title: Prospective description of coughing, hemodynamic changes, and oxygen desaturation during endoscopic sedation.
abstract: BACKGROUND
  Deep sedation is increasingly used for endoscopy. The impact of sedation level on hemodynamic status, oxygenation, and aspiration risk is incompletely described.
  
  
  OBJECTIVE
  To describe the incidence of intraprocedural cough, hemodynamic changes, oxygen desaturation, and their relationship to clinical factors and sedation level.
  
  
  METHODS
  Detailed prospective recordings of hemodynamic changes, oxygen desaturation, and cough during 757 nonemergent endoscopic procedures done under sedation using propofol, midazolam, and/or fentanyl.
  
  
  RESULTS
  Thirteen percent of patients had at least one cough and 3% had prolonged cough. Cough was more common in nonsmokers (P = 0.05), upper endoscopy (P < 0.0001), with propofol (P = 0.0008), longer procedures (P = 0.0001), and hiccups (P = 0.01). The association between supine positioning during colonoscopy and cough approached significance (P = 0.06). Oxygen desaturation was rare (4%) and associated only with deep sedation (P = 0.02). Mean systolic and diastolic blood pressure (BP) dropped by 7.3 and 5.6% respectively. Decreases in systolic BP were more common in whites (P = 0.03), males (P = 0.004), nonsmokers (P = 0.04), during colonoscopy (P < 0.0001), and in patients receiving midazolam and fentanyl (P = 0.01). Heart rate (HR) dropped >20% from baseline in 15% of patients and was more common during colonoscopy (P = 0.002). HR increased >20% in 20% of patients and was more common with coughing (P < 0.0001) and in younger patients (P = 0.0002). No patient required pharmacologic treatment of BP or HR.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Abdul Hamid
authors.initials: AH
authors.lastname: El Chafic
authors.forename: George
authors.initials: G
authors.lastname: Eckert
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D003371:Cough / Q000453:epidemiology* / Q000503:physiopathology; D054810:Deep Sedation; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D010100:Oxygen