Prospective Description of Coughing, Hemodynamic Changes, and Oxygen Desaturation During Endoscopic Sedation

Abstract

We have described procedural predictors of cough that may help clinicians reduce the risk of aspiration during endoscopy. Hemodynamic changes during endoscopy are common but largely clinically insignificant.

Safety and Prevention of Complications in Endoscopic Sedation

“…Additional studies to evaluate complication rates solely during colonoscopic sedation and the predictors of those complications would be informative. Third, previous studies, including Chafic et al [30], did not track lateoccurring sedation complications such as pulmonary infections. Thus, more long-term follow-up studies are needed.…”

“…In order to describe the incidences of complications associated with endoscopic sedation and its relationship to clinical factors and sedation level in more detail, Chafic et al [30] performed a thorough prospective analysis of the incidences of cough, hemodynamic changes, and oxygen desaturation in patients undergoing various sedative regimens for GI endoscopy, and correlated the occurrences of these events with clinical factors, procedure type and duration, sedative agents, and sedation level. Although many previous studies examined measurements of hemodynamic changes during endoscopic procedures [14,15,17,27,[31][32][33][34], few have given detailed descriptions of quantitative changes in hemodynamic parameters and oxygen saturation during endoscopic sedation.…”

“…First, Chafic et al [30] did not include many patients who underwent advanced endoscopic procedures such as ERCP, EUS, and endoscopic submucosal dissection (ESD) and did not assess the relationships between ASA scores and complication rates. High ASA scores and longer procedure times have been suggested to be important predictors of the occurrence of complications during sedation for endoscopy [22,27,28].…”

“…Although nonanesthesiologists have successfully used propofol for patients with higher ASA classes in several reports [35], further studies to determine the safety of non-anesthesiologist-administered sedation for GI endoscopy in patients with high ASA scores or patients who require longer procedure times are still needed. Second, while many previous studies that assessed complication rates associated with endoscopic sedation dealt mainly with upper endoscopic procedures, Chafic et al [30] included many patients who underwent colonoscopy. Colonoscopy patients were more likely to cough when they were rotated into the supine position and to develop drops in blood pressure and bradycardia with sedation.…”

Gastrointestinal endoscopy under sedation is associated with pneumonia in older inpatients—results of a retrospective case-control study

“…4,[9][10][11][12] Therefore, in addition to common risks associated with gastrointestinal endoscopy itself, such as perforation, bleeding and abdominal discomfort, 1,[13][14][15] adverse events related to sedation have to be considered, 16,17 among which cardiovascular and pulmonary events predominate. 1,12,18,19 The attenuation of protective airway reflexes and reduction of the tone of the upper and lower esophageal sphincters, 1,11,18,[20][21][22] the patient's position during endoscopy, 23 insufflation of air or fluid during colonoscopy 24 and the provocation of the urge to gag during EGD may contribute to regurgitation and aspiration of gastric contents. Since patients undergo EGD and colonoscopy without airway management, aspiration of gastric contents plays a decisive role in various studies.…”