Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study

Abstract

Patients presenting for gastrointestinal endoscopy at a group of public university-affiliated hospitals where most sedation is managed by anaesthetists, had a high risk profile and a substantial incidence of significant unplanned intraoperative events and 30-day mortality.

Efficacy of a new dual channel laryngeal mask airway, the LMA®Gastro™ Airway, for upper gastrointestinal endoscopy: a prospective observational study

“…This is an improvement on the reported incidence of hypoxia for upper gastrointestinal procedures, ranging between 2% and 70%. 2,6,21 Post-procedure, only one patient experienced airway compromise because of secretions requiring suctioning, jaw support, and supplemental oxygen. Another patient briefly experienced laryngospasm after removal of the dual channel LMA, which resolved quickly and did not require further intervention.…”

“…Upper gastrointestinal endoscopy is a common medical procedure worldwide. 1,2 Sedation with propofol is widely used and considered a safe sedation technique for upper gastrointestinal endoscopy. 3e5 However, recent evidence from a large prospective multicentre observational study in 2132 patients from university-affiliated hospitals reported a high rate of significant unplanned events in 23% of patients undergoing gastrointestinal endoscopy with propofol sedation, including a significant cardiorespiratory event in 18%.…”

“…3e5 However, recent evidence from a large prospective multicentre observational study in 2132 patients from university-affiliated hospitals reported a high rate of significant unplanned events in 23% of patients undergoing gastrointestinal endoscopy with propofol sedation, including a significant cardiorespiratory event in 18%. 2 With both the number and complexity of interventional upper gastrointestinal endoscopy increasing, more patients may require deep sedation, risking airway and respiratory compromise. 16 Furthermore, airway management may be difficult in patients with obesity and/or obstructive sleep apnoea.…”

More than half of hypoxemia cases occurred during the recovery period after completion of esophagogastroduodenoscopy with planned moderate sedation

“…It must also be emphasized that there were 48 patients (57.1%) that did not have any of the above mentioned illnesses (Table 3). A BMI < 18.5 kgm −2 is also considered to be a risk factor 18 ; however, 74 of the 84 examined patients had a mean BMI of 25.6 (14.1 to 35.9) kgm −2 , and there were only three patients with a BMI < 18.5 kgm −2 . Like emaciation, obesity is thought to pose a major perioperative airway challenge in association with obstructive sleep apnea syndrome.…”

“…Two studies 17,18 examined the relationships between ASA-PS classification and adverse events related to endoscopic procedures, and both studies found that the risk increases as the ASA-PS class increases. In the present study, 71 (84.5%) of the 84 patients that developed hypoxemia were ASA-PS Classes I and II, indicating that the majority of cases did not have serious co-morbid illnesses.…”