Incidence of sedation-related complications with propofol use during advanced endoscopic procedures.
OBJECTIVE
Propofol is an effective sedative in advanced endoscopy. However, the incidence of sedation-related complications is unclear. We sought to define the frequency of sedation-related adverse events, particularly the rate of airway modifications (AMs), with propofol use during advanced endoscopy. We also evaluated independent predictors of AMs.


METHODS
Patients undergoing sedation with propofol for advanced endoscopic procedures, including endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and small-bowel enteroscopy, were studied prospectively. Sedative dosing was determined by a certified registered nurse anesthetist with the goal of achieving deep sedation. Sedation-related complications included AMs, hypoxemia (pulse oximetry [SpO(2)] < 90%), hypotension requiring vasopressors, and early procedure termination. AMs were defined as chin lift, modified face mask ventilation, and nasal airway. We performed a regression analysis to compare characteristics of patients requiring AMs (AM+) with those who did not (AM-).


RESULTS
A total of 799 patients were enrolled over 7 months. Procedures included endoscopic ultrasound (423), endoscopic retrograde cholangiopancreatography (336), and small-bowel enteroscopy (40). A total of 87.2% of patients showed no response to endoscopic intubation. Hypoxemia occurred in 12.8%, hypotension in 0.5%, and premature termination in 0.6% of the patients. No patients required bag-mask ventilation or endotracheal intubation. There were 154 AMs performed in 115 (14.4%) patients, including chin lift (12.1%), modified face mask ventilation (3.6%), and nasal airway (3.5%). Body mass index, male sex, and American Society of Anesthesiologists class of 3 or higher were independent predictors of AMs.


CONCLUSIONS
Propofol can be used safely for advanced endoscopic procedures when administered by a trained professional. Independent predictors of AMs included male sex, American Society of Anesthesiologists class of 3 or higher, and increased body mass index.
Coté
Gregory A
GA
Division of Gastroenterology & Hepatology, Washington University, St. Louis, Missouri 63110, USA.
Hovis
Robert M
RM
Ansstas
Michael A
MA
Waldbaum
Lawrence
L
Azar
Riad R
RR
Early
Dayna S
DS
Edmundowicz
Steven A
SA
Mullady
Daniel K
DK
Jonnalagadda
Sreenivasa S
SS
D000328:Adult; D000368:Aged; D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects*; D001291:Attitude of Health Personnel; D015992:Body Mass Index; D054810:Deep Sedation / Q000009:adverse effects* / Q000379:methods; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D012307:Risk Factors; D012737:Sex Factors
D000777:Anesthetics; D015742:Propofol