • monitored anesthesia care
  • odds ratio
  • OR
  • target controlled infusion
  • TCI

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Adverse events during monitored anesthesia care for GI endoscopy : An 8-year experience. / Agostoni, Massimo; Fanti, Lorella; Gemma, Marco; Pasculli, Nicola; Beretta, Luigi; Testoni, Pier Alberto.

In: Gastrointestinal Endoscopy, Vol. 74, No. 2, 08.2011, p. 266-275.

Research output: Contribution to journalArticle

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abstract = "Background: The importance of sedation during endoscopy is well established. There is no consensus about the best techniques for sedation, which specialist should perform it, and in which location. Objective: To provide data on the epidemiology of adverse events during sedation for endoscopy. Design: Retrospective analysis of a prospective database. Setting: Endoscopy unit of a university hospital. Procedures: A total of 17,999 procedures performed over 8 years. Interventions: Sedation for GI endoscopy. Main Outcome Measurements: We recorded the following information: sex, age, body mass index, smoking habits, American Society of Anesthesiologists and Mallampati scores, duration of the procedure, type of sedative drug administered, whether the procedure was performed emergently, and endoscopic interventions during the maneuver. Adverse events were defined as occurrences that warranted intervention and were classified as hypotension, desaturation, bradycardia, hypertension, arrhythmia, aspiration, respiratory depression, vomiting, cardiac arrest, respiratory arrest, angina, hypoglycemia, and/or allergic reaction. Results: Deep sedation with intravenous propofol target controlled infusion pump was the most frequently used means of administering sedation. Adverse events were rare in both the adult (4.5{\%}) and pediatric (2.6{\%}) populations. Six complications occurred in more than 0.1{\%} of adult cases: arterial hypotension, desaturation, bradycardia, arterial hypertension, arrhythmia, and aspiration. Only bradycardia (2.1{\%}) and hypotension (0.44{\%}) occurred in children. Three adult patients (0.017{\%}) died, and no pediatric patients died. Some predictive models for the occurrence of complications are proposed. Limitations: Retrospective analysis, single-center data collection. Conclusions: Deep sedation during endoscopic procedures is safe in both adults and children. Our data may be useful for the future planning of new clinical strategies in this setting.",
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