Risk Factors for Hypoxemia During Ambulatory Gastrointestinal Endoscopy in ASA I–II Patients

Qadeer, Mohammed A.; López, Rocío; Dumot, John A.; Vargo, John J.

doi:10.1007/s10620-008-0452-2

Cited by 95 publications

(80 citation statements)

References 25 publications

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“…This study is important in highlighting the fact that the doses of propofol were reduced by almost 50% in association with only 1 mg of midazolam. Compared with the Australian study (Qadeer et al, 2009) the doses of fentanyl and midazolam were notably lower compared with higher doses in using propofol alone. In interpreting the Indiana trial one must take into account that in the study only a small number of patients (200 in total) were included.…”

Section: Positive Effects Negative Effectscontrasting

confidence: 55%

“…In terms of approaching the "combination" scheme, an Australian study reported median total doses of 4 mg midazolam, 75 mg fentanyl and 60 mg propofol in a sample of 500 cases from a total of 28,472 patients undergoing ambulatory endoscopy. In all patients the three drugs were used (Qadeer et al, 2009). In a Swiss study (Kulling et al, 2007) that included 27,061 patients undergoing ambulatory endoscopy, propofol was used as single agent for sedation.…”

Section: Positive Effects Negative Effectsmentioning

confidence: 99%

“…There is now evidence to suggest that propofol can be safely and effectively administered in ASA grade I, II and III patients by non-anesthesiologists. In a series of nearly 28,500 cases of sedated endoscopy, the sedative drugs were administered almost entirely by nonanesthetists (Qadeer et al, 2009) and there was no case of mortality and morbidity. In a multicenter trial (Rex&Deenadayalu, 2009) on 650,000 patients who received propofol sedation, given as unique pharmacological agent administered by a nurse under the direction of the endoscopist, there was only one death related to anesthesia.…”

Section: Positive Effects Negative Effectsmentioning

confidence: 99%

See 2 more Smart Citations

Sedation Related to Gastrointestinal Endoscopy

Mitrut¹,

Oana²,

Liliana³

et al. 2011

Gastrointestinal Endoscopy

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Section: Positive Effects Negative Effectscontrasting

confidence: 55%

Section: Positive Effects Negative Effectsmentioning

confidence: 99%

Section: Positive Effects Negative Effectsmentioning

confidence: 99%

See 1 more Smart Citation

Sedation Related to Gastrointestinal Endoscopy

Mitrut¹,

Oana²,

Liliana³

et al. 2011

Gastrointestinal Endoscopy

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“…Hypoxemia has been shown to trigger myocardial ischemia during endoscopy in individuals with and without previous cardiac history and can eventually lead to neurological damage and death [21,22,23]. Due to the intuitive and straight relation between hypoxemia and adverse events as well as the rarity of severe complications during endoscopy, hypoxemia has been used as a surrogate for main periprocedural cardiopulmonary events [24,25]. …”

Section: Introductionmentioning

confidence: 99%

Propofol versus Midazolam in Medical Thoracoscopy: A Randomized, Noninferiority Trial

Grendelmeier

Tamm²,

Jahn

et al. 2014

Respiration

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Background: Hypoxemia is a surrogate marker for periprocedural endoscopic complications. There are no data comparing the safety of propofol sedation with another sedative regimen in medical thoracoscopy. Objective: To evaluate whether sedation with propofol is as safe and effective as sedation with midazolam. Methods: Ninety consecutive patients undergoing medical thoracoscopy were randomly allocated to receive either intravenous propofol or midazolam. Predefined periprocedural complications included hypoxemia, hypotension, bleeding, need for airway insertion, mechanical ventilation, intensive care unit transfer and death. The primary endpoint was the mean lowest oxygen saturation during the procedure. Results: Randomized groups had similar demographics (64 ± 16 years, 57% male, 91% American Society of Anesthesiologists class III-IV) and a balanced distribution of procedures. The mean lowest oxygen saturation during the procedure was significantly lower in the propofol group as compared to the midazolam group (93 ± 6 vs. 96 ± 3%, p = 0.007). Patients randomized to propofol showed more episodes of hypoxemia (27 vs. 4%, p = 0.007) and hypotension (82 vs. 40%, p < 0.0001). No procedure had to be aborted. None of the patients required an artificial airway, mechanical ventilation or intensive care unit care, and none died. Conclusions: As assessed by the surrogate marker hypoxemia, propofol should not be considered the first choice for sedation in medical thoracoscopy.

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“…However, for moderate sedation in left lateral position, unrecognized sleep apnea [59] did not appear to predict transient hypoxia or AEs in one routine endoscopy study [37]; another study found that BMI in ASA I-II patients predicted the number of hypoxemic episodes [43]. Increased BMI and obstructive sleep apnea can predict perioperative morbidity after surgery [60] and may increase risk and make airway maintenance more difficult in deep sedation [42], especially for the semiprone positioning that is standard for ERCP.…”

Section: Case Context and Comorbidity Quantificationmentioning

confidence: 99%

Risk assessment and reduction

Romagnuolo

2014

Ercp

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One of the most important concerns about ERCP is its high risk in comparison to other endoscopic procedures. With post-ERCP pancreatitis rates, in good hands, ranging from 2 to 5% for low-risk procedures and 10 to 20% for high-risk procedures (even after risk-reducing maneuvers), and a mortality of about 1 in 1000 (mainly due to severe pancreatitis), this seems to be an appropriate concern; bleeding (about 1%), perforation (<0.5%), infection (1-2%), and cardiorespiratory AEs can also occur [1]. The risk involved in an individual ERCP case can vary widely. Thus, a biliary stent change in a healthy middle-aged man can be orders of magnitude different than manometry, dual sphincterotomy with pancreatic stenting in a young women with prior post-ERCP pancreatitis; not all ERCPs are the same and not all ERCPists have had the same case spectrum in their training and practice. This AE profile makes it important to ensure training is appropriate for both the endoscopist and the team/unit, to ensure indications are sound, noninvasive alternatives are appropriately considered, and patients are appropriately consented with respect to the risks, benefits, and alternatives.A critical step toward reducing risks is to understand their predictors [2,3]. Some factors may be modifiable and their identification allows time for that modification to occur. For the ones that are not modifiable, identifying the risks Key points• The most common adverse events (AEs) after endoscopic retrograde cholangiopancreatography (ERCP) are pancreatitis, cardiopulmonary events, bleeding, infection, and perforation, and rarely these events can cause disability or be fatal.• The actual risks in an individual case depend upon the context of the procedure, the characteristics of the patient, the skills of the procedure team, and the appropriate use of prophylactic interventions.• Understanding these interacting issues and managing them are key to making wise clinical decisions and improving patient education and informed consent.

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Risk Factors for Hypoxemia During Ambulatory Gastrointestinal Endoscopy in ASA I–II Patients

Abstract: In ASA I and II patients, BMI significantly correlated with the number of hypoxemic episodes, whereas age >or= 60 years and meperidine dose were significant risk factors for hypoxemia.

Cited by 95 publications

References 25 publications

Sedation Related to Gastrointestinal Endoscopy

Sedation Related to Gastrointestinal Endoscopy

Propofol versus Midazolam in Medical Thoracoscopy: A Randomized, Noninferiority Trial

Risk assessment and reduction

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