title: Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures.
abstract: BACKGROUND
  There are limited data on the safety of anesthesia-assisted endoscopy by using propofol-mediated sedation in obese individuals undergoing advanced endoscopic procedures (AEPs).
  
  
  OBJECTIVE
  To study the association between obesity (as measured by body mass index [BMI]) and the frequency of sedation-related complications (SRCs) in patients undergoing AEPs.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A total of 1016 consecutive patients undergoing AEPs (BMI <30, 730 [72%]; 30-35, 159 [16%]; >35, 127 [12%]).
  
  
  METHODS
  Monitored anesthesia sedation with propofol alone or in combination with benzodiazepines and/or opioids.
  
  
  METHODS
  SRCs, airway maneuvers (AMs), hypoxemia, hypotension requiring vasopressors, and early procedure termination were compared across 3 groups.
  
  
  RESULTS
  There were 203 AMs in 13.9% of patients, hypoxemia in 7.3%, need for vasopressors in 0.8%, and premature termination in 0.6% of patients. Increasing BMI was associated with an increased frequency of AMs (BMI <30, 10.5%; 30-35, 18.9%; >35-26.8%; P < .001) and hypoxemia (BMI <30, 5.3%; 30-35, 9.4%; >35, 13.4%; P = .001); there was no difference in the frequency of need for vasopressors (P = .254) and premature termination of procedures (P = .401). On multivariable analysis, BMI (odds ratio [OR] 2.0; 95% CI, 1.3-3.1), age (OR 1.1; 95% CI, 1.0-1.1), and American Society of Anesthesiologists class 3 or higher (OR 2.4; 95% CI, 1.1-5.0) were independent predictors of SRCs. In obese individuals (n = 286), there was no difference in the frequency of SRCs in patients receiving propofol alone or in combination (P = .48).
  
  
  CONCLUSIONS
  Single tertiary center study.
  
  
  CONCLUSIONS
  Although obesity was associated with an increased frequency of SRCs, propofol sedation can be used safely in obese patients undergoing AEPs when administered by trained professionals.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri 63110, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.forename: Riad
authors.initials: R
authors.lastname: Azar
authors.forename: Christine E
authors.initials: CE
authors.lastname: Hovis
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hovis
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Cote
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Lawrence
authors.initials: L
authors.lastname: Waldbaum
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kushnir
authors.forename: Dayna
authors.initials: D
authors.lastname: Early
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Mullady
authors.forename: Faris
authors.initials: F
authors.lastname: Murad
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.forename: Sreenivasa S
authors.initials: SS
authors.lastname: Jonnalagadda
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D015992:Body Mass Index; D016292:Procedural Sedation / Q000009:adverse effects*; D004066:Digestive System Diseases / Q000150:complications / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology*; D000860:Hypoxia / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol