Preparation and Patient Evaluation for Safe Gastrointestinal Endoscopy

Kang, Seong Hee; Hyun, Jong Jin

doi:10.5946/ce.2013.46.3.212

Cited by 20 publications

(17 citation statements)

References 24 publications

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“…Recently, endoscopic sedation has been widely used. [ 4 , 18 , 25 ] Although propofol is commonly used as sedative for endoscopic procedures, respiratory depression is a major problem. [ 5 , 8 , 26 ] Etomidate has emerged as a new sedative that does not affect cardiopulmonary function.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Lee

Min²,

Lee³

et al. 2018

Medicine

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Background and aims:Recent studies have shown that etomidate is associated with fewer serious adverse events than propofol and has a noninferior sedative effect. We investigated whether etomidate–midazolam is associated with fewer cardiopulmonary adverse events and has noninferior efficacy compared to propofol–midazolam for screening colonoscopy in the elderly.Methods:A prospective, single-center, double-blinded, randomized controlled trial was performed. Patients aged over 65 years who were scheduled to undergo screening colonoscopy were randomized to receive either etomidate or propofol based on midazolam. The primary outcome was all cardiopulmonary adverse events. The secondary outcomes were vital sign fluctuation (VSF), adverse events disturbing the procedure, and sedation-related outcomes.Results:The incidence of cardiopulmonary adverse events was higher in the propofol group (72.6%) than in the etomidate group (54.8%) (P = .040). VSF was detected in 17 (27.4%) and 31 (50.0%) patients in the etomidate and propofol groups, respectively (P = .010). The incidence rate of adverse events disturbing the procedure was significantly higher in the etomidate group (25.8%) than in the propofol group (8.1%) (P = .008). Moreover, the incidence rate of myoclonus was significantly higher in the etomidate group (16.1%) than in the propofol group (1.6%) (P = .004). There was no statistical significance between the 2 groups with respect to sedation times and sedation-related outcomes including patients’ and endoscopist's satisfaction. In the multivariate analysis, the etomidate group had significantly low odds ratio (OR) associated with VSF (OR: 0.407, confidence interval: 0.179–0.926, P = .032).Conclusions:We recommend using etomidate–midazolam in patients with high ASA score or vulnerable to risk factors; propofol–midazolam may be used as a guideline in patients with low ASA score.

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Section: Discussionmentioning

confidence: 99%

“…[ 1 – 3 ] One of the most common sedatives is propofol owing to its convenience and fast effect. [ 4 , 5 ] However, propofol is associated with several serious adverse events including hypoxia, hypotension, arrhythmia, and respiratory depression. [ 6 – 8 ]…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Lee

Min²,

Lee³

et al. 2018

Medicine

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“…Before undertaking any GIE procedure, endoscopists should obtain informed consent from the patient, be familiar with the latest guidelines on sedation, be aware of any medical, surgical and drug history elicited in the pre-admission process, and risk factors should be identified in both out-patients and in-patients [7,8] . Additionally, physicians must be prepared to manage sedation-related complications.…”

Section: Pre-sedation Assessmentmentioning

confidence: 99%

Sedation-related complications in gastrointestinal endoscopy

Amornyotin

2013

WJGE

110

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Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient's age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Sedation; Complication; Gastrointestinal; EndoscopyCore tip: Gastrointestinal endoscopic (GIE) procedures are relatively safe. However, these procedures have been shown to cause various effects on cardiorespiratory systems. Sedation-related complications while providing any level of sedation can occur. Fortunately, these complications during GIE procedures are commonly transient and of a mild degree. In addition, significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support. Periodical assessment of the level of sedation and continuous monitoring of cardiovascular and respiratory systems provides timely information. Standardized discharge criteria should be used to determine the patient's readiness for discharge.Amornyotin S. Sedation-related complications in gastrointestinal endoscopy.

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“…In the case reported herein, it is difficult to determine whether the patient experienced a direct procedural complication or an exacerbation of pre-existing asymptomatic SMAD secondary to panendoscopy. In any case, panendoscopy is useful for screening individuals at high risks for UGI cancers[1] and also an elective examination of adult voluntary health check-ups, but the presence of an appropriate indication and associated contraindication should always be thoroughly evaluated prior to procedure[16].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous superior mesenteric artery dissection following upper gastrointestinal panendoscopy: A case report and literature review

Yang¹,

Yen²,

Chua³

et al. 2019

WJCC

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BACKGROUNDComplications associated with upper gastrointestinal (UGI) endoscopy are uncommon, and rarely involve those of cardiovascular nature. We report herein a unique case of spontaneous superior mesenteric artery dissection (SMAD) after UGI pandenoscopy.CASE SUMMARYA 45-year-old man who had previously undergone UGI panendoscopy and colonoscopy during a voluntary health check-up at our facility was admitted to the emergency room (ER) at the same facility due to persistent epigastric pain with radiation to the back. At the ER, the patient did not present notable abnormalities upon physical, conscious, or laboratory examinations apart from mild tenderness in the epigastric abdomen. Acute abdominal aortic dissection was suspected, and abdominal contrast-enhanced computed tomography confirmed SMAD. He was then transferred to the cardiovascular ward and treated conservatively with fasting, prostaglandin E1, and aspirin. The patient recovered and returned home soon after, and was symptom-free 6 months after discharge from the facility.CONCLUSIONSMAD after UGI panendoscopic procedure is a previously unreported complication. Awareness of this complication and associated sequela is warranted.

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Preparation and Patient Evaluation for Safe Gastrointestinal Endoscopy

Cited by 20 publications

References 24 publications

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Sedation-related complications in gastrointestinal endoscopy

Spontaneous superior mesenteric artery dissection following upper gastrointestinal panendoscopy: A case report and literature review

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