Analysis of 153 deaths after upper gastrointestinal endoscopy: room for improvement?

Thompson, Alastair; Wright, Dominic; Murray, William R.; Ritchie, Gillian; Burton, H.; Stonebridge, P. A.

doi:10.1007/s00464-003-9069-x

Cited by 60 publications

(10 citation statements)

References 22 publications

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“…PhD NAPS is increasingly being used worldwide in low-risk patients undergoing endoscopy and/or colonoscopy because of recognition of its safety, rapid and predictable induction and recovery times, earlier patient discharge, increased patient and endoscopist satisfaction, and its presumed economic advantage 2 3 4 5 . This study adds to the mounting evidence that PhD NAPS is safe when stringent patient selection is used and those administering the sedative agents have received the appropriate training 6 7 8 9 . Complications encountered were all minor and predictable based on the nature of the procedure and the side effect profile of the medications utilized, and easily managed by the nurse sedationist and endoscopist.…”

Section: Discussionmentioning

confidence: 94%

Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy

et al. 2017

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Background and study aims Physician-directed nurse-administered balanced propofol sedation (PhD NAPS) in patients undergoing endoscopy and/or colonoscopy is being increasingly utilized worldwide. However, this method of sedation is not universally employed in Australian hospitals due to concerns surrounding its safety. The aim of this study was to assess the safety of PhD NAPS in low-risk patients undergoing endoscopy and/or colonoscopy. Patients and methods This study was conducted at a single tertiary teaching hospital in Adelaide, Australia. It was a prospective study involving 1000 patients with an ASA score of 1 – 3 presenting with any indication for endoscopy, colonoscopy or both. A total of 981 patients (451 male) with a mean age of 53 years (range: 16 – 87) were recruited from January 2010 to October 2012. 440 endoscopies, 420 colonoscopies, and 121 combined procedures were performed. The intra-procedural adverse events (AEs) were recorded. Results There were no major intra-procedural adverse events. Minor AEs occurred in 6.42 % of patients, and resolved spontaneously or with intravenous fluid boluses in all cases. Conclusion PhD NAPS is safe when the proceduralist and nursing staff are adequately trained and strict patient selection criteria are used.

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Section: Discussionmentioning

confidence: 94%

Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy

et al. 2017

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“…Anesthesia support during ERCP is widely accepted and it has become almost a standard practice. Since administering a single-agent during ERCP leads to inadequate sedation and analgesia and thus to excessive drug use and increases in undesirable side effects, using sedative agents in combination has become more widespread [ 1 , 2 ]. Although there are several studies in the literature reporting that administering propofol in combination with an opioid leads to early awakening from sedation [ 3 , 4 ], the number of studies on the effects of opioids on the propofol dose is limited [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP

Haytural

Aydınlı

Demir

et al. 2015

BioMed Research International

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Introduction. Using single anesthetic agent in endoscopic retrograde cholangiopancreatography (ERCP) may lead to inadequate analgesia and sedation. To achieve the adequate analgesia and sedation the single anesthetic agent doses must be increased which causes undesirable side effects. For avoiding high doses of single anesthetic agent nowadays combination with sedative agents is mostly a choice for analgesia and sedation for ERCP. Aim. The aim of this study is to investigate the effects of propofol alone, propofol + remifentanil, and propofol + fentanyl combinations on the total dose of propofol to be administered during ERCP and on the pain scores after the process. Materials and Method. This randomized study was performed with 90 patients (ASA I-II-III) ranging between 18 and 70 years of age who underwent sedation/analgesia for elective ERCP. The patients were administered only propofol (1.5 mg/kg) in Group Ι, remifentanil (0.05 μg/kg) + propofol (1.5 mg/kg) combination in Group II, and fentanyl (1 μg/kg) + propofol (1.5 mg/kg) combination in Group III. All the patients' sedation levels were assessed with the Ramsey Sedation Scale (RSS). Their recovery was assessed with the Aldrete and Numerical Rating Scale Score (NRS) at 10 min intervals. Results. The total doses of propofol administered to the patients in the three groups in this study were as follows: 375 mg in Group I, 150 mg in Group II, and 245 mg in Group III. Conclusion. It was observed that, in the patients undergoing ERCP, administration of propofol in combination with an opioid provided effective and reliable sedation, reduced the total dose of propofol, increased the practitioner satisfaction, decreased the pain level, and provided hemodynamic stability compared to the administration of propofol alone.

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“…Although this regimen has been shown to be as safe as the standard sedation with benzodiazepines and opioids [1,2,3], it is important to be aware of possible complications associated with this type of sedation, such as respiratory depression and hypotension. Sedation levels occur along a continuum and it is not always possible to predict how a patient will respond to sedation.…”

Section: Introductionmentioning

confidence: 99%

Prospective Evaluation of the Routine Use of a Nasopharyngeal Airway (Wendl Tube) during Endoscopic Propofol-Based Sedation

Müller

Wehrmann

Eckardt³

2014

Digestion

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Background/Aims: Insertion of a nasopharyngeal airway (NPA) during endoscopic sedation is only recommended in the event of respiratory problems. We evaluated the safety and efficacy of routine insertion of an NPA during sedation in gastrointestinal (GI) endoscopy. Methods: Between July 2009 and April 2012, patients with colonoscopy or expected longer-lasting or therapeutic upper GI endoscopy were pseudo-randomized in a weekly alternating fashion to perform sedation (midazolam in combination with propofol) with or without NPA insertion. The primary outcome measure was respiratory depression (oxygen saturation <90%). Secondary measures included hypotension (systolic blood pressure <90 mm Hg), bradycardia (heart rate <40 beats/min) or nasopharyngeal damage after NPA insertion. Results: 216 (106 females, mean age 60.7 ± 9.65 years) were enrolled. Colonoscopy was performed in 131 patients and upper endoscopy in 85 patients. In 105 patients an NPA was used (intervention group). Five (4.7%) of those patients showed minor nasopharyngeal injury. Respiratory depression (13.5 vs. 1.9%, p = 0.002) and hypotension (11 vs. 5%, p = 0.09) occurred more frequently in the control than in the intervention group. Conclusion: The routine placement of an NPA can reduce the frequency of hypoxemic events during endoscopic sedation with minor risks for nasopharyngeal injury.

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Analysis of 153 deaths after upper gastrointestinal endoscopy: room for improvement?

Cited by 60 publications

References 22 publications

Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy

Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy

Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP

Prospective Evaluation of the Routine Use of a Nasopharyngeal Airway (Wendl Tube) during Endoscopic Propofol-Based Sedation

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