Anesthesia Related Complications of Gastrointestinal Endoscopies; A Retrospective Descriptive Study

Hormati, Ahmad; Mohammadbeigi, Abolfazl; Mousavi, Seyed Mojtaba; Saeidi, Mozhgan; Shafiee, Hamed; Aminnejad, Reza

doi:10.15171/mejdd.2019.141

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Perioperative hypotension and bradycardia are associated with an increased risk of organ injury and adverse events for ischemia of vital organs, 35,36 and are the most prevalent sedation‐related complications in endoscopic procedures 37 . Remimazolam presented much less cardiopulmonary inhibiting effect.…”

Section: Discussionmentioning

confidence: 99%

“…Benzodiazepine was reported to be associated with abnormal mental symptoms in sedated patients, such as delirium 45 and paradoxical reactions 4,7 . For gastroscopy, delirium may have a lower risk (reported at <0.11%) for its short duration 37,46 . Paradoxical reactions occurred in 1.4–8.9% of patients undergoing endoscopy under midazolam sedation, 7–9 whereas no related data were available on remimazolam.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of 95% effective dose of remimazolam besylate and propofol for gastroscopy sedation on older patients: A single‐centre randomized controlled trial

et al. 2023

Brit J Clinical Pharma

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AimsAdvanced age is an important risk factor for adverse events during procedural sedation. Remimazolam is safe and effective in gastroscopic sedation. However, the ideal dose and application for older patients are not well known. We aim to investigate its 95% effective dose (ED95) for older patients undergoing gastroscopy and to assess its safety and efficacy, with propofol as the comparison.MethodsThe trial consists of 2 parts, patients aged >65 years and scheduled for outpatient painless gastroscopy were enrolled. In the first part, Dixon's up‐and‐down methodology was used to determine the ED95 of remimazolam besylate and propofol for gastroscopic insertion, in combination with 0.2 μg/kg remifentanil. In the second part, patients in each group received 0.2 μg/kg remifentanil and ED95 dose of the study drugs for sedation induction, supplemental doses were added to maintain sedation depth when necessary. The primary outcome was the incidence of adverse events. The secondary outcome was the recovery time.ResultsThe ED95 of remimazolam besylate and propofol induction were 0.2039 (95% confidence interval 0.1753–0.3896) mg/kg and 1.9733 (95% confidence interval 1.7346–3.7021) mg/kg respectively. Adverse events were reported in 26 (40.6%) patients in the remimazolam group and 54 (83.1%) in the propofol group (P < .0001), whereas the remimazolam group presented a higher incidence of hiccups (P = .0169). Besides, the median time to awakening was approximately 1 min shorter with remimazolam than with propofol (P < .05).ConclusionFor older patients undergoing gastroscopy, the ED95 dose of remimazolam is a safer alternative than propofol when inducing the same sedation depth.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of 95% effective dose of remimazolam besylate and propofol for gastroscopy sedation on older patients: A single‐centre randomized controlled trial

et al. 2023

Brit J Clinical Pharma

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“…However, the occurrence of an AE at a site other than the cardiac catheterisation laboratory was not associated with a greater likelihood of a severe outcome vs one in the OR (AOR¼1/16; 95% CI: 0.82e1.66; P¼0.401). A retrospective analysis completed by Hormati and colleagues 35 provided the only data on AEs in adult patients. The study reviewed outcomes from 44 659 adult patients undergoing GI endoscopy procedures between 2013 and 2017, and calculated rates for a number of complications, including haemodynamic instability (9,998; 22.39%), dysrhythmia (1,600; 3.58%), desaturation (608; 1.36%), prolonged apnoea (34; 0.08%), aspiration (43; 0.10%), and death (5; 0.01%).…”

Section: Mortality Morbidity and Adverse Outcomes In Noramentioning

confidence: 99%

Morbidity, mortality, and systems safety in non-operating room anaesthesia: a narrative review

Herman

Jaruzel

Lawton

et al. 2021

British Journal of Anaesthesia

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Non-operating room anaesthesia (NORA) describes anaesthesia delivered outside a traditional operating room (OR) setting. Non-operating room anaesthesia cases have increased significantly in the last 20 yr and are projected to account for half of all anaesthetics delivered in the next decade. In contrast to most other medication administration contexts, NORA is performed in high-volume fast-paced environments not optimised for anaesthesia care. These predisposing factors combined with increasing case volume, less provider experience, and higher-acuity patients increase the potential for preventable adverse events. Our narrative review examines morbidity and mortality in NORA settings compared with the OR and the systems factors impacting safety in NORA. A review of the literature from January 1, 1994 to March 5, 2021 was conducted using PubMed, CINAHL, Scopus, and ProQuest. After completing abstract screening and full-text review, 30 articles were selected for inclusion. These articles suggested higher rates of morbidity and mortality in NORA cases compared with OR cases. This included a higher proportion of death claims and complications attributable to inadequate oxygenation, and a higher likelihood that adverse events are preventable. Despite relatively few attempts to quantify safety concerns, it was possible to find a range of systems safety concerns repeated across multiple studies, including insufficient lighting, noise, cramped workspace, and restricted access to patients. Old and unfamiliar equipment, lack of team familiarity, and limited preoperative evaluation are also commonly noted challenges. Applying a systems view of safety, it is possible to suggest a range of methods to improve NORA safety and performance.

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“…14,15 Upper endoscopy is the procedure of choice for both diagnosis and treatment of acute upper GI bleeding and has a well known and established role in decreased mortality and re-bleeding. [16][17][18][19] Although there have been many advances in the endoscopy techniques and development of modern devices, the mortality rate has not decreased significantly in recent decades. 20,21 Most of the current guidelines and recommendations emphasize the role of early endoscopy (i.e.…”

Section: Introductionmentioning

confidence: 99%

Timing of Emergency Endoscopy for Acute Upper Gastrointestinal Bleeding: A Literature Review

Ejtehadi

Sivandzadeh

Hormati

et al. 2021

Middle East J Dig Dis

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Upper gastrointestinal (GI) bleeding is a common cause for Emergency Department and hospital admissions and has significant mortality and morbidity if it remains untreated. Upper endoscopy is the key procedure for both diagnosis and treatment of acute upper GI bleeding. The aim of this article is to review the optimal timing of endoscopy in patients with acute upper GI bleeding. The cost-effectiveness and the influence of urgent or emergent endoscopy on patients’ outcomes are discussed. Also, we compare and contrast the available evidence and guidelines regarding the recommended time points for performing endoscopy in different clinical settings.

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Anesthesia Related Complications of Gastrointestinal Endoscopies; A Retrospective Descriptive Study

Cited by 8 publications

References 16 publications

Comparison of 95% effective dose of remimazolam besylate and propofol for gastroscopy sedation on older patients: A single‐centre randomized controlled trial

Comparison of 95% effective dose of remimazolam besylate and propofol for gastroscopy sedation on older patients: A single‐centre randomized controlled trial

Morbidity, mortality, and systems safety in non-operating room anaesthesia: a narrative review

Timing of Emergency Endoscopy for Acute Upper Gastrointestinal Bleeding: A Literature Review

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